...Wound V.A.C. – KCI Protocol Emergency General Surgery Service Vanderbilt University Medical Center 10 / 2004 Contributors: Sarah Debelak, APRN-BC Amanda Estapa, APRN-BC Ashlee Piercey, APRN-BC Dr. Jose Diaz, Jr., M.D. STATEMENT OF PURPOSE: POLICY: Define process for implementation, application, and management of negative pressure therapy The Wound V.A.C. will be provided to patients based on physician order PROCEDURES: I. Indications for V.A.C. Therapy A. For patients who would benefit from sub atmospheric (negative) pressure therapy for promotion of wound healing B. For patients who would benefit from drainage and removal of infectious material or other fluids from wounds under the influence of continuous and/or intermittent sub atmospheric pressure C. Types of wounds indicated: 1. Chronic Wounds including Diabetic Ulcers/Pressure Ulcers 2. Acute / Traumatic 3. Subacute Wounds (non-healing surgical wounds) . 4. Dehisced Wounds 5. Partial-Thickness Burns 6. Flaps 7. Grafts Contraindications for V.A.C. Therapy A. Patients with: 1. Grossly Contaminated Wounds 2. Malignancy in the Wound 3. Untreated Osteomyelitis 4. Non-enteric and Unexplored Fistula 5. Necrotic Tissue with Eschar Present B. Do NOT place V.A.C. GranuFoam (Black sponge) over exposed blood vessels or organs. May use VersaFoam (White) or petroleum-based gauze over exposed blood vessels or organs at base of wound with overlaying GranuFoam. Obtaining Equipment and Supplies A. Order the Wound V.A.C. from Materials...
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...Wound Management 1 What is a wound? A wound is defined as the disruption of the normal anatomical structure and function of tissue. Or it could be described more simply as any physical injury involving a break in the skin. A partial thickness injury would be one that is limited to the epidermis and superficially the dermis. There is no damage to the dermal blood vessels. A full thickness injury incorporates damage to the epidermis and dermis, with damage to the dermal blood vessels and deep tissue layers. Wounds can be acute or chronic. An acute wound can be an injury from surgery or trauma and would expect to heal in a month. A chronic wound would be one that shows no sign of healing after a month. This may be due to underlying disease such as diabetes mellitus or circulatory disorders. Some biomechanical abnormalities can slow the healing process. 2 What are the basics of wound care? Wounds should be kept 1, clean 2, moist 3, well nourished (pressure needs to be kept off the wound) Careful observation is needed on removal of any dressings, and notes should be taken recording any the appearance, drainage, granulation and location of the wound. Records need to be made of any cleansing agents and debridement agents used. Also all dressings that are applied need to be listed. Wound cleaning and irrigation, The aims are...
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...Surgical Wound Infection ? I will like to identify patients conditions and other factors contribute to the development of Surgical Wound infections. * Determine the aims or purposes of analysis The purpose is to understand the effect of environment in surgical wound infections. Prevention of infection requires the application of the principles of microbiology and accept practice. Measure of this concept is based on the stages of wound healing and the Centers of Disease Control and Prevention guidelines defining surgical site infection as occurring 30 days postoperative. * Identify all uses of the concept The Merriam-Webster Dictionary was used to explore the general definition of surgical wound infection Surgical of or relating to the process of performing a medical operation: of or relating to surgery. Wound an injury that is caused when a knife, bullet, etc., cuts or breaks the skin. Infection is the act or process of infecting someone or something: the state of being infected. The Oxford English Dictionary (OED) was also used to explore the definition. Surgical relating or used in surgery. Wound is an injury to living tissue caused by a cut, blow, or other impact, typically one in which the skin is cut or broken. Infection is the process of infecting or the state of being infected History of Surgical Wound Infection Hippocrates (Greek physician and surgeon, 460-377 BC), known as the father of medicine, used vinegar to irrigate open wounds and wrapped...
