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1. CONTRAINDICATIONS e Do not place foam dressings of the V A C Therapy System directly in contact with exposed blood vessels anastomotic sites organs nerves and or unprotected intact skin NOTE Refer to Warnings section for additional information concerning bleeding e V A C Therapy is contraindicated for patients with e Malignancy in the wound e Untreated osteomyelitis NOTE Refer to Warnings section for Osteomyelitis information e Necrotic tissue with eschar present NOTE After debridement of necrotic tissue and complete removal of eschar WA CS Therapy may be used WARNINGS Bleeding With or without using V A C Therapy certain patients are at high risk of bleeding complications The following types of patients are at increased risk of bleeding which if uncontrolled could be potentially fatal e Patients who have weakened or friable blood vessels or organs in or around the wound as a result of but not limited to e Infection e Trauma e Radiation Patients without adequate wound hemostasis Patients who have been administered anticoagulants or platelet aggregation inhibitors Patients who do not have adequate tissue coverage over vascular structures If V A C Therapy is prescribed for patients who have an increased risk of bleeding complications they should be treated and monitored in a care setting deemed appropriate by the treating veterinarian If active bleeding develops suddenly or in large amounts
2. Infected Blood Vessels Infection may erode blood vessels and weaken the vascular wall which may increase susceptibil ity to vessel damage through abrasion or manipulation Infected blood vessels are at risk of complications including bleed ing which if uncontrolled could be potentially fatal Extreme caution should be used when V A C Therapy is applied in close proximity to infected or potentially infected blood vessels Refer to Protect Vessels and Organs section above e Hemostasis and Anticoagulants Patients without adequate wound hemostasis have an increased risk of bleeding which if uncontrolled could be potentially fatal These patients should be treated and monitored in a care setting deemed appropriate by the treating veterinarian Caution should be used in treating patients on doses of anticoagulants thought to increase their risk for bleeding relative to the type and complexity of the wound Consideration should be given to the negative pressure setting and therapy mode used when initiating therapy Hemostatic Agents Applied at the Wound Site Non sutured hemostatic agents for example bone wax absorbable gelatin sponge or spray wound sealant may If disrupted increase the risk of bleeding which if uncontrolled could be potentially fatal Protect against dislodging such agents Consideration should be given to the negative pressure setting and therapy mode used when initiating therapy Sharp Edges Bone fragments or s
3. canister Spinal Cord Injury In the event a patient experiences autonomic dysreflexia sudden changes in blood pressure or heart rate in response to stimulation of the sympathetic nervous system discontinue V A C Therapy to help minimize sensory stimula tion and seek immediate medical assistance Bradycardia To minimize the risk of bradycardia VA CS Therapy must not be placed in proximity to the vagus nerve Protect Periwound Skin Consider use of a skin preparation product to protect periwound skin Do not allow foam to over lap onto intact skin Protect fragile friable periwound skin with additional V A C Drape or other transparent film e Multiple layers of the V A C Drape may decrease the moisture vapor transmission rate which may increase the risk of maceration e f any signs of irritation or sensitivity to the drape foam or tubing assembly appear discontinue use and consult a veteri narian e To avoid trauma to the periwound skin do not pull or stretch the drape over the foam dressing during drape application e Extra caution should be used for patients with neuropathic etiologies or circulatory compromise Circumferential Dressing Application Avoid use of circumferential dressings except where a circumferential drape tech nique may be necessary to establish and maintain a seal Consider using multiple small pieces of V A C Drape rather than one continuous piece to minimize the risk of decreased distal circul
4. 2 3 Select an appropriate size of V A C GranuFoam Dressing to cover the entire flap Fig 4 including the suture line and 2 3cm beyond the flap Ensure the area covered by the foam is protected intact skin Step 2 above 4 Prepare and apply the V A C Drape over the foam Refer to V A C Therapy General Dressing Application Instructions pg 8 Apply a SensaT R A C T R A C Pad and connect to canister tubing Refer to SensaT R A C T R A C Pad Application pg 10 Initiate therapy on Continuous setting as indicated in Table 5 6 6 Removal of the V A C Drape requires lateral stretch pull on the drape to prevent lifting of the flap 32 ADDITIONAL INFORMATION FOR V A C THERAPY V A C THERAPY AND HYPERBARIC OXYGEN THERAPY When patients treated with V A C Therapy are receiving regular hyperbaric oxygen treatments disconnect the V A C Therapy unit and canister from the tubing so that pressure changes in the chamber enter the tubing and the dressing In such cases the following procedure Is recommended NOTE The V A C GranuFoam Bridge Dressing contains additional synthetic materials and may pose a risk during Hyperbaric Oxygen Therapy 1 Do not take the V A C Therapy Unit into a hyperbaric oxygen chamber The V A C Therapy Unit is not designed for this environment and should be considered a fire hazard in that environment See Hyperbaric Oxygen Therapy Section pg 6
5. 2 After disconnecting the V A C Therapy Unit from the dressing canister either a replace the V A C Dressing with another HBO compatible material during the hyperbaric treatment or b follow the steps below 3 Disconnect the dressing tubing from the canister tubing Close the dressing tubing and canister tubing clamps before disconnecting d Open the clamp on the dressing tubing and cover with cotton gauze The tubing on the SensaT R A C T R A C Pad is not to be clamped or capped during hyperbaric treatment WARNING Never leave a V A C Dressing in place without active VA CH Therapy for more than 2 hours If therapy is off for more than 2 hours remove the old dressing and irrigate the wound Either apply a new VA CS Dressing from an unopened sterile package and restart V A C Therapy or apply an alternative dressing such as wet to moist gauze as approved during times of extreme need by treating veterinarian 5 After hyperbaric oxygen treatment reconnect the V A C Therapy Unit and resume therapy Check the dressing for air leaks and ensure that the seal is intact V A C DRESSINGS AND DIAGNOSTIC IMAGING e When undergoing X ray MRI fluoroscopy or dye tests the decision to remove the dressing is to be made by the treating veterinarian NOTE FDA informed healthcare professionals of the possibility that x rays used during CT examinations may cause some implanted and external electronic medical devices to malfu
6. on top of the suture line as directed above e Ensure the V A C GranuFoam Dressing directly contact in order to provide adequate distribution of negative pressure and wick fluid from within the suture line e Tertiary closure may be obtained after adequate tissue decompression has occurred SPECIALTY DRESSINGS V A C SIMPLACE DRESSING V A C SIMPLACE DRESSING COMPONENT IDENTIFICATION V A C Spiral GranuFoam V A C Spiral GranuFoam Dressing Medium Dressing Small Quantity 2 Quantity 2 3M Tegaderm Sensat R A C jf eee Dressing OG Pad with Foam le Quantity with Medium 3 Quantity Label V A C Ruler Quantity with Small 2 V A C SPIRAL GRANUFOAM DRESSING APPLICATION 1 Refer to Wound and Periwound Skin Preparation section pg 8 2 Assess wound dimensions and pathology including the presence of undermining or tunnels Fig 1 Do not place any foam dressing into blind unexplored tunnels V A C Simplace Dressing may be used for wounds with shallow undermining or tunnel areas where the distal aspect is visible NOTE f adjunct materials are utilized under the V A C Dressing they must be meshed or fenestrated to allow for effective exudate removal and negative pressure delivery Document on the drape on the supplied Foam Quantity Label attached to the SensaT R A C Pad tubing and in the patient s chart to ensure removal with subsequent dressing
7. to the clipped periwound skin from the wound edge outward for 5 7cm to improve adhesion Wait until adhesive becomes tacky before applying 3M Tegaderm Dressing drape 3 Trim the 3M Tegaderm Dressing to cover the V A C Spiral GranuFoam Dressing and an additional 3 5 cm border of intact periwound tissue Fig 6 The 3M Tegaderm Dressing may be cut into multiple pieces for easier handling Excess 3M Tegaderm Dressing may be kept to seal difficult areas if needed 4 Carefully remove Layer 1 to expose adhesive Fig 7 The 3M Tegaderm Dressing may be held by the Ruler Handling Bars 5 Place the adhesive face down over foam and apply 3M Tegaderm Dressing to cover foam and Intact skin ensuring 3M Tegaderm Dressing covers at least a 3 5 cm border of intact periwound tissue Remove Layer 2 and pat 3M Tegaderm Dressing to ensure an occlusive seal Fig 8 Refer to SensaT R A C T R A C PAD Application section pg 10 Refer to V A C Therapy Initiation section pg 11 BRIDGE APPLICATION WITH V A C SIMPLACE DRESSING CAUTION Patient s skin condition should be carefully monitored refer to Precautions Protect Periwound Skin sec tion 1 Refer to Wound and Periwound Skin Preparation section pg 8 2 Apply V A C Spiral GranuFoam Dressing and 3M Tegaderm Dressing to wound as described in the V A C Spiral Granufoam Dressing Application se
8. A C Dressing in place without active V A C Therapy for more than 2 hours please refer to the Keep V A C Therapy On section above PRECAUTIONS Standard Precautions To reduce the risk of transmission of bloodborne pathogens apply standard precautions for infection control with all patients per institutional protocol regardless of their diagnosis or presumed infection status In addition to gloves use gown and goggles if exposure to body fluids is likely Continuous versus Intermittent VA CS Therapy Continuous rather than intermittent V A C Therapy is recommended over unstable structures such as an unstable chest wall or non intact fascia in order to help minimize movement and stabilize the wound bed Continuous therapy is also generally recommended for patients at increased risk of bleeding highly exudative wounds and fresh flaps and grafts Patient Size and Weight Consider the size and weight of the patient patient s condition wound type and size and the monitoring capabilities of the veterinary hospital or care setting In small patients less than 10 kg or in patients with large wounds loss of significant fluid volume through V A C Therapy could be life threatening Monitor fluid loss hydration blood loss blood pressure and serum protein levels with greater vigilance in patients weighing less than 10 kg or patients with large wounds When assessing fluid loss consider the volume of fluid in the tubing and the V A C
