V.A.C.UltA™ NegAtiVe PressUre WoUNd therAPy system (V.A.C.
Contents
1. Therapy with the V A C UIta Therapy System provided separately ia 2 tete t Race t i te an eae 14 Dies Lalo PT C 15 Wound Preparation V A C VeraFlo Cleanse Dressing Application ceccecececeeseeseseeceseeeeeeeecseeseseeeteeeseneeseeseaes 17 Advanced Drape Applicatioli 2 euenit tn pa e 19 Vera T RA C TM Pad Application 20 MAC Vera TRAC Duo Tube Set Application 21 IrstilliPad ADDIICdlins se ene tan ettet eire E eerte 21 Sensa TRAC M Pad Application ttt POR RI 22 Initiate VAC VeraFlo M Therapy itte tote teret dee E e ee 23 Bridge Away From The Wound Using VAC Verao Cleanse TM Dressing teneret keen tenen ettet trea nh spe iaia 25 Using V A C VeraFlo Dressing in Conjunction with Bandages Garments or Off Loading Devices 27 Explanation of Symbols Used in Disposables 29 The V A C UIta Negative Pressure Wound Therapy System V A C UIta Therapy System is an integrated wound therapy system that can deliver either V C VeraFlo Therapy Instillation which consists of negative pressure wound therapy V A C Therapy coupled with controlled delivery and drainage of topical wound irrigation treatment solutions and suspensions over th2. 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 a Remove both backing Layers 1 and 2 to expose adhesive Fig 12 b Place pad opening in central disc directly over hole in V A C Advanced Drape Fig 13 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 14 22 V A C VERAT R A C DUO TUBE SET APPLICATION The V A C VeraT R A C Duo Tube Set consists of two pads the Instill Pad for fluid instillation and the SensaT R A C Pad for fluid and exudate removal Fig 15 Consider using the V A C VeraT R A C Duo Tube Set for larger sized wounds requiring a flushing technique fluid input and removal occur through locations that are separated Fig 16 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 Ulta Therapy Unit to alarm Instill Pad Fluid In Fluid Flush INSTILL PAD APPLICATION 1 Choose Instill Pad application site Give particular consideration to fluid flow and tubing positioning to allow for optimal flow and avoid placement over bony prominences or within creases in the tissue NOTE Whenever possible the Instill Pad should always
3. in the half moon configuration as it may result in excess pressure over intact skin in a weight bearing area Position one end of the bridging foam A over the hole in the V A C Advanced Drape at wound site Fig 34 Position the other end of the bridging foam A on the drape applied over the intact skin refer to step 3 above where the V A C VeraT R A C Pad will be placed Fig 34 NOTE The large end of the bridge should always be placed higher than the wound Position the T R A C Pad landing area foam B created in steps 6 and 7 adjacent to the bridging foam where the V A C VeraT R A C Pad will be placed Fig 34 Cover the bridging foam A and the T R A C Pad landing area foam B using additional Advanced Drape Fig 35 Apply V A C Advanced Drape as described in the V A C Advanced Drape Application section Pinch V A C Advanced Drape centered between the bridging foam A and the Pad landing area foam B and carefully cut an approximately 2 5 cm hole through the V A C Advanced Drape not a slit Fig 36 It is not necessary to cut into the foam The hole should be large enough to allow for instillation and removal of fluid NOTE Cuta hole rather than a slit as a slit may self seal during therapy Apply V A C VeraT R A C Pad Fig 37 as described in the V A C VeraT R A C Pad Application section Connect V A C VeraT R A C Pad to the V A C UIta
4. particular consideration to fluid flow and tubing positioning to allow for optimal flow and avoid placement over bony prominences or within creases in the tissue NOTE Whenever possible the SensaT R A C Pad should be placed at a lower elevation than the Instill Pad Fig 15 NOTE 7o prevent periwound maceration with wounds that are smaller than the central disc of the pad it is very important that the central disc not overhang the edge of the foam and that the periwound area is properly protected Refer to the Wound Preparation section for periwound area protection instructions Please refer to the Bridge Application with V A C VeraFlo Cleanse Dressing System section in these Instructions for Use and the V A C Therapy Clinical Guidelines for additional dressing application techniques 2 Pinch Advanced Drape and carefully cut an another approximately 2 5 cm hole through the V A C Advanced Drape not a slit Fig 17 The hole should be large enough to allow for the 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 the SensaT R A C Pad which has a central disc and a surrounding outer adhesive skirt a Remove both backing Layers 1 and 2 to expose adhesive Fig 18 b Place pad opening in central disc directly over hole in V A C Advanced Drape Fig 19 c Apply gentle pressure on the central d
