The patient to whom VAC therapy is being considered must be evaluated properly to decide the suitability for the treatment. Proper diagnosis of the wound and associated comorbidities must be known accurately. The foam dressings should not be placed directly over blood vessels, anatomostic sites, organs or nerves. The wound should be debrided properly before application of the foam dressing. The dressings must be placed gently into the wound and not tightly packed. A good dressing seal must be there before starting negative pressure.
The number of foam pieces used for dressing must be entered in the patient’s chart and the count must be rechecked when the dressing is removed. The VAC dressing should not be kept in the wound in case the therapy unit is removed for more than 2 hours. The alarms must be monitored and responded to immediately. Treatment plan must be revised if no improvement in the condition of the wound is observed in 2 weeks. Contraindications VAC therapy is contraindicated to be used on exposed nerves, blood vessels, organs and anastamoses.
Untreated osteomyelitis and malignancy of the wound are contraindications to the therapy. This treatment cannot be used for non-enteric and unexplored fistulas and also for wounds with necrotic tissue with eschar formation (KCI, 2007; Thomas, 2001). VAC therapy can be instituted once the necrotic tissue is debrided and eschar is removed. GranuFoam Silver dressing is contraindicated in those allergic to silver. Warnings 1. Bleeding: Bleeding can occur during VAC therapy and if this is noticed, the treatment should be stopped and measures must be taken to control bleeding.
Some patients are at high risk for bleeding. Inadequate wound hemostasis, friable blood vessels, administration of platelet aggregation inhibitors or anticoagulants and inadequate tissue coverage over blood vessels increases the risk of bleeding and patients with these problems must be monitored thoroughly for bleeding. 2. Infected wounds: These wounds must be monitored carefully for worsening signs of infection like redness, tenderness, rash, increased warmth in the periwound area and swelling around the wound.
Fever is also an important sign of worsening infection. Purulent discharge into the canister also indicates infection. Improperly handled infection can contribute to gangrene and toxic shock syndrome or septic shock (KCI, 2007). 3. Defibrillation and MRI: If VAC therapy dressing is placed on the chest where defibrillation must be given, the dressing must be removed before defibrillation. VAC unit must not be taken while MRI is being done. However, the dressing can be in place. 4.
Hyperbaric Oxygen Therapy (HBO): The VAC unit must not be taken into the HBO chamber as it is a fire hazard (KCI, 2007). The VAC dressing should be replaced with HBO compatible material before entering the patient into the chamber. 5. Spinal cord injury: When VAC therapy is employed in those with spinal cord injury, signs of autonomic hyperreflexia must be looked for because in the presence of these signs, the therapy should be discontinued to prevent further sensory stimulation.