9. Benzoin Tincture or Hollister Medical Adhesive Spray to the clipped periwound skin from the wound edge outward 5 7 cm to improve drape adhesion Wait until adhesive becomes tacky before applying drape Trim and place the V A C Drape to cover the V A C Foam Dressing and the clipped 5 7 cm border of intact periwound skin Fig 4 Do not place drape over unclipped fur Drape may be cut into multiple pieces for easier handling retaining a portion of the Blue Handling Tab on each piece Use any excess drape to seal difficult areas if needed 4 Partially pull back one side of Layer 1 to expose drape adhesive Fig 5 Be sure to hold Layer 1 flap back to prevent re adherence to drape 5 Place the adhesive face down over foam and apply drape to cover foam and intact skin ensuring drape covers at least a 5 7 cm border of intact periwound tissue Fig 6 Remove remaining Layer 1 backing material and pat drape to ensure an occlusive seal Remove green striped stabilization Layer 2 Fig 7 Remove perforated Blue Handling Tabs trom drape Fig 8 SENSAT R A C T R A C PAD APPLICATION NOTE Do not cut off the pad or insert the tubing into the foam dressing This may occlude the tubing and cause the V A C Therapy Unit to alarm 1 Choose pad application site Give particular consideration when positioning the pad to allow for optimal fluid flow and to reduce chances of kinking the tubing Avoid placement of pad over bony
10. C Therapy System Safety Information before beginning wound preparation WARNING Refer to Warnings Patient Restraint 1 The patient s hair must be closely clipped using a 40 clipper blade to provide a minimum 5 7 cm margin of skin around the wound This periwound skin should be surgically prepped to decrease bacterial load and dried completely Debride all necrotic non viable tissue including bone eschar or hardened slough as prescribed by veterinarian Perform thorough wound and periwound area cleaning per veterinarian order or institution protocol prior to each dressing application 4 Ensure adequate hemostasis has been achieved refer to Warnings Bleeding section Hemostasis and Anticoagulants 5 Protect vessels and organs refer to Warnings Bleeding section Protect Vessels and Organs DRESSING APPLICATION FOR SINGLE WOUNDS USING V A C GRANUFOAM SMALL MEDIUM LARGE AND THIN DRESSINGS Refer to Clinical Guidelines Section of this manual for detailed instructions regarding other dressing types for treating different wound types and for multiple wound applications WARNING Refer to Restraints sections under Warnings and Patient Size and Weight and Circumferential Dressing Applica tions sections under Precautions 1 Assess wound dimensions and pathology including the presence of undermined areas VA CS GranuFoam Dressing may be used for wounds with shallow undermining where the distal aspect is visible
11. Clinical Infection and VA CS Therapy In the event of clinical infection V A C Therapy is not intended to replace the use of systemic therapy or other infection treatment regimens V A C Therapy may be used on infected wounds as an adjunct to the standard treatment regimen Osteomyelitis The V A C System should NOT be initiated on a wound with untreated osteomyelitis Consideration should be given to thorough debridement of all necrotic non viable tissue including infected bone if necessary and appropriate antibiotic therapy Protect intact bone with a single layer of non adherent material Protect Tendons Ligaments and Nerves Tendons ligaments and nerves should be protected to avoid direct contact with V A C Foam Dressings These structures may be covered with natural tissue meshed non adherent material or bio engi neered tissue to help minimize risk of desiccation or injury Foam Placement Always use V A C Dressings from sterile packages that have not been opened or damaged Do not force foam dressings into any area of the wound as this may damage tissue alter the delivery of negative pressure or hinder exu date and foam removal Always count the total number of pieces of foam used in the wound and document that number on the drape and in the patient s chart Also document the dressing change date on the drape Foam Removal V A C Foam Dressings are not bioabsorbable Always count the total number of pieces of foam r
12. Refer to V A C Therapy Initiation section pg 1 1 20 V A C GRANUFOAM BRIDGE DRESSING APPLICATION INSTRUCTIONS V A C GRANUFOAM BRIDGE DRESSING COMPONENT IDENTIFICATION Pre Cut V A C GranuFoam Dressing V A C GranuFoam Bridge with pre attached SensaT R A C Pad V A C Ruler Perforated V A C Drape Product Description The V A C GranuFoam Bridge Dressing is a component of the V A C Therapy System and provides for the applica tion of negative pressure wound therapy to those wounds which because of their anatomical location require that the SensaT R A C Pad be placed at a remote location such as with sacral wounds or wounds requiring off loading or compres sion therapy Vertical Bridge Placement and Moderately to Highly Exudating Wounds PRECAUTION For vertical bridge placement on moderately to highly exudating wounds the V A C GranuFoam Bridge Dressing should not be used for prescribed pressure settings below 125 mmHg If using VA CS GranuFoam dressings at the wound site In order to provide adequate therapy and minimize risk of maceration due to a decrease in negative pressure up to 50 mmHg do not use a prescribed pressure setting below 125 mmHg PRE CUT V A C GRANUFOAM DRESSING APPLICATION Assess Wound Foam Quantity Label Date Dressing Applied ee A i e Le vactherapy A A KCI Healing by design e O ZS Bees 330331 Rev B Number
13. V A C Therapy System Safety Information and the V A C Therapy Unit user guide before initiating V A C Therapy WARNING Refer to Restraints section under Warnings 1 Remove V A C Canister from packaging and insert into the V A C Therapy Unit until it locks into place NOTE f the canister is not fully engaged the V A C Therapy Unit will alarm Connect SensaT R A C T R A C Pad tubing to canister tubing and ensure clamp on each tube is open Fig 13 Position clamps away from patient Turn on power to the V A C Therapy Unit and select the prescribed therapy setting Refer to the V A C Therapy Unit user guide for detailed information on how to operate the therapy unit Initiate V A C Therapy Assess dressing to ensure seal integrity The dressing should be collapsed and have a wrinkled appearance There should be no hissing sounds If there is any evidence of non integrity check SensaT R A C T R A C Pad and drape seals tubing connections and canister insertion and ensure clamps are open Secure excess tubing to prevent interference with patient mobility NOTE f a leak source is identified patch with additional drape to ensure seal integrity ENSURING DRESSING INTEGRITY It is recommended that the dressing be checked every two hours to ensure that the foam Is firm and collapsed in the wound bed while therapy is active If it is not e Make sure the therapy unit display screen read
14. a closed moist wound healing environment e Promote perfusion e Remove fluids exudate and infectious materials Table 5 2 Recommended settings for surgical wound dehiscences Initial Target pressure cycle V A C GranuFoam Dressing Continuous 125 mmHg for duration of therapy CLINICAL CONSIDERATIONS FOR DEHISCED WOUNDS e V A C Therapy may be used with retention sutures in place but it is generally important to access and dress all of the wound under and between the sutures Consider applying V A C Drape over adjacent drain puncture sites in the event that a properly applied V A C Dressing is not collapsing Monitor characteristics of wound exudate and voulme and report any significant changes to treating veterinarian e The placement and size of the foam Is critical for optimal results and to achieve reverse tissue expansion See wound edge reapproximation and dressing technique pg 16 e f bowel is visible in the wound base it is best when possible to pull the greater omentum down over the visible bowel then proceed with V A C Therapy as usual If the greater omentum is not available then the surgeon may want to con sider placing mesh over the bowel However applying the V A C Foam to bowel covered by mesh may produce granula tion tissue on the bowel and result in adhesions e V A C Foam can be placed directly over synthetic mesh in abdominal wounds and can facilitate the growth of granula tio
15. around Fig 2 Place lower drape Fig Fig 4 Fig 5 wounds and along over dressings and l Place upper drape bridge path bridge path Place bridge foam over bridge foam Place T R A C Pad N Wounds with Cut hole in drape Cut hole in upper drape foam dressings centered over dressings centered between dressings 1 Refer to Wound and Periwound Skin Preparation section pg 8 2 Place foam dressing in both wounds Fig 1 3 Cover both wounds and intact skin between the two wounds with a piece of V A C Drape or other transparent film or a vapor permeable adhesive film dressing Fig 2 d Cut holes in drape approximately the diameter of a US quarter centered over each dressing Fig 2 5 With an additional piece of foam form the bridge All foam pieces must be in direct contact with each other Fig 3 6 Apply upper drape over bridge foam Fig 4 7 Cut hole in upper drape centered between dressings Fig 4 It is important to place the hole in a central location to ensure that exudate from one wound is not drawn across the other wound 8 Place the SensaT R A C T R A C Pad Fig 5 Consider orientation of the tubing in regards to location of therapy unit or patient mobility 9 It is not recommended to bridge wounds of different etiologies or to bridge an infected wound to a non infected wound 10 Refer to V A C Therapy Initiation pg 11 14 UNDERMINING It is recommended that Continuous t
16. exudate and presence of granulation tissue at each dressing change ORTHOPEDIC HARDWARE The V A C Dressing can be placed on wounds with orthopedic hardware such as pin sites Additional layer of drape applied on top of first layer and up and around pin First Layer V A C Drape of Drape over wound and around Non adherent Attach Braces pins Layer Application Technique 1 Place appropriate V A C Dressing in the wound 2 Cut V A C Drape or other transparent film to appropriate size and place over wound and around pins Fig 1 Wrap the V A C Drape around pins approximately 1 2 cm above the level of the wound ensuring a snug fit 3 Apply additional V A C Drape vertically up and around pins and onto V A C Drape surrounding the pin Do this from both sides of the pin Pinch drape together to form airtight seal as V A C Therapy is initiated Fig 2 4 Complete installation of orthopedic hardware Fig 3 WOUND EDGE REAPPROXIMATION AND DRESSING TECHNIQUE In open wounds without significant tissue loss such as open abdominal wounds V A C Therapy may be used to encourage reapproximation of the wound edges 1 Initial dressing application should include gently placing the V A C GranuFoam Dressing into the wound Fig 1 2 Pressures should be adjusted appropriately to encourage the removal of excessive debris and fluid 3 For subsequent dressing applications the foam should be cut progre