5. A C Dressing and V A C VeraFlo Dressing cartons for details regarding dressing change frequency As with any wound treatment clinicians and patients 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 gangrene toxic shock septic shock and or fatal injury Some signs or complications of systemic infection are nausea vomiting diarrhea headache dizziness fainting sore throat with swelling of the mucus membranes disorientation high fever refractory and or orthostatic hypotension or erythroderma a sunburn like rash If there are any signs of the onset of systemic infection or advancing infection at the wound site contact a physician immediately to determine if V A C Therapy or V A C VeraFlo Therapy should be discontinued For wound infections relating to blood vessels please also refer to the section titled Infected Blood Vessels Infected Wounds with V A C GranuFoam Silver Dressing In the event of clinical infection V A C GranuFoam Silver Dressing is not intended to replace the use of systemic therapy or other infection treatment regimens V A C GranuFoam Sil
6. DED FOR V A C VERAFLO THERAPY WITH THE V A C ULTA THERAPY SYSTEM PROVIDED SEPARATELY V A C VeraT R A C Duo Tube Set optional refer to 1000 mL V A C VeraT R A C Duo Canister Tube Set Application section OR V A C VeraLink 500 mL Cassette Canister All V A C Ulta Therapy System dressings and accessories are packaged sterile and are latex free With the exception of the V A C VeraLink Cassette all disposable components are for single use only The V A C VeraLink Cassette is for single patient use only Re use of disposable components may result in wound contamination infection and or failure of the wound to heal To help ensure safe and effective use all components should only be used with the V A C UIta Therapy Unit The decision to use clean versus sterile aseptic technique is dependent upon wound pathophysiology physician clinician preference and institutional protocol Use appropriate institutional protocols to avoid inadvertent contamination of exposed components DRESSING CHANGES Wounds being treated with the V A C Ulta M Therapy System should be monitored on a regular basis In a monitored non infected wound V A C Dressings and V A C VeraFlo Therapy Dressings should be changed every 48 to 72 hours but no less than three times per week with frequency adjusted by the clinician as appropriate Infected wounds must be monitored often and very closely For these wounds dres
7. Therapy Unit and apply therapy as described in the Initiate V A C VeraFlo Therapy section NOTE When using the V A C VeraT R A C Duo Tube Set follow the steps above and create a secondary bridge for applying the second pad 28 USING V A C VERAFLO DRESSING IN CONJUNCTION WITH BANDAGES GARMENTS OR OFF LOADING DEVICES Off loading Boot 1 Apply V A C VeraFlo Cleanse Dressing and V A C Advanced Drape to wound as described in the previous sections 2 Carefully cut a 3 cm hole in the V A C Advanced Drape not a slit as described in the V A C VeraT R A C Pad Application section Fig 38 Fig 39 3 Cut V A C Advanced Drape in half Fig 40 4 Apply additional V A C Advanced Drape over intact skin where the bridge will be applied Fig 41 Fig 42 Ensure that the draped area will be larger than the foam bridge 5 Cut an appropriately sized piece of V A C VeraFlo Dressing for the bridge Fig 43 and Fig 44 CAUTION Bridge length should be as short as possible to ensure efficient fluid flow 29 10 11 Position small end of the V A C VeraFlo Dressing cut for the bridge over the hole in the V A C Advanced Drape at wound site Fig 44 NOTE Ensure that foam bridge extends over the V A C Advanced Draped skin and does not come into contact with intact skin outside of the drape Position the large end of the V A C VeraFlo Dressing cut for the bridge on the dr
8. V A C ULTA NEGATIVE PRESSURE WOUND THERAPY SYSTEM V A C ULTA THERAPY SYSTEM SAFETY INFORMATION AND V A C VERAFLO CLEANSE DRESSING SYSTEM APPLICATION INSTRUCTIONS Only for use with the KCI V A C Ulta Therapy System TABLE OF CONTENTS lnidications for 2 Transitioning V A C Therapy Into Home Care tenen 3 V A C Ulta Therapy System Contraindications 3 Additional Contraindications Specific to V A C VeraFlo 3 V A C Ulta Therapy System Wan Sarai eaii 4 Additional Warnings for V A C VeraFlo Therapy cccecseceseeseseeceseeeeeeeseseeseseesteeeseneeseeeeaes 8 V A C Ulta Therapy System Precautions cc csccececssscecesenseseseescaterenseseacsesetereeatscereseteaesees 8 Additional Precautions for V A C VeraFlo Therapy 2 10 Additional Precautions for V A C GranuFoam Silver Dressing V A C VeraFlo Cleanse Dressing System Application 12 Diessihigi DESCRIPTION uoto ec e rto 12 V A C VeraFlo Cleanse Dressing System Component Identification 14 Accessories needed for V A C VeraFlo
