Application Tips and Techniques — V.A.C. VERAFLO Therapy

Many of the application techniques used with V.A.C.® Therapy can be used with V.A.C. VERAFLO Therapy. If you can apply V.A.C.® Therapy, you can apply V.A.C. VERAFLO Therapy! We’ve put the following tips together from other clinicians to help you understand some of the nuances between the two techniques—select a topic to get started.

As with any application, please consult the patient’s treating physician about individual conditions and treatment and follow all applicable instructions for use and labeling for product use and operation.

Bridging multiple wounds

The same bridging technique you use with V.A.C.® Therapy can also be used with V.A.C. VERAFLO Therapy. However, it’s important you take into account the extra fluid required to instill both wounds, depending on the length of the bridge.

The V.A.C. VERAT.R.A.C. Pad should be placed to optimize filling of both wounds by taking advantage of gravity. For example, place the V.A.C. VERAT.R.A.C. Pad in an area that is LESS DEPENDENT to allow gravity to work with you in filling the foam (versus a dependent position where the fluid would have to work against gravity in order to fill the foam).

Non-adherent dressings

All exposed or superficial vessels and organs in or around the wound must be completely covered and protected with a meshed non-adherent dressing prior to administration of V.A.C. VERAFLO Therapy. Do not use a petroleum-impregnated dressing. Ensure the non-adherent dressing is compatible with your instillation solution by referring to the solution manufacturer’s guidelines.

Shallow wounds

When applying V.A.C. VERAFLO Therapy to wounds with small volumes, be sure you are mindful of the decrease in volume of fluid needed to fill the foam. Use the Fill Assist feature to determine the amount of fluid needed.

Undermining

In the presence of wound undermining, extra fluid is required to fill the entire amount of foam. Use the Fill Assist feature to determine the amount of fluid needed.

Foot wounds

When using the bridging technique with V.A.C. VERAFLO Therapy on foot wounds, extra fluid is required to bridge the V.A.C. VERAT.R.A.C. Pad. Place the pad in an area that is LESS DEPENDENT to allow gravity to work with you in filling the foam (versus a dependent position where the fluid would have to work against gravity in order to fill the foam).

Preventing a seal loss

  • Place the foam in the wound (do not pack the foam into the wound)
  • Prepare the periwound adequately (dry the skin, apply 3M Cavilon Skin Prep, and allow 3M Cavilon to get sticky)
  • Windowpane the periwound with the drape provided in the dressing kit
  • Take your time during the initial drape placement and apply drape as uniformly as possible, minimizing the amount of wrinkles, folds, or kinks
    • Consider gently rubbing the skin prep over any wrinkles or folds to seal any microleaks that may compromise the seal
  • Select adequate volume of fluid to instill-use the Fill Assist feature to avoid overfilling
  • Reduce fill volume from Fill Assist by 10% to 30%
  • For V.A.C. VERAT.R.A.C. Pad application, take into account the wound size, anatomical position, and the wound’s relation to gravity
  • Minimize patient activity during instillation with dwell time

Minimize leaks in difficult anatomical areas

  • Use hydrocolloid dressing and stoma paste if you have a deep crevice or crack
  • In very wet areas like the perineum, consider use of a stoma adhesive strip paste or ring as a “caulking compound”
  • In areas where movement is common, like joints or the perineum, consider applying the drape in a chevron pattern to provide give and flexibility
  • Allow the Seal Check feature to do its job; it helps to provide the 2.5-minute cure time designed to maximize adherence of the drape
  • Consider the location of your V.A.C. VERAT.R.A.C. Pad—let gravity work with you, not against you
  • Consider the benefit of the V.A.C. VERAT.R.A.C. Duo Pad—it could help with managing the dwell phase

Instillation with dwell time (NPWTi-d):

A controlled, automated process in which instilled topical wound solution is slowly introduced into the wound and remains in the wound bed for a defined period of time before being removed by applying negative pressure.

Dressing soak

For easier dressing removal and increased patient comfort, use the dressing soak tool to soak the dressing in the wound with a topical solution before changing the dressing. Just be sure to account for the soak volume as you would for any programmed V.A.C. VERAFLO Therapy cycle when managing the fluid in the bag/bottle on your input/output.

Patient comfort

Provide adequate pain relief and patient education prior to initiating therapy or changing the dressing. Position the patient to best accommodate pain tolerance and wound access. If additional help is needed to support patient position, have appropriate assistance available.

Instillation with dwell time (NPWTi-d):

A controlled, automated process in which instilled topical wound solution is slowly introduced into the wound and remains in the wound bed for a defined period of time before being removed by applying negative pressure.

Maceration

Good periwound protection and appropriate instillation fluid volume should not result in maceration. Make sure you apply skin prep provided in the kit to the periwound and consider use of a barrier ring or strip to act like a “caulk” around the wound borders. If the wound bed is becoming macerated, decrease the dwell time. If it’s severe, a hydrocolloid border may help decrease maceration. Also, consider discontinuation of instillation therapy until maceration is resolved.