17. remove the old dressing and irrigate the wound Either apply a new V A C Dressing from an unopened sterile package and restart V A C Therapy or apply an alternative dressing such as wet to moist gauze as approved during times of extreme need by treating clinician To disconnect for short periods of time 1 Close the clamps on the canister and dressing tubing 2 Turn the therapy unit OFF 3 Disconnect the dressing tubing from the canister tubing 4 Cover the ends of the tubing and secure Use canister tubing cap if available To re connect 1 Remove tubing cap or protective covering from the end of the tubing 2 Reconnect the dressing tubing and the canister tubing 3 Open both clamps 4 Turn the therapy unit ON Confirm that previous therapy settings resume 12 V A C DRESSING REMOVAL Remove an existing V A C Dressing according to the following procedure 1 Raise the tubing connectors above the level of the therapy unit 2 Close clamp on the dressing tubing 3 Separate canister tubing and dressing tubing by disconnecting the connector A Allow the therapy unit to pull the exudate in the canister tube into the canister then close the clamp on the canister tubing Press THERAPY ON OFF to deactivate the V A C Therapy Unit Wait for 15 30 seconds to allow for foam to decompress 6 To remove the drape from the skin gently stretch the drape horizontally to release adhesive from the skin Do not peel
18. this technique is used all dressed wound sites must be assessed for seal integrity The dressing should be collapsed V A C GranuFoam Dressings should have a wrinkled appearance There should be no hissing sounds Sensal R A C T R A C Pad Y Connector e Do not connect infected wounds with non infected wounds through a Y connector e Do not connect wounds with different etiology in which cross contamination may occur e Avoid using a Y connector to connect wounds that would be optimally treated with differing pressure settings e Consider the Y connector as an extension of canister tubing e It is not recommended to Y connect grafts and or flaps Change the Y connector at least once a week or more frequently as needed when the canister is changed Dispose of the Y connector the canister tubing and the canister in accordance with specific institution protocols or state and local regulations 13 BRIDGING TECHNIQUE Wounds that are in close proximity to one another on the same patient and of similar pathologies may also be treated with one V A C Therapy Unit using a technique known as bridging The advantages of bridging include e The ability to join multiple wounds of like origin with one V A C Therapy unit e Allowng placement of the SensaT R A C T R A C Pad and tubing in an appropriate location based on wound size wound type and wound location Step by Step Bridging Guidelines Fig 1 Clipped area
19. 5 mmHg until the drainage amount tapers off This will ensure adequate fluid removal and maintain integrity of the V A C Dressing seal Continuous Therapy is recommended throughout entire therapy for patients who are experiencing discomfort where the wound contains tunneling undermining or with flaps and grafts e V A C Therapy should not be initiated on a wound with osteomyelitis until the wound has been thoroughly debrided of all necrotic non viable tissue including infected bone if necessary and appropriate antibiotic therapy has been initiated In acute wounds with exposed bone or fractures the V A C System may be used to help remove fluid and may remove infectious material secondary to the traumatic wound e V A C GranuFoam Dressing is recommended for traumatic wounds with large tissue deficits 2I DEHISCED WOUNDS V A C Therapy is suitable for the treatment of a variety of large and small wounds arising from postoperative complications In such cases the principles of wound management are adequate surgical debridement and antibiotic as necessary followed by the immediate application of V A C Therapy The following recommended therapy ranges are a guide based on common settings for each wound type Individual patient conditions may vary Consult treating veterinarian to verity settings for each patient Goals and Objectives e Apply controlled localized negative pressure to help draw wound edges e Provide
20. AL Therapy for veterinary use V A C Therapy for Veterinary Use USER MANUAL vac therapy KCI TABLE OF CONTENTS WA TAERAA EE EE 3 ITF LA KEE 3 VAG THERAPY SYSTEM SAFETY INFORMATION FOR VETERINARY USE TEE 4 CONSIDERATIONS FOR VAC THERAPY FOR VETERINARY USE scccnstoanssccunasvsnesontonesasenivoes inaenea ae K ENEE ENNE EEEE EN TETEREKAN D V A C THERAPY GENERAL DRESSING APPLICATION INSTRUCTION 8 ENSURING DRESSING INTEGRI GE 11 MARHAD TASE A a E E E E E rare 12 CHARGING FAE CAN TER E 12 DISCONNECTING FROM TRE VAC THERAPY ONI WEE 12 MPC DRE SING Ferg EE 13 SPECIFIC DRESOING TECRINIQUES AIND SPECIALLY DR ES SIN GS E E Belg IE e EN 15 UIP ga EE 15 WOUND EDGE REAPPROAIMANON AND DRESSING TECHNIQUE sc ccn scsensdanesnmsdutianpesceitemenpuied sdaieone sinsadiamausaleddvensasiehdaasansnsnaennambedes 16 DRESSING SMALL WOUNDS AND SENSAT R A C T R A C 1 M PAD APPLICATION ebe eege serene 16 SURGICAL INCBIONZCOMPROMISED SUTURE CINE eege 17 PE AES DRE IRI E 18 KE a SUPT re TEE 18 VAC ORANUFOAM BRIDGE DRESSING APPLICATION INSTRUCTIONS ccsceadndossaeteasacstiecnsiseadsendenevaecenniecalandesnescumecmanectinads 21 CLINICAL GUIDELINES VAG THERAPY FOR VETERINARY USE cvteistacuoviapsceenuatiostaemmmonedeaasteanstcedubiountieewmsontiaeeebliesasaenactonnhbes 24 EE WARP ONT ORIN EE 24 WOUND SPECIFIC INFORMA TON E SE V A C THERAPY RECOMMENDED GUIDELINES This User Manual includes Safety information Dressing Applica
21. Always leave 1 2 cm between the reflec tion of skin onto subcutaneous tissue and V A C Dressing NOTE fa non adherent interfacial layer is utilized under the V A C Dressing ensure material is meshed or fenestrated to allow for effective exudate removal Cut V A C Foam Dressing to dimensions that will allow the foam to fit the wound size without overlapping onto intact skin Fig 1 CAUTION Do not cut the foam over the wound as fragments may fall into the wound Fig 2 Away from wound site rub cut foam edges to dislodge any fragments or loose particles that may fall into or be left in the wound upon dressing removal Gently place foam into wound cavity ensuring contact with all wound surfaces Fig 3 Do not force V A C Foam Dressing into any area of the wound NOTE Ensure foam to foam contact between adjacent pieces of foam for even distribution of negative pressure NOTE Always note the total number of pieces of foam used in the dressing and document on the drape and in the patient s chart NOTE Superficial or retention sutures should be covered with a single layer of non adherent material placed between the sutures and the V A C Drape V A C DRAPE APPLICATION CAUTION Patient s skin condition should be carefully monitored refer to Precautions Protect Periwound Skin section NOTE Do not attempt to apply V A C Drape to wet or moist skin as it will not achieve adequate seal 1 Apply an adhesive
22. CI representative For additional and most current information please see KCI s website at www kcianimalhealth com CAUTION U S Federal law restricts this device to sale rental by or on the order of a veterinarian V A C THERAPY GENERAL DRESSING APPLICATION INSTRUCTIONS BASIC V A C THERAPY SYSTEM COMPONENTS V A C GranuFoam SensaT R A C Dressing T R A C Pad ke V A C Canister V A C Therapy Unit DRESSING APPLICATION INTERVAL Wounds being treated with the V A C Therapy System should be monitored on a regular basis In a monitored non infected wound V A C Dressings should be changed every 48 to 72 hours maximum but no less than 3 times per week with fre quency adjusted by the veterinarian as appropriate First dressing application should be maximum 48 hours to assess granulation rate Subsequent dressing applications should be at the veterinarian s discretion but no longer than 72 hours Infected wounds must be monitored often and very closely For these wounds dressings may need to be changed more often than 48 hours the dressing change intervals should be based on a continuing evaluation of wound condition and the patients clinical presentation rather than a fixed schedule For details regarding the various V A C Dressing options contact your local KCI representative or refer to KCI s website at www kcilanimalhealth com WOUND AND PERIWOUND SKIN PREPARATION WARNING Review all V A
23. Ffoam Bridge Dressing with additional V A C Drape strips as required to avoid migration of the bridge dressing and to minimize additional pressure points NOTE f adjustment to the length of VA C GranuFoam Bridge Dressing is desired a Z fold may be used Fold VA CH GranuFoam Bridge Dressing as shown in Fig 21 and secure to patient with additional V A C Drape strips 8 Refer to V A C Therapy Initiation section pg 11 23 CLINICAL GUIDELINES V A C THERAPY FOR VETERINARY USE NOTE Selectable pressure settings and therapy options vary by device All products allow for continuous 125 mmHg which is commonly prescribed by clinicians for many wound types Should individual patient conditions or circumstances in the judgment of the treating clinician require a different pressure setting or mode of therapy options please contact your supplier to discuss the availability of other options that may be appropriate V A C THERAPY MONITORING PAIN MANAGEMENT Patients receiving V A C Therapy may experience a reduction in pain as the wound begins to heal However some patients experience discomfort during treatment or dressing changes Appropriate analgesic sedation or anesthetic protocol should be considered In addition the following strategies should be considered e f the patient experiences discomfort during dressing change consider premedication the use of a non adherent inter posed layer before