9. anced Drape 20 V A C ADVANCED DRAPE APPLICATION CAUTION Patient s skin condition should be carefully monitored refer to Precautions Protect Periwound Skin section 1 Trim the V A C Advanced Drape to cover the foam and an additional 3 5 cm border of intact periwound tissue Fig 8 The V A C Advanced Drape may be cut into multiple pieces for easier handling Excess V A C Advanced Drape may be kept to seal difficult areas if needed 2 Carefully remove Layer 1 to expose adhesive Fig 9 The V A C Advanced Drape may be held by the Ruler Handling Bars 3 Place the adhesive face down over foam and apply V A C Advanced Drape to cover foam and intact skin ensuring V A C Advanced Drape covers at least a 3 5 cm border of intact periwound tissue 4 Remove Layer 2 and pat V A C Advanced Drape to ensure an occlusive seal Fig 10 NOTE Proper sealing of the wound with the V A C Advanced Drape is essential for assuring therapy is delivered to the wound Use of V A C VeraFlo Therapy in wounds where large volumes of instillation fluid are delivered to the wound or in wounds in anatomical locations that are difficult to seal require additional precautions to assure that the dressing is adequately sealed throughout therapy Consider adjusting patient placement during instillation cycle application of an additional layer of drape in tissue folds or areas more likely to be susceptible to leaks and supporting t
10. ape applied over the intact skin refer to step 4 above where the V A C VeraT R A C Pad will be placed Fig 44 NOTE The large end of the bridge should always be placed higher than the wound Cover the bridge using V A C Advanced Drape Fig 45 Fig 46 Apply V A C Advanced Drape as described the V A C Advanced Drape Application section Pinch V A C Advanced Drape and carefully cut an approximately 2 5 cm hole through the V A C Advanced Drape not a slit Fig 47 The hole should be made on the large end of the created bridge It is not necessary to cut into the foam The hole should be large enough to allow for instillation and removal of fluid NOTE Cuta hole rather than a slit as a slit may self seal during therapy Apply V A C VeraT R A C Pad Fig 48 as described the V A C VeraT R A C Pad Application section CAUTION Ensure V A C VeraT R A C Pad is placed outside of the bandages garments or off loading devices Fig 48 Connect V A C VeraT R A C Pad to the V A C Ulta M Therapy Unit and apply therapy as described in the Initiate V A C VeraFlo Therapy section NOTE When using the V A C VeraT R A C Duo Tube Set follow the steps above and create a secondary bridge for applying the second pad 30 EXPLANATION OF SYMBOLS USED IN DISPOSABLES LABELING Method of Sterilization REE STERILE Radiation m Keep Dry Do not use if package is damaged or open be U
11. ausing 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 V A C Therapy or V A C VeraFlo Therapy Where possible completely smooth and cover any residual edges to decrease the risk of serious or fatal injury should shifting of structures occur Use caution when removing dressing components from the wound so that wound tissue is not damaged by unprotected sharp edges 1000 mL Canister DO NOT USE the 1000 mL canister on patients with a high risk of bleeding or on patients unable to tolerate a large loss of fluid volume including children and the elderly Consider the size and weight of the patient patient condition wound type monitoring capability and care setting when using this canister This canister is recommended for acute care hospital use only 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 treatment goals and V A C VeraFlo Therapy parameters for the V A C UIta Therapy System Refer to dressing application instructions found in V
12. be placed higher than the SensaT R A C Pad Fig 15 NOTE 7o prevent periwound maceration with wounds that are smaller than the central disc of the pad it is very important that the central disc not overhang the edge of the foam and that the periwound area is properly protected Refer to the Wound Preparation section for periwound area protection instructions Refer to the Bridge Application with V A C VeraFlo Cleanse Dressing System section in these application instructions and the V A C Therapy Clinical Guidelines for additional dressing application techniques Pinch V A C Advanced Drape and carefully cut an approximately 2 5 cm hole through the V A C Advanced Drape not a slit Fig 17 The hole should be large enough to allow for the input of fluid It is not necessary to cut into the foam NOTE Cuta hole rather than a slit as a slit may self seal during therapy 23 3 Apply the Instill Pad which has a central disc a surrounding outer adhesive skirt and the smaller diameter tube a Remove both backing Layers 1 and 2 to expose adhesive Fig 18 b Place pad opening in central disc directly over hole in V A C Advanced Drape Fig 19 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 20 SENSAT R A C PAD APPLICATION 1 Choose pad application site for the SensaT R A C Pad Give
13. cluding bleeding which if uncontrolled could be potentially fatal Extreme caution should be used when V A C Therapy or V A C VeraFlo Therapy is applied in close proximity to infected or potentially infected blood vessels Refer to Protect Vessels and Organs section Hemostasis Anticoagulants and Platelet Aggregation Inhibitors 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 physician Caution should be used in treating patients on doses of anticoagulants or platelet aggregation inhibitors 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 Refer to Additional Warnings for V A C VeraFlo Therapy section Sharp Edges Bone fragments or sharp edges could puncture protective barriers vessels or organs c
