The nurse assesses the client's wound and notices leakage at the edge of the transparent film of the wound vacuum assisted closure (VAC). Which should the nurse implement to promote wound healing and prevent infection?

Question

1. Apply another layer of transparent film.
2. Change the client's wound VAC dressing.
3. Patch the leaks with an adhesive dressing.
4. Contain leakage with a large ABD dressing.

Answer 1

2
2. The nurse replaces the client's entire wound VAC dressing because it cannot es-tablish negative wound pressure unless it is airtight and a leaking dressing provides an entry for pathogens. In addition, a leak in the dressing means the negative pressure pulls room air currents over the wound bed potentially contaminating the site.
1. If the nurse applies another layer of transparent film, the nurse contains potential contaminants in the dressing increasing the risk of infection.
3. The nurse avoids an adhesive dressing because it can irritate the skin and can be too porous for establishing negative pressure.
4. Containing the leakage with a secondary dressing is usually a reasonable approach; however, the nurse cannot establish negative wound pressure with a leak in the sys-tem or by covering it with a dressing as porous as an ABD pad.