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CHAPTER 32 Skin Integrity & Wound Healing
6.Avoid placing dressings that wrap all the way around an extremity. If necessary, place several smaller pieces of drape rather than one continuous piece. When pressure is applied, a circumferen- tial dressing may interfere with circula- tion if wrapped too tightly. 7. Identify a site over the dress- ing for the suction track tubing apparatus. 8. Pinch up a piece of drape and cut at least a 2-cm round hole. Do not make a slit or X, as this may close off under pressure.
(adjustable pressures, depending on the device used). Suction draws excess exudate away from the wound and into an evacuation container. 11.Connect tubing from the dressing to the suction track tub- ing going to the collection canister. Allows for collection and measurement of drainage. 12. Position the tubing and connec- tor away from bony prominences and skin creases. Prevents pressure injury to the skin. 13. Ensure clamps are open on all tubing. 14. Turn on power to the pump and set to the prescribed therapy set- tings to initiate therapy. Therapy should be maintained for at least 22 out of 24 hours daily. Alterna- tive wound care should be considered if the vacuum cannot be tolerated for this length of time. 15.Listen for audible leaks and observe dressing collapse or wrin- kling as pressure is applied to the wound bed. With an adequate seal, the dressing will collapse almost immediately. Any leak (i.e., between the dressing and drape, around tubing, at skin crevices, or at tubing connection sites) will pre- vent collapse.
If you cut the foam over the wound, parti- cles may fall into the wound and create irritation.
3. Gently place the foam dressing into the cavity without overlapping onto intact skin. Do not overfill the cavity or pack into deep crevices. a.Do not place foam into blind/ unexplored tunnels. Forcing foam dressings into any area may damage tissue, alter the delivery of negative pressure, or hinder exu- dates or foam removal. b.Do not allow foam dressing to overlap onto healthy skin. Foam dressing becomes very wet during therapy and will macerate and damage intact skin. c.If you use more than one piece, note the total number of pieces that were placed into the wound so you can document them on the transparent dressing and in the patient record. An accurate record of the number of foam pieces is necessary to prevent retained material within the wound. 4. Apply a liquid skin preparation product to periwound, if needed. Skin preps can protect the periwound skin from excess fluid, adhesive stripping, or other damage. 5. Apply transparent film/drape 3 to 5 cm (1 to 2 in.) from wound margins without pulling, stretching, or wrin- kling the drape. Do not push down or compress foam while placing drape. The occlusive dressing creates a seal to help create negative pressure within the wound. Tension from pulling, stretching, or wrinkling the dressing may lead to tissue injury. More pressure will be placed on the wound bed than necessary if you have flattened the foam before turning on the suction unit.
9.Place the track adhesive and suction device directly over the hole in the drape and apply gentle pressure to secure. Negative pressure removes excess wound exudate from the wound bed.
10.Connect suction track tubing to the canister tubing and open clamps.The canister is attached to a vacuum pump that provides either continuous or intermittent nega- tive pressure, adjusted for the type of wound. Set suction to the pre- scribed pressure, which is typically in the range of –5 to –125 mm Hg
16.Change the canister at least once a week or when filled. Write the date on the canister. This will help to know when it was changed last as well as how often it is being changed for fluid loss.
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