14. cted in accordance with ASTM 3574 08 physical properties tests Property Result Tensile Strength Wet saline conditions V A C VeraFlo Cleanse than V A C VeraFlo Dressing had approximately 3 times greater tensile strength Dressing Dry conditions V A C VeraFlo Cleanse Dressing had approximately 2 5 times greater tensile strength than V A C VeraFlo than V A C VeraFlo Dressing Tear Strength Wet saline conditions V A C VeraFlo Cleanse Dressing had approximately 3 times greater tear strength than V A C VeraFlo Dressing Dry conditions V A C VeraFlo Cleanse Dressing had approximately 3 times greater tear strength Dressing 14 Animal studies were conducted in healthy juvenile pigs in order to measure wound fill granulation tissue thickness Full thickness excisional wounds were created on each animal four wounds on each side of the spine and sterile dressings were applied on surgery day 0 following creation of the wounds On day 0 paired wounds with the same dressing were treated with either negative pressure wound therapy NPWT at 125 mmHg continuous or instillation therapy each cycle consisting of instillation of 20 mL saline soak time of five minutes followed by 150 minutes of NPWT at 125 mmHg continuous After seven days of continuous therapy interrupted only or dressing changes on days three and five wound fill volume was measured usin
15. ding tubing with a moist towel throughout the treatment in the chamber For HBO therapy the V A C Tubing or V A C VeraFlo Therapy Tubing must not be clamped Never leave a V A C Dressing in place without active V A C Therapy for more than two hours please refer to the Keep V A C Therapy On section NOTE f using V A C VeraFlo Therapy ensure that irrigation fluid or treatment solutions are fully removed from the dressing prior to stopping negative pressure wound therapy ADDITIONAL WARNINGS FOR V A C VERAFLO THERAPY Topical Wound Solutions Topical wound solutions or suspensions may enter internal body cavities if the wound is open to such cavities They should not be infused into wounds with unexplored tunnels or unexplored undermining as they may enter into unintended cavities Pauses in Negative Pressure Application of V A C VeraFlo Therapy will result in pauses of negative pressure wound therapy which is not recommended on wounds requiring continuous V A C Therapy Do not use V A C VeraFlo Therapy over unstable structures such as unstable chest wall or non intact fascia on patients at increased risk of bleeding highly exudating wounds on flaps grafts or wounds with acute enteric fistulae Bioengineered Tissue V A C VeraFlo Therapy is not intended for use with cellular or accellular bioengineered tissues Hemostasis Patients with difficult or fragile wound hemostasis are a
16. dry before covering with dressings Reapplication of 3M Cavilon No Sting Barrier Film is necessary each time dressings are changed the barrier film is removed by the V A C Advanced Drape adhesive e If desired the film can be removed by using most medical adhesive removers as directed Clean and dry the involved area and reapply 3M Cavilon No Sting Barrier Film 6 Ensure adequate hemostasis has been achieved refer to Warnings Bleeding section Hemostasis Anticoagulants and Platelet Aggregation Inhibitors 7 Protect sensitive structures vessels and organs refer to Warnings Bleeding section Protect Vessels and Organs 8 Sharp edges or bone fragments must be eliminated from wound area or covered refer to Warnings Bleeding section Sharp Edges 18 V A C VERAFLO CLEANSE DRESSING APPLICATION Refer to V A C Therapy Clinical Guidelines for detailed instructions for treating different wound types and for multiple wound applications 1 Foam Quantity Label Date Dressing Applied VAC VeraFlo Dressing CI Number of foam pieces used in wound Assess wound dimensions and pathology including the presence of undermining or tunnels Fig 2 The V A C VeraFlo Cleanse Dressing System may be used with explored tunnels or undermining where the distal aspect is not visible Do not place any foam dressing into blind unexplored tunnels NOTE A non adherent material can be
17. e used to check for leaks in the system Refer to the V A C Ulta Therapy System User Manual for instructions on how to use the Seal Check tool NOTE f a leak source is identified patch with additional V A C Advanced Drape to ensure seal integrity Secure excess tubing to prevent interference with patient mobility NOTE f the wound is over a bony prominence or in areas where weight bearing may exert additional pressure or stress to the underlying tissues a pressure relief surface or device should be used to optimize patient offloading 26 BRIDGE AWAY FROM THE WOUND Bridge application should be used 1 to prevent periwound maceration with wounds that are smaller than the central disc of the pad s or 2 when there is a need to place the pad s away from the wound site to prevent pressure on or around the wound CAUTION Patient s skin condition should be carefully monitored refer to Precautions Protect Periwound Skin section CAUTION a vertical bridge placement created for moderately to highly exudating wounds the negative pressure at the wound site could be reduced by approximately 25 mmHg for every foot 30 5 cm of the bridge Consider adjusting the negative pressure setting accordingly CAUTION The V A C VeraFlo Cleanse Dressing is not intended for use as a bridge away from the wound when used in conjunction with bandages garments or off loading devices for example unna boot If the use of bandages gar