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...Journal of Wound, Ostomy and Continence Nursing In the article Combined Negative Pressure wound therapy and ultrasonic MIST therapy for open surgical Wounds: A Case Series, is a detailed summary about four different case studies that underwent colorectal surgical procedure, and healed through secondary intention. Secondary intention is when a wound is left open and allowed to close by epithelialization and contraction. Surgical wounds left to heal by secondary intention are at a greater risk for developing infections, increased hospital stay, incur greater hospital costs, higher readmission, and patient morbidity. This Journal looks into two new developments for open wound treatments. The first new treatment is non-contact low frequency therapy (NCLPU) that uses cavitation and acoustic microstreaming. Cavitation is the formation and vibration of microscopic bubbles whose movement promote changes in cellular activity. Acoustic microstreaming is the movement of fluids in and around cells by the physical force of sound waves resulting in increased protein synthesis and increased permeability of the cell membranes and vascular walls. The second new development is combined negative pressure wound therapy (NPTWT), a vacuum source creating continuous or intermittent negative pressure inside the wound to remove fluid, exudates and infectious material promoting wound healing, closure and the reduction of edema. With the reduction of edema improved tissue perfusion, delivery of nutrients...
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...Wound Care Education Abstract The purpose of this paper is to identify a patient health issue that would benefit from patient education. During the clinical rotation at Jackson South the group identified a need in wound care especially for patients with other underlying health issues such as diabetes. A large percentage of patients had wounds that would require patients to properly care for them once discharged. The group identified a lack of patient knowledge on how to care for these wounds and decided to develop a patient education pamphlet to teach patients how to care for wounds while not in a hospital setting. The group identified one particular patient that had insufficient knowledge in self-care. Wound Care J.G. is a 65-year-old male patient with a history of a cerebrovascular accident, hypertension, diabetes and multiple pressure ulcers. The patient was admitted to Jackson South Community Hospital with multiple wounds for suspected infection. He currently has two pressure ulcers present. One is a stage IV ulcer located at his right hip and the other is a stage III ulcer located on the heel of his right foot. He is scheduled for a CAT scan to rule out any collections in the hip and medical management of the wounds will be continued. Factors that contributed to the development of these ulcers were his lack of sensation due to his diabetes and being bed bound. He is alert and oriented and is in no acute distress. He currently lives with his only daughter, who will...
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...Wounds are injuries that break the skin or other body tissues. They include cuts, scrapes, scratches, and punctured skin. The skin of the elderly may degenerate on its own and sometimes even without the presence of an injury. Elderly wound care is a significant and important part of the duties for nursing staff. Bedsores, ulcers and other types of wounds require lots of treatment and attention, which is a major responsibility for licensed nursing staff (Bock, M. (2003). However, there are instances when improper elderly wound care can result in further health complications or even early death. There are a number of types of chronic wounds that may require to be treated in a nursing facility. The different types of wounds are lacerations, abrasions, contusions, and avulsions. There are a lot of factors that determines wound closure, the type of wound, size, the location of wound, how long-standing the wound is, condition of the patient, whether infection is present, and urgency of closure. Pressure ulcers often occur because of limited mobility and confining physical structures such as wheelchairs and bed rails. With elimination of pressure, a good blood supply, and adequate nutrition, the pressure ulcers will generally heal. With our aging population, chronic diseases that compromise skin integrity such as diabetes, peripheral vascular disease (venous hypertension, arterial insufficiency) are becoming increasingly common. Skin breakdown with ulcer and chronic wound formation...
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...Fish are very beneficial to humans, they are now known to serve many more purposes for humans. Fish skin is found to contain wound healing properties and several beneficial antimicrobials. This is due to their highly evolved immune systems which are starting to become discovered. The nile tilapia, catfish and snakehead murrels are known to possess both the properties stated. Fish skin in general contains omega-3 polyunsaturated fatty acids along with several other elements which could be used as a skin graft in order to decrease inflammation and time needed to heal a wound. There is new research on sharks and how they evolved to have an immunity against cancer causing genes. Moreover, this research could be used to better the human race and...
