Vacuum Assisted Closure System Pediatric Initiating

  Initiating the Vac

   1. Review the prescribing practitioner's order for dressing change or review institution-specific protocol.
   2. Ensure child and family understand procedure and questions are answered.
   3. Determine how many and what types of dressings are necessary; gather needed equipment and supplies.
   4. Ensure appropriate cardiopulmonary monitoring.
   5. Perform hand hygiene.
   6. Assess child's pain level with an age-appropriate scale; administer premedication per prescribing practitioner's order and use two patient identifiers per institution-specific protocol.
   7. Position child in a position that is comfortable and allows for direct visualization of the wound. Respect the child's modesty, and prevent child from being chilled.
   8. Ensure child's privacy by closing curtains and doors.
   9. Perform hand hygiene.
  10. Put on clean gloves; consider gown and eye or face shield if potential for splashing of blood and body fluids.
  11. Gently remove previous dressing by holding the skin taut with one hand and loosening the edges and peeling back the dressing toward the wound, with the other hand (if applicable).
  12. Assess wound bed for color, consistency, odor, and amount of drainage.
  13. Discard soiled dressing and sponge in appropriate receptacles; remove soiled gloves and perform hand hygiene.
  14. If dressing change is done as a sterile procedure, establish sterile field on a clean surface; open sterile packages containing sponges, drape, and drainage tubing onto established field with aseptic technique. If clean technique is used, open packages, keeping contents clean.
  15. Put on new pair of clean or sterile gloves.
  16. Irrigate wound with NS or alternative solution per prescribing practitioner's order.
  17. Clean and dry periwound area with sterile gauze.
  18. Shave or clip hair around wound border (extending approximately 3 to 5 cm outside wound margins).
  19. Evaluate need for application of skin preparation or hydrocolloid wafer to periwound skin and apply as needed.
  20. Measure and document dimensions of wound and pathology. Select appropriate foam material.
  21. Ensure adequate amount of V.A.C. foam to fill the entire wound cavity (more than one size or piece may be used).
  22. Cut the V.A.C. foam geometrically to fit the size and shape of the wound, including any tunneling or undermined areas (multiple pieces or sizes of sponge may be used to fill a wound bed).
  23. Cut occlusive drape to size to cover sponge and at least 5 cm of intact skin (a larger area may be preferred depending on location of wound).
  24. If exposed tendons, nerves, or blood vessels are found and polyurethane sponge is used, a protective barrier may be placed in the wound bed (e.g., Adaptic, Johnson & Johnson, New Brunswick, NJ) per prescribing practitioner's order.
  25. Place the sponges into the wound cavity, ensuring sponges reach the edge of the wound margins, including areas of tunneling or undermining. If more than one piece of sponge is used, sponge edges must be in contact with each other.
  26. Place the suction tubing onto the sponges. Tubing should be positioned away from bony prominences.
  27. Cover the foam and at least 3 to 5 cm of healthy skin with the transparent drape.
  28. Place a piece of sponge or other gauze padding on healthy skin under tubing and secure tubing several centimeters away from wound.
  29. Remove drainage canister from packaging and insert canister into the V.A.C. therapy unit until it clicks into place.
  30. Connect tubing from dressing to tubing from suction canister. Ensure both clamps are open.
  31. Turn the green-lit power button on the side of the V.A.C. therapy unit to "on."
  32. Press the "therapy on/off" button located on front of the unit and ensure that the dressing compresses.
  33. Ensure that suction is maintained and no leaks occur. Cover leaks with excess drape or by gently pressing around wound edges and the area of the suction tubing on the sponge.
  34. Discard used supplies in appropriate receptacles.
  35. Remove gloves and personal protective equipment; perform hand hygiene.
  36. Document the procedure in the child's record.
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