This is a list of wound VAC tricks that I have learned over the years. These tips will make your dressing change go faster with longer lasting results.
1. Cutting Foam – I typically use a number ten blade to cut the foam and drape. The drape can be a little tough to cut with a blade so you may want to work with scissors.
2. Sizing the Foam – I size the wound with my gloved finger then bring it over to the foam. Cutting a mark in the foam for the horizontal line, then repeating the process for the vertical line. Always make the foam a little smaller (than the wound opening) to allow for contraction.
3. Corners or Bridging – Cutting the foam in half makes the foam more workable around corners or when bridging. This is best done with a 10 blade (as always watch your fingers).
4. Leaks – Check the connections (sometimes they crack). Listen for leaks with your stethoscope. Rub skin prep along the edges to paste down any open drape. Drape over any suspect areas.
5. Small Wounds - For smaller wounds surround the wound edges with a hydrocolloid (duoderm thin) or VAC drape to reduce the risk of foam suction trauma on normal tissue.
6. Difficult Contours – Stoma paste is useful for the filling in difficult contours or skin folds so the VAC drape can sit over a flatter surface, and maintain a seal. Make sure the stoma paste is dry before turning on the VAC or else it will suck the paste inward.
7. Protecting – Cover and protect weakened, irradiated or sutured blood vessels or organs with Silicone or other type of non-contact layer (Mepitel – Molnlycke or Conformant 2 Wound Veil – Smith & Nephew).
8. Pain Reduction- Mepitel and Wound Veil, is also very useful for patients who have pain with VAC foam removal. If this is the case, place a narrow strip of the non contact sheet along the top line of wound tissue ( closest to the skin). This prevents the foam from getting caught in the most innervated tissue.
Instill 1% lidocaine into the tubing and foam 30 minutes prior to removal of the foam from the wound bed. Use adhesive remover to lift the drape to reduce tape burn. Give pain medication prior to removal of the foam dressing.
9. Large Wounds – Contract larger wounds by cutting the VAC foam smaller than the wound. Then, after securing the drape to one side of the wound edge, pull the drape over the VAC foam. At the same time push (with care) the undraped wound edge towards the wound bed and sponge. Finally, lay the drape down on the undraped side a few cm at a time while slowly moving the tension providing hand out from under the drape.
10. Rash - If the skin is reactive (rash) to the VAC drape use duoderm thin as the first layer. Make as small of a VAC drape foot print as possible (so that none of the drape adheres to the skin, only over the duoderm).
11. Small opening Large undermining - This trick is called the “cinnamon bun”. First, cut a spiral in the foam. Then feed the spiraled foam into the wound opening, leaving a few inches on top to secure the dressing.
12. Legal - With a black sharpee write on the VAC drape how many pieces were used.