18. e wound bed OR V A C Therapy which consists of negative pressure wound therapy alone When using V A C VeraFlo Therapy Instillation there are important Contraindications Warnings and Precautions that should be considered in addition to the Contraindications Warnings and Precautions for V A C Therapy Contraindications Warnings and Precautions specific to V A C VeraFlo Therapy are highlighted in grey throughout the document and are identified by the V A C VeraFlo Therapy symbol to the left of the text When using V A C Therapy alone the V A C VeraFlo Therapy Contraindications Warnings and Precautions are not applicable The V A C Ulta Therapy Unit is for use only with V A C Dressings V A C GranuFoam V A C GranuFoam Silver V A C WhiteFoam V A C VeraFlo and V A C VeraFlo Cleanse Dressing Systems and disposables V A C VeraFlo Therapy should only be delivered with V A C VeraFlo Dressings and disposables NOTE The V A C GranuFoam Silver Dressing is not intended to be used with V A C VeraFlo Therapy because instillation solutions may negatively impact the benefits of the V A C GranuFoam Silver Dressing IMPORTANT As with any prescription medical device failure to consult a physician and carefully read and follow all therapy unit and dressing instructions and safety information prior to each use may lead to improper product performance and the potential for seriou
19. ed States Brand name referenced is not a trademark of KCI its affiliates or licensors V A C ULTA THERAPY SYSTEM WARNINGS Bleeding With or without using V A C Therapy or V A C VeraFlo 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 Patients who have weakened or friable blood vessels or organs in or around the wound as result of but not limited to Suturing of the blood vessel native anastamoses or grafts organ Infection Trauma 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 or V A C VeraFlo 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 physician If active bleeding develops suddenly or in large amounts during V A C Therapy or V A C VeraFlo Therapy or if frank bright red blood is seen in the tubing or in the canister immediately stop therapy leave dressing in place take measures to stop the bleeding and seek immediate medical assistance The V A C UIta Therapy Unit and dressings both V A C Therapy and V A C VeraFlo Therapy
20. g a saline fill method and granulation tissue thickness was determined from stained formalin fixed wound tissue samples with the following results Property Result Granulation Thickness Saline instillation therapy V A C VeraHo Cleanse Dressing generated 24 less granulation tissue than V A C VeraFlo Dressing NPWT V A C VeraHo Cleanse Dressing generated 30 less granulation tissue than V A C VeraFlo Dressing Wound Fill Volume Saline instillation therapy V A C VeraHo Cleanse Dressing generated 27 less wound fill than V A C VeraFlo Dressing NPWT V A C VeraHo Cleanse Dressing generated 35 less wound fill than V A C VeraFlo Dressing This data indicates that V A C VeraFlo Cleanse Dressing has increased mechanical strength and provides a less robust granulation tissue response in swine It is uncertain how swine data may correlate to human results NOTE Never place any foam dressing into blind unexplored tunnels V A C VeraFlo Cleanse Dressing can be used when transitioning from V A C VeraFlo Therapy to V A C Therapy 15 V A C VERAFLO CLEANSE DRESSING SYSTEM COMPONENT IDENTIFICATION 3 V A C VeraFlo Cleanse Dressing V A C Advanced Drape Quantity 3 V A C atl bee foo few Pad 3M Cavilon No Sting Barrier Film a vAC Ruler Quantity 2 ACCESSORIES NEE
21. he wound area with surface contact or pillow to prevent bulging of drape if the wound is in a dependent position 5 Remove the Ruler Handling Bars 21 V A C VERAT R A C PAD APPLICATION The V A C VeraT R A C Pad is an all in one system that incorporates tubing for fluid input and tubing for exudate fluid removal through a single pad interface Fig 12 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 Ulta Therapy Unit to alarm 1 Choose pad application site Give particular consideration to tubing positioning to allow for optimal flow and avoid placement over bony prominences or within creases in the tissue NOTE 7o prevent periwound maceration with wounds that are smaller than the central disc of the pad it is very important that the central disc not overhang the edge of the foam and that the periwound area is properly protected Refer to the Wound Preparation section for periwound area protection instructions Refer to the Bridge Application with V A C VeraFlo Cleanse Dressing System section in these application instructions and the V A C Therapy Clinical Guidelines for additional dressing application techniques Pinch V A C Advanced Drape and carefully cut an approximately 2 5 cm hole through the V A C Advanced Drape not a slit Fig 11 The hole should be large enough to allow for the input of fluid and the removal of