24. LICATION VA C Drape Strips a Handling d YA 1 Refer to Wound and Periwound Skin Preparation section pg 8 Remove the release liner from the VA CS GranuFoam Bridge Fig 11 Align the pre cut hole on the underside of the V A C GranuFoam Bridge with the pre cut hole on the Perforated V A C Drape at the wound site Fig 12 Apply firm even pressure to the adhesive end of the V A C GranuFoam Bridge Dressing to ensure proper adhesion to wound site d Route the V A C GranuFoam Bridge to a location away from bony prominences that will minimize pressure or stress to underlying tissue Minimize wrinkles and creases when applying the V A C GranuFoam Bridge Dressing 5 If the VA C GranuFoam Bridge Dressing is applied on the foot route the V A C GranuFoam Bridge through the instep and up the leg Fig 13 6 Secure the V A C GranuFoam Bridge to the patient s skin a Carefully tear Perforated V A C Drape strips along perforations Fig 14 b Pull back Layer 1 to expose adhesive Fig 15 c Secure VA CH GranuFoam Bridge Fig 16 NOTE Secure the dressing to ensure that range of motion of the foot Is not limited d Remove second Layer 1 Fig 17 e Remove Layer 2 and pat drape to ensure an occlusive seal Fig 18 f Remove Blue Handling Bar Fig 19 7 Repeat Step 4 as necessary to fully secure V A C GranuFoam Bridge to patient Fig 20 NOTE Secure the VA CH Granu
25. V A C GranuFoam Dressing into any area of the wound NOTE Ensure foam to foam contact between adjacent pieces of foam for even distribution of negative pressure NOTE Always note the total number of pieces of foam used and document on the supplied Foam Quantity Label Fig 7 on the V A C GranuFoam Bridge Tubing and in the patient s chart NOTE Superficial or retention sutures should be covered with a single layer of non adherent material placed between the sutures and the V A C Drape PERFORATED VA CS DRAPE APPLICATION CAUTION Patient s skin condition should be carefully monitored refer to Precautions Protect Periwound Skin sec tion 1 Trim as necessary Fig 8 and place the Perforated V A C Drape with pre cut hole to cover the Pre Cut V A C Granu Foam Dressing and an additional 3 5 cm border of intact periwound tissue Additional Perforated V A C Drape may be used to seal difficult areas if needed Carefully remove Layer 1 to expose adhesive Fig 9 The Perforated V A C Drape may be held by the Blue Handling Bar Place the adhesive face down with pre cut hole centered over foam and apply additional Perforated V A C Drape to cover foam and intact skin ensuring drape covers at least a 3 5 cm border of intact periwound tissue Fig 10 4 Remove second Layer 1 and Layer 2 and pat drape to ensure an occlusive seal 5 Remove Blue Handling Bar 22 V A C GRANUFOAM BRIDGE APP
26. anisters are packaged sterile or fluid path sterile and are latex free All disposable components of the V A C Therapy System are for single use only To help ensure sate and effective use use only MA CS GranuFoam Dressings with V A C Therapy Units The decision to use clean versus sterile aseptic technique is dependent upon wound pathophysiology veterinarian preference and institutional protocol IMPORTANT As with any prescription medical device failure to consult a veterinarian and carefully read and follow all thera py unit and dressing instructions and safety information prior to each use may lead to improper product performance and the potential for serious or fatal injury Do not adjust therapy unit settings or perform therapy application without directions from or supervision of the attending veterinarian INDICATIONS FOR USE The V A C Therapy System is an integrated wound management system for use in the veterinary hospital clinic or other suit able care setting as determined by a licensed veterinarian It is intended to create an environment that promotes wound heal ing by secondary or tertiary delayed primary intention by preparing the wound bed for closure reducing edema promoting granulation tissue formation and perfusion and by removing exudate and infectious material It is indicated for patients with chronic acute traumatic subacute and dehisced wounds pressure ulcers flaps grafts and closed surgical incisions
27. ated e Check the therapy hour meter to ensure that the actual number of therapy hours received matches the number of recom mended therapy hours Find out why there is a therapy deficit and remedy the situation e The exudate volume should experience a gradual decrease as the extracellular debris is brought to equilibrium Persistent large volumes of exudate may signal infection or other complications and should be evaluated by the prescribing veternar lan Determine if occult infection is present Increase pressure settings by 25 mmHg increments if drainage increases Determine if there is a positional seal leak which may be preventing effective exudate removal Evaluate dressing technique Assess for the need to bridge SensaT R A C T R A C Pad away from the wound Protect the surrounding tissue with V A C Drape or other transparent film Isolate wound drainage from periwound skin see pg 14 for specific dressing technique information Check for potential for external pressure on the wound dressing which may cause the wound exudate to be forced onto the periwound skin WOUND ODORS Wounds treated with V A C Therapy may have an odor due to the foam and wound fluids which contain bacteria and pro teins The type of bacteria and proteins present may be responsible for the type and strength of the odor e t is imperative that the wound be thoroughly cleaned during each dressing change to decrease bacterial load a
28. ation Extreme care should be taken not to stretch or pull the drape when securing it but let it attach loosely and stabilize the edges with an elastic wrap if necessary When using cir cumferential drape applications it is crucial to systematically and recurrently palpate distal pulses and assess distal circulatory status If circulatory compromise is suspected or distal edema Is observed discontinue therapy remove dressing and contact the attending veterinarian Do not apply circumferential dressings to patients in the thoracic or cranial abdominal region Application in these areas may inhibit chest excursions and ventilation with potentially fatal consequences V A C Therapy Unit Pressure Excursions In rare instances tubing blockages with the V A C Therapy Unit may result in brief vacuum excursions to more than 250 mmHg negative pressure Resolve alarm conditions immediately Refer to the Therapy Unit User s Guide or contact your KCI representative for additional information CONSIDERATIONS FOR V A C THERAPY FOR VETERINARY USE WARNING Patients having an increased risk of bleeding complications should be treated and monitored in a care setting deemed appropriate by the treating veterinarian In addition to the contraindications warnings and precautions for use of V A C Therapy consider the following before pre scribing V A C Therapy for veterinary use e The Patient s Situation e Clinical condition adequate hemos
29. cal surface area for patients of smaller size and weight Restraints Ensure patient is restrained physical chemical during dressing application change and at initiation of therapy Infected Wounds Infected wounds should be monitored closely and may require more frequent dressing changes than non infected wounds dependent upon factors such as wound conditions and treatment goals Refer to dressing application instructions for details regarding dressing change frequency As with any wound treatment veterinarian caregivers should frequently monitor the patient s wound periwound tissue and exudate for signs of infection worsening infection or other complications Some signs of infection are fever tenderness redness swelling itching rash increased warmth in the wound or periwound area purulent discharge or strong odor Infection can be serious and can lead to complications such as pain discomfort fever necrosis septic shock and or fatal injury Some signs or complications of systemic infection are depressed attitude lethargy vomiting diarrhea pale mucous membrane decreased capillary refill time high fever and hypotension If there are any signs of the onset of systemic infection or advancing infection at the wound site contact the attending veteri narian immediately to determine if V A C Therapy should be discontinued For wound infections relating to blood vessels please also refer to the section titled Infected Blood Vessels
30. changes 3 Carefully tear the V A C Spiral GranuFoam Dressing along the perforation to a size that will allow the foam to be placed gently into the wound without overlapping onto intact skin Fig 2 CAUTION Do not cut or tear the foam over the wound as fragments may fall into the wound Fig 3 Away from wound site rub foam edges to remove any fragments or loose particles that may fall into or be left in the wound upon dressing removal d Gently place foam into wound cavity ensuring contact with all wound surfaces Fig 4 Do not force the V A C Spiral GranuFoam Dressing into any areas of the wound NOTE Ensure foam to foam contact between adjacent pieces of foam for even distribution of negative pressure NOTE Always note the total number of pieces of foam used in the wound and document on the supplied Foam Quantity Label attached to the SensaT R A C Pad tubing Fig 5 and in the patient s chart NOTE Superficial or retention sutures should be covered with a single layer of non adherent material placed between the sutures and the 3M Tegaderm Dressing Foam Quantity Label Date Dressing Applied eec ef oe i vactherapy Number of foam pieces used in wound 18 3M TEGADERM APPLICATION CAUTION Patient s skin condition should be carefully monitored refer to Precautions Protect Periwound Skin section 1 Apply an adhesive Benzoin Tincture or Hollister Medical Adhesive Spray
31. ction Carefully cut a 2 5 cm hole in the 3M Tegaderm Dressing not a slit as described in the SensaT R A C Pad Application section pg 10 NOTE Always note the total number of pieces of foam used in the wound and document on the supplied Foam Quantity Label attached to the SensaT R A C Pad tubing Fig 5 and in the patient s chart Apply additional 3M Tegaderm Dressing over intact skin where the bridge will be applied Fig 1 Fig 2 d Cutor tear an appropriately sized piece of V A C Spiral GranuFoam Dressing for the bridge Fig 3 Place small end of the V A C Spirial GranuFoam Dressing bridge over the hole in the 3M Tegaderm Dressing at wound site Fig 4 and position the larger end of the V A C Spiral GranuFoam Dressing bridge where the SensalT R A C Pad will be placed 6 Using additional 3M Tegaderm Dressing cover the Bridge Fig 5 Fig 6 Apply 3M Tegaderm Dressing as described in the 3M Tegaderm Dressing Application section 7 Pinch 3M Tegaderm Dressing and carefully cut an approximately 2 5 cm hole through the 3M Tegaderm Dressing not a slit Fig 7 The hole should be large enough to allow for removal of fluid and or exudate It is not necessary to cut into the foam NOTE Cuta hole rather than a slit as a slit may self seal during therapy 8 Apply SensaT R A C Pad Fig 8 as described in the SensaT R A C Pad Application section 9
