Vacuum-assisted closure (VAC) therapy, also known as negative pressure wound therapy, is used to enhance delayed or impaired wound healing. The VAC device applies localized subatmospheric pressure to draw the edges of the wound toward the center. It's applied after a special dressing is placed in the wound or over a graft or flap; this wound packing removes fluids from the wound and stimulates growth of healthy granulation tissue. (See Understanding vacuum-assisted closure therapy.)
VAC therapy is indicated for acute and traumatic wounds, pressure ulcers, and chronic open wounds, such as diabetic ulcers, meshed grafts, and skin flaps. It's contraindicated for fistulas that involve organs or body cavities, necrotic tissue with eschar, untreated osteomyelitis, and malignant wounds. This therapy should be used cautiously in patients with active bleeding, in those taking anticoagulants, and when achieving wound hemostasis has been difficult.

Equipment
Waterproof trash bag • goggles • gown, if indicated • emesis basin • normal saline solution • clean gloves • sterile gloves • sterile scissors • linen-saver pad • 35-ml piston syringe with 19G catheter • reticulated foam • fenestrated tubing • evacuation tubing • skin protectant wipe • transparent occlusive air-permeable drape • evacuation canister • vacuum unit.

Preparation of equipment
Assemble the VAC device at the bedside per manufacturer's instructions. Set negative pressure according to the physician's order (25 to 200 mm Hg).

Implementation
  • Check the physician's order, and assess the patient's condition.
  • Explain the procedure to the patient, provide privacy, and wash your hands. Put on goggles—and a gown, if necessary—to protect yourself from wound drainage and contamination.
  • Place a linen-saver pad under the patient to catch any spills and avoid linen changes. Position the patient to allow maximum wound exposure. Place the emesis basin under the wound to collect any drainage.
  • Put on clean gloves. Remove the soiled dressing and discard it in the waterproof trash bag. Attach the 19G catheter to the 35-ml piston syringe and irrigate the wound thoroughly using the normal saline solution.
  • Clean the area around the wound with normal saline solution; wipe intact skin with a skin protectant wipe and allow it to dry well. Remove and discard your gloves.
  • Put on sterile gloves. Using sterile scissors, cut the foam to the shape and measurement of the wound. More than one piece of foam may be necessary if the first piece is cut too small.
  • Carefully place the foam in the wound. Next, place the fenestrated tubing into the center of the foam. The fenestrated tubing, embedded into the foam, delivers negative pressure to the wound.
  • Place the transparent occlusive air permeable drape over the foam, enclosing both the foam and the tubing. Remove and discard your gloves.
  • Connect the free end of the fenestrated tubing to the evacuation tubing connected to the evacuation canister.
  • Turn on the vacuum unit.
  • Make sure the patient is comfortable.
  • Properly dispose of drainage, solution, linen-saver pad, and trash bag, and clean or dispose of soiled equipment and supplies according to facility policy and Centers for Disease Control and Prevention guidelines.

Special considerations
  • Change the dressing every 48 hours. Try to coordinate dressing change with the physician's visit so he can inspect the wound.
  • Measure the amount of drainage every shift.
  • Adjust the negative pressure setting according to the physician's orders.
  • Audible and visual alarms alert you if the unit is tipped greater than 45 degrees, the canister is full, the dressing has an air leak, or the canister becomes dislodged.

Complications
Care and cleaning of wounds may temporarily increase the patient's pain. They also increase the risk for infection.

Documentation
Document the frequency and duration of therapy, the amount of negative pressure applied, the size and condition of the wound, and the patient's response to treatment.