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...Section 1 A surgical wound as defined by Dempsey, French, Hillege & Wilson, 2009, “is the result of planned invasive therapy or treatment.” Surgical wounds comprise of not only incisions made in surgery, but intravenous therapys and lumbar punctures (Dempsey et al., 2009). Each wound varies in size, depending on the procedure required (Lynn, 2010). Surgical wounds heal by primary intention (Schilling McCann, 2006). A primary intention wound consists of minimal tissue loss, and are typically held together by sutures, staples or clips, therefore resulting in a faint scar, as stated by Carville, 2003. Mrs Baxter’s wound will heal by secondary/tertiary intention. Tertiary intention is also known as ‘Delayed Primary Intention” (Carville, 2003). As seen in the case study, Mrs. Baxter’s wound is quiet large (5x7x3cm) and secondary intention healing is needed as the wound extends from the epidermis to the dermis and the subcutaneous tissue (Schilling McCann, 2006). Schilling McCann, 2006, classifies this as a full thickness wound. Secondary intention healing is characteristically used when the wound edges are unable to be...
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...Wound Cleansing: Water or Normal Saline? Ashtin Plummer MidAmerican Nazarene University Wound Cleansing: Water or Normal Saline? Wound cleansing has been discussed about for many years, different solutions and techniques have been discussed to use, and it is an important part of preventing infection. Wound cleansing is described as the use of fluids to remove debris and dead tissue from the surface of the wound. The purpose of wound cleansing is to make the best possible conditions at the wound site, for uncomplicated wound healing. The most commonly used solution would be normal saline due to being an isotonic solution and it does not disrupt with normal healing process of wounds (Ljubic, 2013). Normal saline has just been known as best practice for many years. However, is tap water able to do the same thing as saline without increased risk for infection or delay in wound healing? “Tap water is also said to be effective in wound cleansing and has advantages of being cost effective and easily accessible” (Ljubic, 2013). Wound care is a major service provided in home health care and due to going to patients’ homes, normal saline is not always accessible. Saline is not always accessible due to running out of supply while at a patients’ home. Wounds can also take a decent amount of time to heal so using tap water with these patients may be more cost-effective in the long run, not delay wound healing, and not increase the patients risk for infection. PICO Question ...
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...-Number of shots heart; type of gun used; position of pt when shot; distance of the pt from the gun. History should be gathered from the pt, available eye-witnesses, and emergency medical service providers Does the patient have intra or extraperitoneal bleeding that requires surgical intervention? Does the patient have peritoneal contamination requiring washout and repair of a hollow viscus? Penetrating injuries with any hemodynamic instability and/or signs of intraperitoneal injury are treated operatively at the outset of management -GSWs most often injure the small bowel followed by the colon and liver Clinical thinking Does the patient have an adequate airway, and ability to protect it? Is the patient breathing? Is oxygenation and ventilation adequate? A GSW in the abdomen may penetrate the diaphragm and cause a significant thoracic injury -Does that patient have adequate blood volume and perfusion? How does the patient respond to resuscitation, does the pt take beta blockers that may mask an appropriate tachycardia? -evaluate the pts ability to follow commands and respond appropriately. Is neurological disability a central phenomenon from shock, or is there a direct spinal cord injury? The patient must always be adequately exposed to evaluate all injuries, don’t over look the axial, back, gluteal cleft, and perineum. Patients with penetrating abdominal injuries are best served by antibiotic therapy prior to operative intervention. Initial therapy should be broad...
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...Dietary Protein Increase and the Promotion of Wound Healing in Diabetic Adult Patients Dietary Protein Increase and the Promotion of Wound Healing in Diabetic Adult Patients Introduction There are approximately 23 million people diagnosed with diabetes in the U.S. (American Diabetes Association, 2012) and this population continues to grow. There are multiple complications associated with diabetes. One major and expensive complication is diabetic wounds. The cost of care in the U.S. alone for this population is approximately $245 Billion annually. (American Diabetes Association, 2012) Proper wound care is an essential step in the wound healing process, however,wound care alone is not sufficient. Nutritional status is extremely important in wound healing. Diabetic patients need to be educated and assessed for protein-energy malnutrition (PEM) as the body’s nutritional needs significantly increase during the wound healing process (Demling, 2009). Supplementation (especially protein) and the importance of it for wound healing need to be discussed with the patient. Without all the necessary interventions applied the process of wound healing can be lengthy and may lead to infection, excessive hospitalization and potential amputations. Understanding the body’s nutritional needs and how the body uses protein in the repair process is imperative. The recommendation for the amount of protein supplementation is between 0.8grams/kilogram to 1.2 grams/kilogram and is based on patient...