32. d Do not place V A C GranuFoam Dressing directly over exposed organs blood vessels anastomotic sites nerves and or unprotected intact skin Ensure appropriate debridement prior to treatment Do not tightly pack V A C Dressings into the wound place dressings gently into the wound e Ensure a good drape seal has been achieved e Always count the total number of pieces of foam used in the wound Document the foam quantity and dressing change date on the drape or Foam Quantity Label if available and in the patient s medical record e Keep V A C Therapy on for at least 22 hours in a 24 hour period Do not leave the V A C Dressing in place if the therapy unit is switched off for more than 2 hours in 24 Monitor continuously and check and respond to alarms e When dressing is removed count the number of foam pieces removed correlate the count with the number of pieces previously placed in the wound and verify the complete removal of all V A C Foam dressing pieces If no response or improvement in the wound is observed within two weeks reassess the treatment plan Seek advice support trom local KCI representative as needed Follow Standard Precautions V A C THERAPY SYSTEM SAFETY INFORMATION FOR VETERINARY USE Disposable components of the V A C Vacuum Assisted Closure Therapy System including the V A C GranuFoam Dress ing tubing and drape are packaged sterile and are latex free VA CS Therapy Unit c
33. during V A C Therapy or if frank bright red blood is seen in the tubing or in the canister immediately stop VA CS Therapy leave dressing in place take mea sures to stop the bleeding and seek immediate medical assistance The V A C Therapy Units and dressings should not be used to prevent minimize or stop vascular bleeding Protect Vessels and Organs All exposed or superficial vessels and organs in or around the wound must be completely covered and protected prior to the administration of V A C Therapy Always ensure that V A C Foam Dressings do not come in direct contact with vessels or organs Use of a thick layer of natural tissue should provide the most effective protection If a thick layer of natural tissue is not available or is not surgi cally possible multiple layers of fine meshed non adherent material Adaptec or Mepitel may be considered as an alternative if deemed by the treating veterinarian to provide a complete protective barrier If using non adherent materi als ensure that they are secured in a manner as to maintain their protective position throughout therapy Consideration should also be given to the negative pressure setting and therapy mode used when initiating therapy Caution should be taken when treating large wounds that may contain hidden vessels which may not be readily apparent The patient should be closely monitored for bleeding in a care setting deemed appropriate by the treating veterinarian
34. e comorbidities such as diabetes end stage renal disease or heart disease have a high incidence of surgi cal wound dehiscence Patients with excessive edema and fluid accumulation are also at risk for wound dehiscence V A C Therapy placed over potentially compromised suture lines may assist with healing and maintenance of wound stability e Refer to Wound and Periwound Skin Preparation section pg 8 e Protect intact epithelium on both sides of the suture line with VA CS Drape or other transparent film picture frame the suture or staple line leaving the suture line exposed Ensure adhesive does not contact the surgical closure e Lay a single layer of a wide meshed non adherent material over the exposed sutures or staples Adaptec or Mepitel may be considered as an alternative e Cut a strip of VA C GranuFoam Dressing and gently place on top of the non adherent material e Cover the foam with V A C Drape ensuring drape covers at least a 3 5 cm border of periwound tissue e Initiate therapy at 75 to 125 mmHg Continuous e Dressing changes should occur every 48 72 hours no less than three times per week e Therapy is usually required for a short period of time Suture lines that are extremely edematous and weeping may require removal of one or two sutures e VA CT GranuFoam Dressing strips may be cut and gently placed into the suture line where the sutures have been removed e Then place VA CS GranuFoam
35. elief For example a patient with pressure ulcer may be sitting on it for too long Cut the foam slightly smaller than the wound edges for wounds with little depth to enhance inward epithelial migration Do not allow the wound edges to roll downward during V A C Therapy Provide a therapeutic pause by interrupting V A C Therapy for 1 2 days then resume Change the therapy settings from Continuous to Intermittent or vice versa Adjust pressure settings as can be tolerated for wounds that are inappropriate for Intermittent therapy such as tunnels or wounds with high amounts of exudate Evaluate nutritional status and supplement as necessary Check the therapy hour meter to ensure that the actual number of therapy hours received matches the number of recom mended therapy hours 22 hours a day If the number of therapy hours is less than 22 each day find out why there is a therapy deficit and remedy the situation Assess for wound infection With veterinarian order obtain a microbiology culture or biopsy and treat accordingly DETERIORATION OF THE WOUND If a wound has been progressing well trom dressing change to dressing change but then deteriorates rapidly consider the fol lowing interventions and where necessary seek the guidance expertise of a specialist Check the therapy hour meter to ensure that the actual number of therapy hours received matches the number of recom mended therapy hours 22 hours a day If
36. emoved from the wound and ensure the same number of foam pieces was removed as placed Foam left in the wound for greater than the recommended time period may foster ingrowth of tissue into the foam create difficulty in removing foam from the wound or lead to infection or other adverse events If significant bleeding develops immediately discontinue the use of the V A C Therapy System take measures to stop the bleeding and do not remove the foam dressing until the treating veterinarian is consulted Do not resume the use of the V A C Therapy System until adequate hemostasis has been achieved and the patient is not at risk for continued bleeding Keep V A C Therapy On Never leave a V A C Dressing in place without active V A C Therapy for more than 2 hours If therapy is off for more than 2 hours remove the old dressing and irrigate the wound Either apply a new V A C Dressing from an unopened sterile package and restart V A C Therapy or apply an alternative dressing at the direction of the treating veterinarian Acrylic Adhesive The V A C Drape has an acrylic adhesive coating which may present a risk of an adverse reaction in patients who are allergic or hypersensitive to acrylic adhesives If a patient has a known allergy or hypersensitivity to such adhesives do not use the V A C Therapy System If any signs of allergic reaction or hypersensitivity develop such as redness swelling rash urticaria or significant pru
37. foam placement or managing the discomfort as prescribed by the treating veterinarian e Ensure the patient receives adequate analgesia during treatment e A sudden increase or change in the character of the pain requires investigation LENGTH OF TREATMENT The length of treatment depends on the treating veterinarian s goal of therapy wound pathology wound size and manage ment of patient co morbidities If a patient is not a surgical candidate V A C Therapy may be utilized for an extended period of time as long as satisfactory progress continues When to discontinue VA CS Therapy V A C Therapy should be discontinued when e The goal of therapy has been met In some cases this will be full closure of the wound in others the wound may be closed surgically e The wound shows no progress for one to two consecutive weeks and potential solutions to encourage wound healing have failed Individual circumstances may vary INDICATORS OF EFFECTIVE V A C THERAPY e The exudate volume should gradually decrease over time e The wound appearance may change color and become a deeper red as V A C Therapy helps promote perfusion to the wound The exudate color may change from serous to serosanguineous and some sanguineous or bloody drainage may also be noted during negative pressure therapy This is due to the mechanism of action of V A C Therapy to help promote perfu sion The change in wound drainage characteristics may be related to di
38. harp edges could puncture protective barriers vessels or organs causing injury Any injury could cause bleeding which if uncontrolled could be potentially fatal Beware of possible shifting in the relative position of tissues vessels or organs within the wound that might increase the possibility of contact with sharp edges Sharp edges or bone fragments must be eliminated from the wound area or covered to prevent them from puncturing blood vessels or organs before the application of VA CS Therapy Where possible completely smooth and cover any re sidual edges to decrease the risk of serious or fatal injury should shitting of structures occur Use caution when removing dressing components from the wound so that wound tissue is not damaged by unprotected sharp edges Patient Size Consider the size and weight of the patient patient s condition wound type and size and the monitoring capabilities of the veterinary hospital or care setting In small patients less than 10 kg or patients with large wounds loss of significant fluid volume through V A C Therapy could be life threatening Monitor fluid loss hydration blood loss blood pressure and serum protein levels with greater vigilance in patients weighing less than 10 kg or patients with large wounds When assessing fluid loss consider the volume of fluid in the tubing and the V A C canister WARNING Veterinarian should evaluate placing negative pressure therapy over large portion of trun
39. herapy be used in the presence of wound undermining Initial Dressing Application 1 Gently place V A C GranuFoam Dressing in all undermined areas beginning at the distal portion Do not pack foam into undermined areas 2 Pull foam back out 1 2 cm leaving some foam in the wound to contact with the foam in the wound bed This specific placement leaves the distal portion of the undermined area clear of foam allowing the distribution of higher pressures to collapse the free areas of undermining together encouraging the wound cavity edges to granulate together from the distal portion outward 3 Monitor the amount of exudate and presence of granulation tissue at each dressing change Subsequent Dressing Changes When the exudate volume decreases and the presence of granulation tissue is noted subsequent dressing changes must be altered in the following way 1 Gently place the foam into the undermined areas all the way to the distal portion Do not firmly pack foam into under mined areas 2 Pull foam back out 1 2 cm leaving some foam in the wound to contact with the foam in the wound bed This specific placement leaves the distal portion of the undermined area clear of foam allowing the distribution of higher pressures to collapse the free areas of undermining together encouraging the wound cavity edges to granulate together from the distal portion 3 Initiate Continuous therapy at previous settings 4 Monitor the amount of
