VAC Instill
VAC Instill Indications: patients who would benefit from VAC Therapy combined with
Controlled delivery and drainage of topical would treatment solutions and
suspension over the wound bed
VAC Instill Contraindications
Same contraindications as the traditional VAC, but also including:
1. Hydrogen peroxide or alcohol based solutions
VAC Instill Appropriate Irrigation:
1. Dermacyn is an appropriate topical wound antimicrobial irrigation solution.
2. Analgesic solutions to provide localized pain management
VAC Instill Settings
1. Instillation time – the time to fill the foam.
Range 1 second to 120 seconds
2. Hold (fluid remains in the foam) 1 second to 60 mins
3. VAC – 125 mmHg continuous until the entire process repeats itself
4. Repeats (automatically) 1 min to 12 hours
A typical order for the VAC Instill
1. Instill long enough to saturate the sponge ( 10-20 seconds for a smaller wound).
2. Hold time of 10 minutes
3. Continuous NPWT -125 mmHg until automatically repeated every hour.
VAC Instill Application Techniques
1. Because the instillation is gravity feed system, place the instillation pad at the highest nondependent aspect of the wound bed.
2. Place the vacuum pad in a more dependent aspect of the wound.
3. Test run the suction to check for an adequate seal.
4. Follow next by a trial irrigation to determine how much solution is required to saturate the sponge and bathe the wound. (Jerome, 2007)
VAC Instill Guidelines
1. Insure that the solution bag is clearly marked as “irrigation only”.
2. Hang the solution (the instillation is gravity feed) from a different pole than those being currently used for IV fluid.
3. Picture framing the small or narrow wound with hydrocolloid dressing protect the periwound skin and prevent maceration.
Lidocaine Irrigation
Concentration
1:200,00; 25cc of 1% lidocaine in 250cc NS or2% Lidocaine in 500cc of NS
Note: Many contraindications, possible reactions, or side effects may exist including:
Contraindications
Anticoagulation therapy
Infection
Cautions
Impaired cardiovascular or hepatic function
Side effects
EKG variations at toxic levels of absorption
(Wolvos, T. 2004)
Jerome, 2007. Advances in Negative Pressure Wound Therapy: The VAC
Instill. Journal of Wound, Ostomy and Continence Nursing. Volume 34(2),
March/April 2007, p 191-194.
Wolvos, T. T. 2004. Wound Instillation — The Next Step in Negative Pressure
Wound Therapy. Lessons Learned from Initial Experiences. Ostomy/Wound
Management – ISSN: 0889-5899 – Volume 50 – Issue 11 – November 2004 –
Pages: 56 – 66
Matthew Livingston R.N. C.W.S.
