Wound V.A.C.

System for Wounds

Nursing Alert

V.A.C. Therapy requires an MD order. This therapy can be utilized in all health care settings including home. Refer to the VAC Guidelines for specific information and precautions. REMEMBER Therapy must not be interrupted for more than 2 hours in 24 hr period.
Getting Ready

   1. Perform hand hygiene and don gloves.
   2. Establish a sterile field with all cleansing supplies and materials for appropriately sized V.A.C.® dressing.
   3. Position the patient to facilitate cleansing and dressing application.
   4. Cleanse the wound according to orders and/or institution protocol.
   5. Physician or advanced practice nurse may debride necrotic tissue or eschar if applicable. Healthy, vascularized tissue is reached and with a clean wound bed there is enhanced granulation tissue development.
   6. Clip hair on the border around the wound (if needed) and thoroughly cleanse skin surrounding wound.
   7. Dry and prepare the periwound tissue as appropriate. Skin degreasing/medical cleansing agents may be necessary to apply to periwound tissue.
   8. Choose appropriate V.A.C. foam for wound type.
   9. Remove gloves. Perform hand hygiene. Apply sterile gloves.
  10. Open the V.A.C. foam onto sterile, dry surface; inspect it for any defects.
  11. Cut the V.A.C. foam with sterile scissors to fit the dimensions of the wound, in a location away from the wound.
  12. Size and trim the dressing drape to cover the foam plus a 3- to 5-cm border of intact skin. Do not discard excess drape. Excess drape may be needed later as a patch.
  13. Gently place the foam into the wound cavity covering the entire wound base and sides as well as areas of tunneling and undermining. 
  14. Cover foam and 3 to 5 cm of surrounding healthy tissue with drape to ensure an occlusive seal.
  15. Cut approximately 1 cm hole in the drape and position the T.R.A.C. pad over the hole.
  16. Secure tubing with an additional piece of drape or tape (pad underneath tubing) several centimeters away from the dressing. (optional)
  17. Use excess drape to patch leaks and secure borders as needed. Leaks must be patched to prevent deactivation of the V.A.C. system.
  18. Document in patient record.

Applying the V.A.C.® Device

   1. Remove canister from the sterile packaging and push it into the V.A.C. unit until it clicks.
   2. Connect the dressing tubing to the canister tubing, making sure both clamps are open.
   3. Place the V.A.C. unit on a level surface or hang from the footboard.
   4. Press in the green-lit power button.
   5. V.A.C. unit settings are typically preset at 125 mm Hg, but can be adjusted based upon individual patients needs. Variable negative-pressure settings can be chosen as well as a continuous or intermittent mode.
   6. Using touch screen, press the therapy option to ON.
   7. Be sure that the dressing is suctioned down or pruned and no air leaks present.

Dressing Removal

   1. To remove the dressing,
   2. Tighten clamp on the dressing tube.
   3. Separate canister tube and dressing tube by disconnecting the connector.
   4. Allow the pump unit to pull the exudate in the canister tubing into the canister and then tighten clamps on the canister tube.
   5. Press Therapy On/Off.
   6. Gently stretch drape horizontally and slowly pull up from skin. Do not peel. Gently remove foam.
   7. Discard disposables in accordance with institution policy.
   8. Document in patient record.

Kitty's note:  Dressing comes off much easier if  saturated with sterile saline.  Often the sponge is adhered to the wound bed due to the suction of the vac and is quite painful to the patient.