This thing is the most temperamental piece of machinery I’ve ever met in my life, and that includes a few of the computers I’ve had over the years, which is saying a lot.
Let me explain how it works, because I’m sure a lot of you playing along at home are having a hard time picturing this thing. I know I did before I saw it.
So I have this great big open wound in my abdomen that needs to heal from the inside out. Conventional treatment for a wound like this is a wet-to-dry dressing, which consists of gauze moistened with saline packed into the wound and topped off with dry gauze. The wound vac works somewhat similar, except that instead of putting wet gauze into the wound, the wound is filled with a piece of special foam. The foam comes in large sheets which are cut to the size of the wound. For some wounds, like mine, the nurse may need to cut more than one piece of foam and put them together in the wound like a gross game of Tetris. Once the foam is in the wound, it’s held in place with what the wound vac company calls “drape.” The drape is just a special sheet of clear plastic that goes completely over the foam and the surrounding skin to form an airtight seal.
Once the drape is in place, you need to cut a hole in the drape over the foam. The size of this hole is, as we have discovered, extremely important. Anything smaller than a quarter and all hell breaks loose. Tubing is attached over the hole, then the other end of the tubing is attached to a canister in the wound vac machine. When the machine is turned on, all the air is sucked out of the foam and the wound, providing constant negative pressure. Any fluid that accumulates in the wound is sucked out through the foam into the tubing and eventually ends up in the collection canister. There’s a special little packet of something inside the canister that breaks open when fluid hits it and turns the fluid into a solid gel. The end result looks like cherry Jell-O. It’s disgusting. I don’t think I’ll have have room for Jell-O again.
The beauty of this system is that the constant negative pressure encourages blood flow to the wound, which helps healing. Constantly sucking out the fluids keeps the wound clean and prevents infection. It also promotes granulation, which is something I have no idea what it is, but everyone tells me it’s desirable. Wounds heal considerably faster with the vac and the scar is smaller. It’s a great invention.
When it’s working.
And therein lies the problem, because it’s really fucking persnickety. We found out about the too small hole issue first hand, when the machine stopped working suddenly. We had to get our nurse out here to remove just 24 hours after it was put on, because it wasn’t working. Apparently, it can’t stay on in a non-working mode for more than 2 hours, or bad things can happen. I don’t know what those bad things are – infection? damage to the tissue? – but I’ll take their word on it. So it was an emergency situation to get her here quickly. She replaced the vac dressing, only to have the same thing the next night, at which point we had to have the on call night nurse come over and put on a wet-to-dry dressing.
All of this is bad for the wound, because the vac foam dressing is meant to stay in place for at least 48 hours. Pulling it out before than can disrupt the wound’s healing, so this is a problem. Because of this, we asked our nurse to have a nurse from KCI – the company that makes the wound vac – come with her to put the vac on. The KCI nurse confirmed that my nurse was doing everything right, except the size of the hole. So we started making sure the hole was at least the size of a quarter and things seemed fine.
Cut to last Sunday night. I saw what looked like a dark blood clot blocking the beginning of the tube, right at the foam. The clot stayed there, with nothing being drawn from the wound. A little while later, the machine started to have pressure fluctuations and eventually the blockage warning started beeping. Another visit from the emergency on call nurse followed, resulting in a wet-to-dry dressing being put on. This time wasn’t as bad, since it was at least 48 hours since the vac had been put on, but it wasn’t good for my state of mind. I need to prepare for these dressing changes mentally, because pulling out the foam hurts like a bitch, so doing it when I’m not expecting it to be done really sucks.
Lois, our regular nurse, came back on Monday and put the vac back on. Everything seemed fine until a few hours ago, when the “canister full” alert started beeping. That canister wasn’t anywhere near full, but we changed it anyway. A little later, the blockage alert warning beeped. Turned out there was a kink in the canister tubing, causing a blockage. This caused there to be no vacuum pressure while we sorted it out, and I’m pretty certain the foam shifted during that time. Now, the pressure is fluctuating once in a while, and a sort of leaking noise can be heard now and again from where the tubing meets the foam.
For now, the pressure seems to be staying up and there’s still fluid being sucked out, so I’m hoping it stays this way until tomorrow morning when Lois comes to change the dressing. If the fluctuating gets worse and the leaking sound gets worse, it will mean another emergency visit from an on call nurse.
So this is why I have a love/hate relationship with this machine. The wound is healing so well with it, but it so often isn’t working. Not to mention, I’m constantly tethered to it, which sucks. It’s embarrassing, too. I don’t like to go outside with it, because you can see the tubing with the yuck flowing through it.
They tell me it will be all healed in about a week-and-a-half, which I hope is true.