40. in the tubing post graft may indicate a complication underneath the foam If there is any sign of infection remove the V A C Dressing and assess the wound 29 PRESSURE ULCERS In the management of full thickness pressure ulcers stages 3 and 4 V A C Therapy can be used either as a definitive treat ment or to optimize the wound bed prior to surgical closure The following recommended therapy ranges are a guide based on common settings for each wound type Individual patient conditions may vary Consult treating veterinarian to verify settings for each patient Goals and objectives e Promote granulation tissue formation e Promote perfusion e Provide a closed moist wound healing environment e Helo manage wound environment Table 5 4 Recommended settings for pressure ulcers Initial Subsequent Target pressure Target pressure cycle cycle V A C GranuFoam VA CS WhiteFoam Dressing Dressing Continuous Consider 125 mmHg 125 175 mmHg first 48 hours Intermittent Titrate up for 5 min ON more drainage 2 min OFF for rest of therapy Clinical Considerations e All patients require a detailed medical and nutritional assessment and any factors that might influence etiology and or healing must be addressed particularly the provision of adequate nutrition and appropriate pressure relief e V A C Therapy is not a debriding tool and is not a substitute for effective surgical and or other forms of debridement e f the pa
41. irst 48 hours Intermittent 5 min ON 2 min OFF for rest of therapy Clinical Considerations e V A C Therapy may be used after debridement to help remove infectious material and assist granulation tissue forma tion The presence of orthopedic hardware is not a contraindication to the use of V A C Therapy see Orthopedic Hardware og 15 Veterinarians should exercise judgement when observing the quality of granulation tissue and remain alert to any Sign of infection that may indicate underlying osteomyelitis In such cases consult the treating veterinarian Tendons ligaments blood vessels organs and nerves vital structures must be completely covered and protected prior to the administration of V A C Therapy Coverage with a muscle flap or other thick layer of natural tissue provides the most effective protection If not available consider using non adherent porous material i e fine mesh gauze or tissue e V A C Foam may be applied directly over absorbable or nonabsorbable mesh or intact fascia Do not place the V A C Dressing over exposed blood vessels or organs If active bleeding develops suddenly or in large amounts during V A C Therapy or if frank bright red blood is seen in the tubing or in the canister immediately stop VA CS Therapy take measures to stop the bleeding and seek immediate medical assistance For wounds with large amounts of exudate consider increasing target pressures by 25 7
42. lcers incisions flaps and grafts The components of the V A C Therapy System work as an integrated product to optimize both the delivery and the benefits of negative pressure wound therapy An open pore reticulated polyurethane foam NA CS GranuFoam is cut to fit the wound then covered with an adhesive drape The open cells of the foam enable equal distribution of the negative pressure across the surface of the wound while tubing transfers accumulated fluids to the V A C Canister The software controlled therapy unit applies negative pressure to the wound bed The user can select Continuous or Intermittent therapy depending upon wound type and the needs of each patient SensaT R A C T R A C Therapeutic Regulated Accurate Care technol ogy delivers monitors and helps to maintain target pressure and relays signals to the therapy unit The safety features of the V A C Therapy System include alarms that signal tubing blockages a full or missing canister inactive therapy low battery and leaks in the seal of the dressing POINTS TO REMEMBER WHEN USING V A C THERAPY e Ensure that the patient wound Is a suitable candidate for V A C Therapy e Read and follow all user instructions and safety information that accompany KCI products e Ensure accuracy of diagnosis and address all underlying and associated co morbidities Ensure appropriate V A C Dressing selection and suitable indication specific V A C Dressings are use
43. ll allow the foam to be placed gently into the wound but not overlap onto intact skin Fig 3 NOTE Do not cut the foam over the wound as fragments may fall into the wound Fig 4 Away from the wound site rub or trim foam removing any fragments to ensure loose particles will not fall into or be left in the wound upon dressing removal 5 Gently place foam into wound cavity ensuring contact with all wound surfaces Fig 5 Do not force foam dressing into any area of the wound 6 To accommodate the size of the SensaT R A C T R A C Pad cut another piece of foam large enough to extend 2 3 cm beyond the SensaT R A C T R A C Pad Fig 6 and lay on the foam in the wound Fig 7 Assure the foam does not extend onto intact skin that it is positioned on the product used to frame the wound and protects the intact skin Fig 8 Trim and place the V A C Drape to cover the foam dressing and an additional 3 5 cm border Fig 9 Pinch drape and cut a 2 5 cm hole through the drape not a slit The hole should be large enough to allow for removal of fluid and or exudate It is not necessary to cut into the foam 9 Apply the SensaT R A C T R A C Pad to the larger piece of foam Fig 10 10 Seal the drape of the SensaT R A C T R A C Pad with additional drape if necessary 11 Refer to V A C Therapy Initiation pg 11 SURGICAL INCISIONS COMPROMISED SUTURE LINES Patients with multipl
44. lm e Ensure VA CS GranuFoam is appropriate for the depth of the wound by either cutting or beveling it or use specific thinner V A C GranuFoam Dressings where indicated e Position the dressing tubing on flat surfaces and away from the perineal area bony prominences or pressure areas e Secure or anchor the tubing with an additional piece of drape or tape positioning the anchor several centimeters away from the dressing or wound This prevents tension on the tubing trom pulling on the dressing If secured directly to the dressing tension on the tubing may interrupt the dressing seal CHANGING THE CANISTER The V A C Canister should be changed when full the alarm will sound or at least once a week to control odor Follow standard precautions as the system may contain body fluids Close the clamps on both the canister and dressing tubing Turn therapy off Disconnect the canister tubing from the dressing tubing Remove the canister from the unit Dispose of the canister according to specified institution protocol or state and local regulations Install a new canister as described in therapy unit s labeling and instructional materials eS ee YS SS Connect the new canister to the dressing tubing and initiate therapy as ordered DISCONNECTING FROM THE V A C THERAPY UNIT WARNING Never leave a V A C Dressing in place without active V A C Therapy for more than 2 hours If therapy is off for more than 2 hours
45. lster and stability for flap e Help protect the wound environment e Remove fluids and exudate e Assist flap take Table 5 6 Recommended settings for flaps Initial Target pressure cycle VA CS GranuFoam Dressing Continuous 125 150 mmHg for duration of therapy Clinical Considerations e Higher pressures may be considered with large bulky flaps to help bolster the flap e When there is a need to assess flap for sign of ischemia or infection and the flap needs to be inspected during therapy cut the V A C GranuFoam Dressing in half before applying it and place the drape in strips with one strip directly over the area where the two halves of foam meet Removing this strip of drape allows the clinician to gently separate the foam to inspect the underlying tissue After inspecting the flap place the foam pieces back together reseal with an additional strip of drape and continue therapy Flap Dressing Application with VA CS Therapy semi occlusive barrier 1 Suture the flap in place using about a third fewer sutures than usual The greater spacing will allow V A C Therapy to remove fluid through the suture line 2 Place a single layer of VA CS Drape or other semi occlusive barrier dressing or vapor permeable adhesive film dressing over the intact epidermis on top of the flap and on the opposite side of the suture line Fig 1 Place a single layer of wide meshed non adherent dressing over the exposed suture line Fig
46. n tissue from the structures beneath the mesh extending up through the mesh into the wound base e V A C Therapy can be an important tool in the management of thoracic wounds Due to the vital structures located in the thoracic cavity V A C Therapy should be applied with the utmost care and vigilance Patients with deep thoracic wounds i e patients with mediastinitis or sternal wound infection should have dressing changes supervised or performed by the attending specialist surgeon e For sternal wounds the lowest negative pressure setting is recommended initally Monitor closely while progressing to target treatment pressure as tolerated e For patients with an unstable thoracic wall Continuous Therapy is recommended throughout the treatment period to help stabilize the chest wall This helps pull the wound edges together and provides a splinting effect which may allow the patient to be more mobile and more comfortable For other than dehisced sternal or abdominal wounds better results may be achieved with Intermittent Therapy once exudate levels are stable and where the primary goal is to create granulation tissue 28 MESHED GRAFTS Apply V A C Dressing immediately after graft placement and begin therapy as soon as possible In general the pressure set ting used to prepare the recipient bed before grafting should be continued after grafting Continuous therapy should be used to provide a constant bolster The foll