22. isc and outer skirt to ensure complete adhesion of the pad d Pull back on blue tab to remove pad stabilization layer Fig 20 24 INITIATE V A C VERAFLO THERAPY WARNING Review all V A C Ulta Therapy System Safety Information included in this document pages 2 11 before initiating V A C Therapy Refer to the V A C UIta Therapy System User Manual for complete details on using the V A C UIta Therapy Unit Fig 24 1 Remove the V A C VeraLink Cassette from packaging and insert into the V A C UIta Therapy Unit until it locks into place Fig 21 NOTE f the V A C VeraLink Cassette is not fully engaged the therapy unit will alarm NOTE The V A C VeraLink Cassette is for single patient use and should not be used for more than three days Refer to institutional guidelines if applicable 2 Use the V A C VeraLink Cassette spike to connect the instillation solution bottle bag to the V A C VeraLink Cassette Fig 22 3 Hang instillation solution bottle bag on the therapy unit s adjustable hanger arm Refer to the V A C UIta Therapy System User Manual for detailed instructions 4 Connect the instillation line of the V A C VeraT R A C Pad or V A C VeraT R A C Duo ube Set Instillation Pad tubing to the V A C VeraLink Cassette tubing Fig 23 5 Ensure both tubing clamps are open and are positioned appropriately to prevent pressure points and or skin irrita
23. ls and undermined areas Fig 4 NOTE Do not force the V A C VeraFlo Cleanse Dressing into any areas of the wound NOTE Do not over pack the wound cavity Do not place multiple pieces of foam in tunnels to prevent foam from being left behind at subsequent dressing changes NOTE f using multiple pieces of foam ensure foam to foam contact between adjacent pieces of foam for even distribution of fluid and negative pressure Cut and remove any excess length of unused foam away from wound Fig 6 CAUTION Do not cut or tear the foam over the wound as fragments may fall into the wound Fig 5 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 NOTE Do not allow foam to overlap onto intact skin NOTE Always note the total number of pieces of foam used in the wound and document on the drape on the supplied Foam Quantity Label attached to the V A C Vera R A C TM Pad or if used the V A C VeraT R A C Duo Tube Set tubing Fig 7 and in the patient s chart The Log tool on the V A C Ulta Therapy Unit can be used to record the number of foam pieces used in the wound Refer to the V A C Ulta Therapy System User Manual for instructions on using the Log tool NOTE Retention sutures should be covered with a single layer of non adherent wide meshed porous or fenestrated material placed between the sutures and the V A C Adv
24. ments or off loading devices is necessary consider constructing a bridge with V A C VeraFlo Dressing page 29 USING V A C VERAFLO CLEANSE DRESSING 10 11 12 13 14 Apply V A C VeraFlo Cleanse Dressing and V A C Advanced Drape to wound as described in the previous sections Carefully cut a 3 cm hole in the V A C Advanced Drape not a slit as described in the V A C VeraT R A C Pad Application section to allow for foam to foam contact and fluid flow Fig 26 Apply additional Advanced Drape over intact skin where the bridge will be applied Fig 27 Fig 28 Ensure that the draped area will be larger than the foam bridge Carefully tear the V A C VeraFlo Cleanse Dressing into two separate halves Fig 29 Fig 30 Cut an appropriately sized piece of V A C VeraFlo Cleanse Dressing A for a bridge from one of the two halves created in step 4 above Fig 34 CAUTION Bridging foam length should be as short as possible to ensure efficient fluid flow Cut a 5 cm long piece of V A C VeraFlo Cleanse Dressing B from the other half of V A C VeraFlo Cleanse Dressing created in step 4 above to create an additional T R A C Pad landing area foam Fig 34 Trim the top half moon sections of the bridging foam and T R A C Pad landing area foam to create two flat pieces of foam Fig 32 Fig 33 NOTE Do not place the bridging foam over skin
25. oam used in the wound and the dressing change date and document that number on the drape in the patient s chart and on the foam quantity label attached to the pad tubing if provided Foam Removal V A C Foam Dressings and V A C VeraFlo Therapy Foam Dressings are not bioabsorbable Always count the total number of pieces of foam removed 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 Ulta Therapy System take measures to stop the bleeding and do not remove the foam dressing until the treating physician or surgeon is consulted Do not resume the use of the V A C Therapy or V A C VeraFlo Therapy until adequate hemostasis has been achieved and the patient is not at risk for continued bleeding Keep V A C Therapy and V A C VeraFlo Therapy On Never leave a V A C Dressing or V A C VeraFlo Therapy Dressing in place without active V A C Therapy or V A C VeraFlo Therapy for more than two hours If therapy is off for more than two hours remove the old dressing and irrigate the wound Either apply a new V A C Dressing or V A C VeraFlo Therapy Dressing from an unopened sterile package and restart the