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...Education on Wound Care for Diabetic Patients Education on Wound Care for Diabetic Patients Abstract Non-compliance of wound care management has increased the risk of infection and amputations. Diabetes wound care management is an important and fundamental aspect when it comes to diabetes teaching and education. Assessment of the feet daily and at a primary care office will provide information such as noncompliance, risks for neuropathy, peripheral vascular disease, macro-vascular disease, and possible amputation. Education provided by health care practitioners to the diabetic population will promote decrease in risk for further complications and the patient to be involved in their own care. Assessment, treatment, and education on wound care management with the involvement of the patient will increase the patient’s quality of life and be very beneficial to both the practitioner and the patient. Keywords: diabetic wound care management, diabetic ulcer care, outpatient diabetes management, diabetic care management Introduction Working in a primary care setting will involve a multitude of disease processes- diabetes mellitus being one of them. Diabetes is a disease that is characterized by high levels of blood glucose with a defect in insulin secretion and cell resistance. Without proper management, diabetes may lead to other issues in health. Examples of such, would be, delay in wound healing, leading to foot ulcerations, which thus increases the risk for amputations...
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...for a wound to heal completely. Before closing a wound, your health care provider will clean it as well as possible. .If you are getting stitches sutures or staples, the skin in the area of your wound may be numbed with a medicationmedicine (local anesthesia) first. Just when a wound gets closed depends on the type of woundWhen your wound gets closed depends on the type of wound you...
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...------O: 40 y.o. Caucasian male. General: well-groomed, pleasant male. Patient had stage four pressure ulcer on sacrum. Removed wound dressing. There was 5% of thin serosanguineous drainage on ABD dressing. There was 20% of thin serosanguineous drainage on 4x4s. There was 50%of thin serosanguineous drainage on the kerlix super sponges. No unusual odor noted. Irrigated wound with NS, fluid returned clear. Obtained wound culture, sent to lab. Wound measured 10cm x 7.7cm. In the wound bed there was slough from 11 o’clock to 1 o’clock position and from 4 o’clock to 5 o’clock position. Slough making up 20% of wound bed. 80% of wound bed was granulation tissue. Bone was showing in the middle of wound. No redness or edema noted. No ecchymosis noted. Wound not approximated. Applied sterile wet-to-dry dressing. Patient tolerated procedure well. No signs of facial grimacing or guarding during procedure. -------------------------------------------------------------------------------------------------------------------------A: Impaired skin integrity related to physical immobility as evidenced by stage four pressure ulcer on sacrum. ------------------------------------------------------------------------------------------------------------------------------P: The nurse will reposition patient q2h to prevent further skin breakdown. The nurse will assess the wound daily for redness, swelling, warmth, pain and...
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...left side of the chest. The wound is very painful, like most burn wounds. A wound of this nature extends deep into the second layer of skin and can quickly develop into a full thickness burn or third degree burn. The symptoms include skin that is red and white, not easily blanch able along with bloody blisters, which are often moist and painful. The Registered Nurse should assess and provide wound care including timely wound irrigation and dressing changes, along with monitoring for signs of infection. The primary goal is to promote healing, minimize further damage and prevent infection. If the patient’s wound is open, note its color. If the wound is red, that demonstrates healthy tissue regeneration. If the wound is yellow purulent drainage and slough (dead skin) are present. If the wound is black the presence of a thick, necrotic material called eschar is present which hinders healing and must be removed. If the wound is closed the skin edges should be well-approximated. Ultimately, the Registered Nurse is working towards a wound which is free of infection and, therefore, completely healed. When cleaning the wound area, the Registered Nurse should use asepsis/sterile technique so the wound is free of all microorganisms. When cleansing a wound, always start with the cleanest area; never return to an area you have previously cleaned. Be sure to discard cleansing swab after each horizontal or vertical stroke. The Registered nurse should moisten the wound bed prior to removal of the...
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