47. nction Most patients with electronic medical devices undergo CT scans without any adverse consequences However the agency has received a small number of reports of adverse events in which CT scans may have interfered with electronic medical devices including pacemakers defibrillators neurostimulators and implanted or externally worn drug infusion pumps FDA Is continuing to investigate the issue and Is working with the manufacturer to raise awareness in the healthcare community e In diagnostic procedures there is a possibility of shadow casting in the area of the wound e The dressings and attached tubing can be safely left in place for all of these procedures V A C THERAPY AND MAGNETIC RESONANCE IMAGING MRI When patients treated with V A C Therapy require MRI the following special considerations should be used 1 The V A C Therapy Unit is MR unsafe Do not take the V A C Therapy Unit into the MR environment see pg 6 Magnetic Resonance Imaging section 2 Taking the V A C Therapy Unit into the active MR environment could cause injury to the patient or caregiver or damage the equipment 3 The V A C Dressing can typically remain on the patient with minimal risk in an MR environment assuming that use of VA CS Therapy is not interrupted for more than two hours 4 The V A C GranuFoam Dressings the SensaT R A C T R A C Pad and tubing contain no metallic components that would require removal prior t
48. nd mini mize odor e If malodor remains after thorough cleaning of the wound this may be a sign of possible infection e V A C Canister with Isolyser gel can greatly reduce odors e Canister may need to be changed more often to control odor e f you determine that the V A C Therapy Unit is the source of odor discontinue use of that therapy unit and contact your KCI representative for replacement e Assess for wound infection With veterinarian order obtain a microbiology culture or biopsy and treat accordingly 26 WOUND SPECIFIC INFORMATION This section details specific complex technical interventions for which veterinarians must be appropriately qualified to carry out ACUTE TRAUMATIC WOUNDS PARTIAL THICKNESS BURNS V A C Therapy may be used in the care of patients with acute traumatic wounds including partial thickness burns and ortho pedic wounds The following recommended therapy ranges are a guide based on common settings for each wound type Individual patient conditions may vary Consult treating veterinarian to verify settings for each patient Goals and Objectives e Promote granulation tissue formation e Promote perfusion e Remove fluids exudate and infectious materials e Assist take of flap or skin tissue Table 5 1 Recommended settings for acute traumatic wounds partial thickness wounds Initial Subsequent Target pressure cycle cycle V A C GranuFoam Dressing Continuous Consider 125 mmHg f
49. o MRI 5 The veterinarian may choose to remove the V A C Dressing prior to imaging in an area where the wound is located due to potential shadowing 33 MANUFACTURER INFORMATION KCI USA Inc San Antonio TX 78219 USA CONTACT INFORMATION For additional information concerning V A C Therapy for Veterinary Use contact your local KCI representative or call 1 877 524 4838 877 KCI 4VET For additional and most current information please see KCI s website at www kcianimalhealth com KCI 3M Tegaderm is a trademark of 3M Company Mepitel is a registered trademark of M lnlycke Health Care AB Adaptic is a trademark of Systagenix Wound Management All other trademarks designated herein are proprietary to KCI Licensing Inc its affiliates and licensors The V A C Therapy System is patented and or subject to pending patent 2012 KCI Licensing Inc All rights reserved 320310 Rev E 07 2012
50. of foam pieces used in wound Refer to Wound and Periwound Skin Preparation section pg 8 Carefully tear the Perforated V A C Drape in halt along perforation Fig 1 Carefully tear off the Perforated V A C Drape section with pre cut hole Fig 2 e Ww ibe Assess wound dimensions and pathology including the presence of undermining or tunnels Fig 3 Do not place any foam dressing into blind unexplored tunnels Pre cut MACH GranuFoam Dressing may be used for wounds with shallow undermining or tunnel areas where the distal aspect is visible NOTE f adjunct materials are utilized under the V A C GranuFoam Bridge Dressing they must be meshed or fenestrated to allow for effective exudate removal Document on the drape on the supplied Foam Quantity Label on the VA CS GranuFoam Bridge Tubing and in the patient s chart to ensure removal with subsequent dressing changes 5 Select an appropriately sized Pre cut VA CH GranuFoam Dressing and tear away from foam block Fig 4 Fig 5 2 NOTE Pre cut VA C GranuFoam Dressing may be further trimmed as necessary CAUTION Do not tear or trim the foam over the wound as fragments may fall into the wound Away from wound site rub foam edges to remove any fragments or loose particles that may fall into or be left in the wound upon dressing removal 6 Gently place foam into wound cavity ensuring contact with all wound surfaces Fig 6 Do not force the Pre Cut
51. owing recommended therapy ranges are a guide based on common settings for each wound type Individual patient conditions may vary Consult treating veterinarian to verify settings for each patient Goals and Objectives e Remove fluid e Help protect wound environment e g minimize shearing forces e Provide bolster and stability for skin grafts split and full thickness e Assist flap and skin graft take Table 5 3 Recommended settings for meshed grafts Initial Target pressure cycle V A C GranuFoam Dressing Continuous 75 125 mmHg for duration of therapy Recommended V A C Dressing Application Post Graft Procedure 1 Select a single layer of wide meshed non adherent material 2 Cut the non adherent material to the size of the grafted area plus a 1 cm border e so it extends about 1 cm outside the staple line and place over the graft 3 Cut the V A C GranuFoam Dressing to the same size as the non adherent material and place it gently on top of the non adherent layer Apply V A C Drape according to the dressing application technique pg 10 Apply the SensaT R A C T R A C Pad or tubing according to dressing application technique pg 10 Set negative pressure to the desired level as indicated in Table 5 3 Expect more drainage in the tubing and canister in the first 24 hours of V A C Therapy post graft after which the drainage usually tapers off significantly Significant drainage
52. prominences or within creases in the tissue NOTE Consider a light soft bandage over SensaT R A C T R A C pad to alleviate stress to the underlying tissue 2 Pinch drape and cut a 2 5 cm hole approximately the diameter of a US quarter through the drape Fig 9 The hole should be large enough to allow for removal of fluid and or exudate It is not necessary to cut into the foam NOTE Cuta hole rather than a slit as a slit may self seal during therapy 3 Apply pad which has a central disc and a surrounding outer adhesive skirt Remove both backing Layers 1 and 2 to expose adhesive Fig 10 a b Place pad opening in central disc directly over hole in drape Fig 11 c Apply gentle pressure on the central disc and outer skirt to ensure complete adhesion of the pad d Pull back on blue tab to remove pad stabilization layer Fig 12 Pad d Pad Assembly X Stabilization Layer NOTE To prevent periwound maceration with wounds that are smaller than the central disc of the pad it is very important that the central disc lay on top of foam only It may be necessary to augment the V A C Dressing with an additional piece of V A C Foam cut 1 2 cm larger than the diameter of the central disc Please refer to the Clinical Guidelines Section of this manual for a specialized technique regarding Small Wounds and SensaT R A C T R A C pad application pg 16 10 V A C THERAPY INITIATION WARNING Review all
53. ritus discontinue use and consult the attending veterinarian immediately If broncho Spasm or more serious signs of allergic reaction appear seek immediate medical assistance Defibrillation Remove the V A C Dressing if defibrillation is required in the area of dressing placement Failure to remove the dressing may inhibit transmission of electrical energy and or patient resuscitation Magnetic Resonance Imaging MRI Therapy Unit The V A C Therapy Unit is MR Unsafe Do not take the V A C Therapy Unit into the MR environment Magnetic Resonance Imaging MRI V A C Dressings V A C Dressings can typically remain on the patient with mini mal risk in an MR environment assuming that use of the V A C Therapy System Is not interrupted for more than 2 hours refer to Keep V A C Therapy On above Hyperbaric Oxygen Therapy HBO Do not take the V A C Therapy Unit into a hyperbaric oxygen chamber The V A C Therapy Unit is not designed for this environment and should be considered a fire hazard After disconnecting the V A C Therapy Unit either i replace the V A C Dressing with another HBO compatible material during the hyperbaric treatment or ii cover the unclamped end of the V A C Tubing with moist cotton gauze and completely cover the V A C Dressing includ ing tubing with a moist towel throughout the treatment in the chamber For HBO therapy the V A C Tubing must not be clamped Never leave a V
54. s THERAPY ON If not press the THERAPY ON OFF button e Confirm the clamps are open and the tubing is not kinked e Identity air leaks by listening with a stethoscope or moving your hand around the edges of the dressing while applying light pressure e f the seal is broken and the V A C Drape has become loose trim away any loose or moist edges ensure the skin is dry and then patch with additional drape to ensure seal integrity CAUTION Use as few layers of drape as possible Multiple layers of the V A C Drape may decrease the moisture vapor transmission rate which may increase the risk of maceration especially in small wounds lower extremities or load bear ing areas NOTE f the wound is over a bony prominence or in an area where weight bearing may exert additional pressure or stress to the underlying tissues a pressure relief surface or technique should be used to optimize patient wound protection MAINTAINING A SEAL Maintaining a seal around the dressing Is key to successful V A C Therapy Recommendations to maintain the integrity of the seal e Use Benzoin Tincture or Hollister Medical Adhesive Spray e Dry the periwound area thoroughly after cleansing A protective skin barrier preparation may be used to prepare the skin for drape application e For delicate periwound tissue or in areas that are difficult to dress apply protective skin preparation and frame the wound with V A C Drape or other transparent fi