26. on included with those devices for important information V A C ULTA THERAPY SYSTEM CONTRAINDICATIONS Do not place foam dressings of the V A C Ulta Therapy System including both Therapy and V A C VeraFlo Therapy Dressings directly in contact with exposed blood vessels anastomotic sites organs or nerves NOTE Refer to Warnings section for additional information concerning Bleeding VA C Therapy and V A C VeraFlo Therapy are contraindicated for patients with Malignancy in the wound Untreated osteomyelitis NOTE Refer to Warnings section for Osteomyelitis information Non enteric and unexplored fistulas Necrotic tissue with eschar present NOTE After debridement of necrotic tissue and complete removal of eschar Therapy may be used Sensitivity to silver VA C GranuFoam Silver Dressing only ADDITIONAL CONTRAINDICATIONS SPECIFIC TO V A C VERAFLO THERAPY Do not use V A C Dressings with Octenisept hydrogen peroxide or solutions that are alcohol based or contain alcohol Do not deliver fluids to the thoracic or abdominal cavity due to the potential risk to alter core body temperature and the potential for fluid retention within the cavity Do not use V A C VeraFlo Therapy unless the wound has been throughly explored due to the potential for inadvertent instillation of topical wound solutions to adjacent body cavities Not available in the Unit
27. r to the V A C Ulta Therapy System User Manual for instructions on using the Log tool Refer to Warnings regarding Foam Removal in the Safety Information section 2 Ensure debridement of all necrotic non viable tissue including bone eschar or hardened slough as prescribed by treating physician 3 Perform thorough wound and periwound area cleaning per physician order or institution protocol prior to each dressing application 17 4 Protect fragile friable periwound skin with additional V A C Advanced Drape 3M Tegaderm Dressing or other similar medical grade transparent film skin protectant or hydrocolloid NOTE Depending on region 3M Cavilon No Sting Barrier Film may be provided in the dressing package 5 Application of the 3M Cavilon No Sting Barrier Film if used a Skin should be clean and dry prior to application of 3M Cavilon No Sting Barrier Film b Use supplied wipe to apply a uniform coating of film over entire area of concern Fig 1 C area is missed reapply to that area only after first application of 3M Cavilon No Sting Barrier Film has dried approximately 30 seconds d f 3M Cavilon No Sting Barrier Film is applied to area with skin folds or other skin to skin contact make sure that skin contact areas are separated to allow the film to thoroughly dry before returning to normal position Allow 3M Cavilon No Sting Barrier Film to thoroughly
28. rapy or apply an alternative dressing at the direction of the treating clinician Acrylic Adhesive The V A C Drape supplied with V A C Dressings and the V A C Advanced Drape supplied with V A C VeraFlo Therapy Dressings have 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 UIta Therapy System If any signs of allergic reaction or hypersensitivity develop such as redness swelling rash urticaria or significant pruritus discontinue use and consult a physician immediately If bronchospasm or more serious signs of allergic reaction appear seek immediate medical assistance Defibrillation Remove the V A C Dressing or V A C VeraFlo Therapy 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 Ulta Therapy Unit is MR Unsafe Do not take the V A C Ulta Therapy Unit into the MR environment Magnetic Resonance Imaging MRI V A C Dressings V A C Dressings and V A C VeraFlo Therapy Dressings can typically remain on the patient with minimal risk in an MR environment assuming that use of the V A C Ulta M Therapy System is not in
29. rigid components to ensure they do not create inadvertent pressure points in relation to patient position V A C UIta Therapy Unit Pressure Excursions In rare instances tubing blockages with the V A C UIta Therapy Unit may result in brief vacuum excursions to more than 250 mmHg negative pressure Resolve alarm conditions immediately Refer to the V A C Ulta Therapy System User Manual or contact your KCI representative for additional information ADDITIONAL PRECAUTIONS FOR V A C VERAFLO THERAPY Suitable Solutions V A C VeraFlo Therapy is intended for use with V A C 40 VeraFlo Therapy disposables and topical wound treatment solutions suspensions Only use solutions or suspensions that are Indicated for topical wound treatment according to solution manufacturer s instructions for use Some topical agents may not be intended for extended tissue contact If in doubt about the appropriateness of using a particular solution for V A C VeraFlo Therapy contact the solution s manufacturer about its suitability for saturated topical wound exposure Compatible with V A C Dressings and disposable components Contact your KCI representative for a list of solutions shown to be compatible with V A C 9 Dressings and disposable components NOTE Hypochlorous acid solutions applied frequently at high concentrations can lead to significant material degradation Consider utilizing concentrations and expos
