I have a colostomy, about 1" opening, and for 8 years I had no problem with my pouches. Then for 3 or 4 months I can't seem to have a bag on for more than a day, and there is leakage. What is deep convexity and should I have different kind of pouches that have a deep convexity? Would that help? Thank you.
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- Tue, 8/14/12 - 9:00am
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I am a layperson. My wife has a non-healing ischial pressure ulcer that is currently being treated with a wound vac set at continuous therapy of 120 mmHg. However, I recently read that a literature review indicated that continuous therapy should not be standardized and may not be as effective as intermittent and lower pressure therapy (Christian Willy, The Theory and Practice of Vacuum Therapy). In addition, I was informed by a highly experienced wound care professional that a low diastolic blood pressure reading (118/50) suggests the need for a lower setting on the wound vac. Before discussing these topics with my wife’s doctor, I would like to be reasonably well-informed. If anyone would share their experience or knowledge of the literature on these two issues, such feedback would be much appreciated. Thank you.
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Blood pressure has no bearing on Negative Pressure Wound Therapy. Blood pressure is not a static thing, you will get different readings at different times of the day. Determining what negative pressure you should have when using VAC is dependant on many other variables: wound size, amount of exudate, pain tolerance. Intermittent pressure can be used and you can achieve good outcomes; however, again, it is dependant on wound size, exudate amount, etc. Call KCI and an experienced Clinician can answer your questions, specific to your wife's wounds.
Reply to this comment »If your wife has a non-healing wound, my first approach is to correct what can be corrected to help the wound close. I always start with nutrition - protein, veggies and fruit. Is she eating like an athelete in training? Is she getting supplements to make sure her nutrition is good?
Reply to this comment »How are you handling pressure reduction? I will assume you have been educated about appropriate pressure reduction.
Finally, when you see the wound, is it a healthy pink? If it is pale pink, then I decrease the suction on the VAC. If there is very little drg., in my practice, I decrease the suction. All of this is based on experience, I am not sure how much research is out there.
My standard is to go from 120 to 75 mmHg and have the pt. return in 1 week to monitor the effect the change has on the wound.
Hope this is helpful?
Carolyn
Thanks for your comments.
With respect to diet, my wife is consuming over 100 grams of protein a day with protein shakes, vitamin supplements, Boost, and meals. However, she eats small amounts of fruit and veggies.
She has a Roho cushion and pressure mapping showed that the pressure reduction on the wound has been maximized when she is in bed or sitting up. She sits up for about 2 1/2 hours a day for eating, taking pills, etc. Otherwise, she is lying down in bed with a special air mattress.
The wound is pale pink and producing nothing in the cannister. The measurements and volume of her wound are not decreasing but instructions are to keep it running on continuous at 120 (Smith & Nephew vac).
From some reading I have done, it appears that many clinicians use lower pressures as you do at about 75 for the circumstances I've outlined.
With a set of circumstances like those I have described, would you also often use intermittent rather than continuous negative pressure?
Again, thanks for your thoughts. Robert.
Reply to this comment »As the co-author of a publication on the safe use of negative pressure wound therapy in adults in this and the April 2012 issue of Ostomy Wound Management, I would like to share the following (for more details, please read both publications):
1) There is virtually no research to help guide the decision about amount of pressure and/or whether it should be continuous or intermittent. A recent AHRQ report also showed no evidence to help you decide one way or the other.
2) Evidence about its efficacy and effectiveness in pressure ulcers is rather limited.
But we DO know that:
1) Addressing the underlying cause of the ulcer is, if at all possible, the most important intervention to help the wound heal. See earlier comments about nutrition!
2) The wound should show evidence of healing. Specifically, there is substantial evidence showing that if no measurable reduction in wound size is observed after 2 to 4 weeks of care - the entire plan of care should be revisited.
If only all patients had advocates like you!
Reply to this comment »Hope this is helpful.
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