Be prepared

Have all supplies gathered and ready prior to V.A.C. VERAFLO Therapy application or dressing change, such as:

  • Cleansing products to clean the wound and periwound
  • Scissors
  • Camera
  • Measuring tool
  • Appropriate disposables: V.A.C. VERAFLO Dressing or V.A.C. VERAFLO CLEANSE Dressing, V.A.C. VERALINK Cassette, and Canister
  • Ordered topical wound solution
  • Any additional items to facilitate seal: surgical skin adhesive; ostomy strips, paste, or rings; additional drape or supplies to windowpane, etc.

Physician orders

V.A.C. VERAFLO Therapy requires a physician order for use. The order should include the frequency of instillation, dwell time, and solution being used along with negative pressure settings. Ensure any consents are signed, dependent on facility policy. Refer to the Pharmacy Solution Guide for more information.

Documentation

  • Always count and then document the type and total number of foam pieces used in the wound and ensure the same number of foam pieces are removed at the next dressing change
  • Document when cassettes, canisters, and dressings are changed
  • Be sure your instillation solution is being accounted for in your input/output
  • The solution is considered a medication, so it should be included on your medication administration record (MAR)
    • Change bags/bottles per facility policy
    • If there is an option in fluid volume per bottle/bag, consider the amount you will be instilling over a 24-hour period so you can anticipate and plan for minimizing the number of spikes

Expert Panel Recommendations for V.A.C. VERAFLO Therapy with V.A.C. VERAFLO CLEANSE CHOICE Dressings1

An expert panel made recommendations that may be used to guide the appropriate use of V.A.C. VERAFLO Therapy in conjunction with V.A.C. VERAFLO CLEANSE CHOICE Dressing safety information.

The V.A.C. VERAFLO CLEANSE CHOICE Dressing should be used in combination with V.A.C. VERAFLO Therapy.

Based on existing experience, the following range of V.A.C VERAFLO Therapy settings are suggested for use with the V.A.C VERAFLO CLEANSE CHOICE Dressing:

  • dwell time of 1 to 20 minutes
  • negative pressure time phase of 30 minutes to 3.5 hours
  • negative pressure of -125 or -150mm Hg
  • topical solution volume will greatly vary between wounds

(Please see page S7 of Recommendations, Table 3 for details on various recommended dwell times and NPWT time phases)

The V.A.C VERAFLO CLEANSE CHOICE Dressing may be an appropriate adjunct therapy after adequate wound treatment and evaluation for wound types, such as:

  • wounds with exposed bone
  • wounds with treated, underlying osteomyelitis
  • wounds with intact synthetic mesh
  • extensive hematoma cavity with confirmed hemostasis
  • wounds in the presence of orthopedic fixation hardware
  • wounds being prepared for definitive closure or coverage (eg, split-thickness skin graft, full-thickness skin graft, or flap)

Appropriate wounds for V.A.C VERAFLO Therapy with the V.A.C VERAFLO CLEANSE CHOICE Dressing contain a majority area of slough/ fibrinous tissue and:

  • have heavy bioburden
  • are difficult to granulate

The V.A.C VERAFLO CLEANSE CHOICE Dressing can be used with caution in cases of:

  • patients at an increased risk of bleeding complications
  • signs of systemic infection or advancing infection at the wound site
  • exposed structures
  • explored tunnels
  • explored undermining

Appropriate patients for V.A.C VERAFLO Therapy with the V.A.C VERAFLO CLEANSE CHOICE Dressing are patients with wounds that contain nonviable tissue, including:

  • operative candidates when surgical debridement is not available
  • operative candidates who refuse surgical debridement
  • patients who have undergone excisional sharp debridement, but nonviable tissue remains in the wound bed
  • non-operative candidates when surgical debridement is not appropriate

Panel suggests the following goals for using the V.A.C. VERAFLO CLEANSE CHOICE Dressing:

  • cleanse wounds when areas of slough or nonviable tissue remain present on the wound surface
  • remove thick exudate
  • remove infectious materials
  • promote granulation tissue formation
  • help provide a bridge to a defined endpoint for a clinical plan of care

The topical solutions that have been recommended for instilling during standard V.A.C. VERAFLO Therapy also are recommended when using the V.A.C. VERAFLO CLEANSE CHOICE Dressing. However, more research is needed to determine optimal topical solutions to best address various types of bioburden and wound characteristics.

REFERENCES:

1. Kim P, et al. Use of a Novel Foam Dressing with Negative Pressure Wound Therapy and Instillation: Recommendations and Clinical Experience. Wounds. 2018;30(3): S1–S17.

3M and Cavilon are trademarks of 3M Company.

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