NONIMMERSION IRRIGATION DEVICE

Note: These instructions are specific to the KCI

Vacuum Assisted Closure
(V.A.C.) device. Other devices are used similarly,
but the clinician must
check for specific instructions for the device
being used.
Equipment Required
Negative pressure wound therapy (NPWT)
device, including
drain, drain tubing, and canister
Foam dressing (note that there are special foam
and
transparent film dressings intended only for use
with specific
NPWT devices)
Transparent film dressing (drape)
Irrigation device and normal saline
Gloves
Nonadherent dressing (optional)
Procedure
1. Remove old wound dressings and clean the
wound bed
using an irrigation device and normal saline.
2. If the previous dressing adheres to the wound,
consider
placing a nonadherent mesh dressing on the
wound before
placing the foam dressing for the NPWT
treatment. Cover
superficial or retention sutures with a single layer
of
nonadherent dressing.
3. Make sure there is no bleeding in the wound. If
there is
bleeding, do not use this type of treatment.
4. Protect vessels, organs, and nerves by covering
with natural
tissues or nonadherent mesh dressing.
5. Clean and dry the periwound area.
6. Assess wound size and shape, and cut the foam
dressing to a
size that will allow the dressing to be gently
placed into the
wound without overlapping onto intact skin. Be
sure to cut
the foam away from the wound site and to
remove loose
fragments, so they do not fall into the wound.

7. Gently place the cut foam into the wound bed,

ensuring
contact with all wound surfaces. Do not pack or
force the
foam dressing into any part of the wound. Do not
place
foam dressing into blind or unexplored tunnels
where the
distal aspect is not visible. Note and document
the total
number of pieces of foam used.
8. Trim and place the transparent film dressing
(drape) to cover
the foam dressing and an additional 3 to 5 cm of
intact
periwound skin. The dressing may be cut into
multiple pieces
if necessary. Do not discard excess drape; this
may be
needed later to patch difficult areas.
9. Partially pull the backing (label 1) off the
transparent film to
expose its adhesive.
10. Place the transparent film, adhesive side
down, over the
foam in the wound and over the periwound intact
skin.
Do not pull or stretch the transparent film over
the foam
dressing. Minimize wrinkles to avoid pressure
leaks.
11. Pat the transparent film to ensure a good seal.
12. Remove the support layer (label 2) and blue
handling tabs.
13. Choose the drain application site, taking into
consideration fluid
flow and tubing position to allow for optimal
drainage; avoid
placement over bony prominences or within
tissue creases.
14. Pinch the transparent film and cut a 2-cm hole
through it. The
hole should be large enough to allow for removal
of fluid or
exudate. It is not necessary to cut into the foam.
Cut a hole
rather than a slit because a slit may self-seal
during therapy.
15. Apply the drain. Remove the pads backing to
expose adhesive.

Place the drain directly over the hole in the

transparent
film. Apply gentle pressure on the drain and skirt
to ensure
complete adhesion. Remove the support layer and
blue
handles along the perforations.
16. Remove the canister from sterile packaging
and insert into
the NPWT unit until it locks in place. If the
canister is not
fully engaged, the unit will alarm.
17. Connect the drain tubing to the canister
tubing, and ensure
that the clamps on each tube are open.
18. Turn on the power to the NPWT unit and
select the appropriate
settings, depending on the type of wound and the
kind of foam
dressing used.
Makers of the V.A.C. therapy system recommend
continuous negative pressure for the first 48
hours
followed by intermittent negative pressure (5
minutes
on, 2 minutes off) for the rest of treatment for
acute
wounds, partial-thickness burns, pressure ulcers,
diabetic
foot ulcers, and chronic wounds. They
recommend
continuous negative pressure for the duration of
treatment
for surgical wound dehiscence, meshed grafts,
dermal
substitutes, flaps, and abdominal wounds.
Recommended pressures depend on the wound
type and the kind of foam used in the wound.
Target
pressures range from 50 mm Hg to 175 mm Hg.
See the
manufacturers recommendations for specific
wound and
foam types.
19. Assess dressing to ensure seal integrity. The
dressing should
be collapsed, and there should be no hissing
sounds. Secure
excess tubing to prevent interference with patient
mobility.

The dressing should be checked every 2 hours to

ensure
that the seal is still intact and the device is
running. Leaks
may be patched with additional transparent film
dressing.
The dressing should be removed, the wound
irrigated, and
the dressing replaced if treatment is stopped for
longer than
2 hours. The unit may be disconnected for shorter
periods
of time without replacing the dressing.
20. Change the canister when it becomes full. The
alarm
will sound when the canister is full. If it does not
fill
sooner, the canister should be changed at least
once a week
to control odor. Large (1000 mL) canisters should
not be used for patients at risk of bleeding, or for
elderly
patients or children, who cannot tolerate a large
loss of
fluid volume.
It is recommended that NPWT be on for 22 out of
24 hours for best results. The dressing should be
checked
every 2 hours to ensure that the seal is intact and
that no
bleeding is occurring. The dressing should be
changed
every 48 hours, or every 12 to 24 hours if the
wound is
infected. The wound should be reassessed at 2
weeks for
signs of healing. The average length of treatment
is 4 to
6 weeks.
Advantages
Enhances wound healing
Provides continuous coverage to large wounds,
reducing
wound contamination and infection risk
Comfortable
Maintains optimally moist wound environment
while keeping
surrounding skin dry
Infrequent dressing changes reduce mechanical
disruption and

cooling of healing tissues.

Disadvantages
More expensive in the short run than standard
dressing
changes
Patient is tethered to suction unit.

Potential for skin irritation from the adhesiv

adhesive dressing
More time-consuming to set up than standard
dressing changes
Does not substitute for hydrotherapy