55. sruption of capillary buds of granulation tissue If active bleeding develops suddenly or in large amounts during VA CS Therapy or if frank bright red blood is seen in the tubing or in the canister immediately stop V A C Therapy take measures to stop the bleeding and seek immediate medical assistance Observations during the first dressing change may include a slight increase in the size of the wound This is related to the mechanism of action of V A C Therapy e Wound measurements should begin to decrease as the active state of healing continues Weekly wound measurements should be performed and documented A steady decrease in wound dimensions should be noted every week If this does not occur comprehensive assessment and troubleshooting interventions should be implemented immediately See Minimal Changes in Wound Size section as follows e As the wound continues to form granulation tissue new epithelial growth should be seen at the wound edges 24 INDICATORS OF INEFFECTIVE THERAPY A steady decrease in wound dimensions should be noted every week If this does not occur comprehensive assessment and troubleshooting interventions should be implemented immediately see below Minimal Changes in Wound Size When there is little or no change in the wound for one to two consecutive weeks technique and underlying co morbidities are not the cause the following may be useful Ensure the patient is receiving adequate pressure r
56. ssively smaller to allow controlled reapproximation of the wound edges Fig 2 and 3 Initial foam application Controlled reapprox Complete closure after which progressively imation of the wound is achieved smaller pieces of foam edges allows for are used gradual closure DRESSING SMALL WOUNDS AND SENSAT R A C T R A C PAD APPLICATION For wounds that are smaller in dimensions lt 4 cm than the SensaT R A C T R A C Pad the following dressing applica tion is recommended to protect the periwound tissue and prevent maceration 1 Refer to Wound and Periwound Skin Preparation section pg 8 2 Assess wound dimensions and pathology including the presence of undermining or tunnels Fig 1 Do not place any foam dressing into blind unexplored tunnels V A C GranuFoam and V A C Simplace Dressings may be used for wounds with shallow undermining or tunnel areas where the distal aspect is visible and noted to ensure removal with subsequent dressing changes NOTE f adjunct materials are utilized under the foam they must be meshed or fenestrated to allow for effective exudate removal Document on the drape or Foam Quantity Label if available and in the patient s medical record to ensure removal with subsequent dressing changes 3 Prepare the periwound area by applying protective skin barrier preparation and frame the wound with transparent film Fig 2 16 d Cut foam dressing to dimensions that wi
57. tasis and a low risk of active and or large amounts of bleeding at the wound site e Caregiver statf able to read and understand safety labeling respond to alarms able to follow instructions for use e Ability to control patient self trauma to V A C Therapy Unit V A C Dressings or wound e Ability to limit restrict patient activity as advised by attending veterinarian e The Patient s Wound e Must be assessed for exposed vessels anastomotic sites organs and nerves Adequate protection must be present with out the need for a protective non adherent layer placed between the V A C Dressing and the exposed structure for the sole purpose of protection of these structures refer to Protect Vessels and Organs in the Warnings section e Labeling e The prescribing veterinarian should be familiar with the V A C Therapy labeling materials that accompany the therapy unit and dressing e An intormation folder is provided with the therapy unit The prescribing veterinarian should carefully review these materials with the caregiver staff or veterinary technician e KCl offers in service and training programs for use of V A C Therapy for veterinarians Contact your local KCI representative or in the US call 1 877 524 4838 877 KCI 4VET If there are any questions regarding the proper placement or usage of V A C Therapy please refer to the Clinical Guidelines section in this manual tor more detailed instructions or contact your local K
58. the number of therapy hours is less than 22 each day find out why there Is a therapy deficit and remedy the situation Check for small leaks with a stethoscope or by listening Tor a whistling noise or moving your hand around the edges of the dressing while applying light pressure Patch if necessary However avoid applying more than two layers of drape Clean wound more thoroughly during dressing changes Assess for wound infection With veterinarian order obtain a microbiology culture or biopsy and treat accordingly Change dressing often ensuring that it is being changed at least every 48 hours Examine the wound and debride as necessary Debride the wound edges if they appear non viable or rolled under as this may inhibit the formation of granulation tissue and migration of epithelial cells over an acceptable wound base Assess for osteomyelitis and if present treat accordingly 25 CHANGES IN WOUND COLOR If the wound assessment reveals dark discoloration e Rule out mechanical trauma Relieve wound of excessive pressure excess foam in the wound or a pulled or stretched drape over the foam Remember to roll the drape over the foam do not stretch it over foam e Decrease pressure by 25 mmHg increments e f patient is taking anticoagulant medication evaluate recent coagulation laboratory values e Thin the depth of the foam before applying the dressing to prevent overpacking If the wound appears white excessively moist or macer
59. therapy Clinical Considerations In chronic wounds where a diagnosis is uncertain tissue biopsy for histological evaluation or other definitive testing is recommended It is important to identify any underlying etiology and use relevant measures to address underlying disease processes Chronic wounds may benefit from aggressive debridement of the soft tissue to remove any epithelial cells that may have migrated over the wound surface sinus tract or tunnel Care must be taken to prevent further trauma and or pressure when placing V A C tubing particularly over bony promi nences If a patient s skin cannot tolerate frequent dressing changes and the drape around the wound is intact you may cut the drape around the foam remove foam clean wound as ordered then replace foam and drape Drape in periwound area may be left on for one additional dressing change NOTE Multiple layers of the VA CH Drape may decrease the moisture vapor transmission rate which may increase the risk of maceration especially in small wounds lower extremities or load bearing areas 31 FLAPS V A C Therapy is used in the immediate postoperative flap patient as a bolster to maintain the position of the tissues The following recommended therapy ranges are a guide based on common settings tor each wound type Individual patient conditions may vary Consult treating veterinarian to verify settings for each patient Goals and Objectives e Provides bo
60. tient s skin cannot tolerate frequent dressing changes it may not be necessary to remove the entire drape In stead cut the drape around the foam remove the foam irrigate the wound as directed by the clinician then replace the foam and reseal with an additional piece of drape VA CS Drape around periwound area may be left on for one addi tional dressing change e Multiple layers of the V A C Drape may decrease the moisture vapor transmission rate which may increase the risk of maceration especially in small wounds lower extremities or load bearing areas e Care must be taken to prevent trauma and or pressure when placing V A C tubing particularly over bony prominences consider bridging pg 14 30 CHRONIC WOUNDS V A C Therapy can be used either as a definitive treatment or to optimize the wound bed prior to surgical closure The following recommended therapy ranges are a guide based on common settings tor each wound type Individual patient conditions may vary Consult treating veterinarian to verify settings for each patient Goals and objectives Promote granulation tissue formation Promote perfusion Provide a closed moist wound healing environment Help manage wound environment Table 5 5 Recommended settings for chronic wounds Initial Subsequent Target pressure cycle cycle V A C GranuFoam Dressing Continuous Consider 50 125 mmHg first 48 hours Intermittent 5 min ON 2 min OFF for rest of
61. tions and Clinical Guidelines for veterinary use These guidelines are only general recommendations Consult treating veterinarian as individual patient circumstances may vary Always consult device specific instructions provided with the V A C Therapy Unit and important safety information prior to use NOTE The word patient as used within this guide refers to the animals associated with veterinary practice INTRODUCTION Vacuum Assisted Closure V A C Therapy is an advanced wound healing therapy that can be readily integrated into the veterinarian s wound healing practice to help optimize patient care It is a flexible therapy that with appropriate precautions in place may be used in the veterinary hospital This advanced wound healing technology includes microprocessor controlled therapy units specialized dressings and 24 hours a day 7 days a week technical support The V A C Therapy System is a wound management system for use in the veterinary hospital clinic or other suitable care setting as determined by a licensed veterinarian It is intended to create an environment that promotes wound healing by secondary or tertiary delayed primary intention by preparing the wound bed for closure reducing edema promoting granula tion tissue formation and perfusion and by removing exudate and infectious material It is indicated for patients with chronic acute traumatic subacute and dehisced wounds partial thickness burns u
62. vertically Ge 7 Gently remove foam from the wound WARNING Refer to Foam Removal section under Warnings 8 Discard disposables according to institutional or state regulations NOTE f dressing adheres to wound consider introducing sterile water or normal saline into the dressing waiting 15 30 minutes then gently removing the dressing from the wound Consider placing a single layer wide meshed non adherent material prior to placement of the V A C Foam Dressing to potentially reduce future adherence or consider more frequent dressing changes If the patient indicates discomfort during the dressing change consider premedication the use of a non adherent interposed layer before foam placement or managing the discomfort as prescribed by the treating veterinarian Refer to Pain Management section pg 24 for specific recommendations SPECIFIC DRESSING TECHNIQUES AND SPECIALTY DRESSINGS TECHNIQUES FOR TREATING MULTIPLE WOUNDS When using any of these specialty dressing techniques first review the following sections of this manual e The Wound and Periwound Skin Preparation section pg 8 e The V A C Drape Application section pg 10 e The SensaT R A C T R A C PAD Application section pg 10 e The V A C Therapy Initiation section pg 11 Y CONNECTOR TECHNIQUE By applying a Y connector to the canister tubing one V A C Therapy Unit may be used to simultaneously treat multiple wounds on the same patient If

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