30. s or fatal injury Do not adjust therapy unit settings or perform therapy application without directions from or supervision by the clinical caregiver INDICATIONS FOR USE The V A C Ulta Negative Pressure Wound Therapy System is an integrated wound management system that provides Negative Pressure Wound Therapy with an instillation option Negative Pressure Wound Therapy in the absense of instillation 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 granulation tissue formation and perfusion and by removing exudate and infectious material The instillation option is indicated for patients who would benefit from vacuum assisted drainage and controlled delivery of topical wound treatment solutions and suspensions over the wound bed The V A C Ulta Negative Pressure Wound Therapy System with and without instillation is indicated for patients with chronic acute traumatic sub acute and dehisced wounds partial thickness burns ulcers such as diabetic pressure and venous insufficiency flaps and grafts TRANSITIONING V A C THERAPY INTO HOME CARE The V A C Ulta Therapy System is not intended for home use If there is a need to continue V A C Therapy when a patient transitions home consider using other KCI Therapy Systems approved for the post acute care environment Refer to the safety informati
31. s should be closely monitored for fluid loss and dehydration Also patients with highly exudating wounds or large wounds in relation to the patient size and weight should be closely monitored as they have a risk of excessive fluid loss and dehydration When monitoring fluid output consider the volume of fluid in both the tubing and canister Spinal Cord Injury SCI In the event an SCI 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 or V A C VeraFlo Therapy to help minimize sensory stimulation and seek immediate medical assistance Bradycardia To minimize the risk of bradycardia V A C Therapy and V A C VeraFlo Therapy must not be placed in proximity to the vagus nerve Enteric Fistulas Wounds with enteric fistulas require special precautions to optimize V A C Therapy Refer to V A C Therapy Clinical Guidelines for more detail Therapy is not recommended if enteric fistula effluent management or containment is the sole goal of therapy NOTE V A C VeraFlo Therapy should not be used in the presence of enteric fistula to prevent wound contamination Protect Periwound Skin Consider use of a skin preparation product to protect periwound skin Do not allow foam to overlap onto intact skin Protect fragile friable periwound skin with additional V A C Advanced Drape skin protec
32. se By Latex Free ew Date of Manufacture Lot Batch Number Do Not Resterilize Single Use Only Do Not Resterilize Consult Instructions Manufacturer For Use CAUTION Federal US Authorized _ law restricts this device to EC Representative Rx Only sale rental by or on the EC REP in the order of a physician European Community REP Catalog Number E Content Information Each Contains PHTHALATES V A C VeraT R A C Pad tubing V A C VeraT R A C Duo Tube Set tubing V A C VeraLink Cassette tubing Always count and record number of foam pieces used in wound 31 KCI CC KCI USA Inc KCI Medical Products UK Ltd San Antonio TX 78219 USA Wimborne Dorset 1 800 275 4524 BH21 7SH www kci1 com United Kingdom www kci medical com Rx Only 3M Tegaderm and Cavilon are trademarks of 3M Corporation Unless otherwise specifically noted in the text all other trademarks designated herein are proprietary to KCI Licensing Inc its affiliates and licensors 2011 KCI Licensing Inc All rights reserved 350159 Rev D 8 2011 32
33. 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 or V A C VeraFlo Therapy Always ensure that V A C Foam Dressings and V A C VeraFlo 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 surgically possible multiple layers of fine meshed non adherent material may be considered as an alternative if deemed by the treating physician to provide a complete protective barrier If using non adherent materials 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 physician Infected Blood Vessels Infection may erode blood vessels and weaken the vascular wall which may increase susceptibility to vessel damage through abrasion or manipulation Infected blood vessels are at risk of complications in
34. sings may need to be changed more frequently with the dressing change intervals based upon a continuing evaluation of wound condition and the patient s clinical presentation rather than a fixed schedule Refer to the V A C Therapy Clinical Guidelines which are available at www kci1 com or contact your local KCI representative for a printed copy WOUND PREPARATION WARNING Review all V A C Ulta Therapy System Safety Information included with the V A C UIta Therapy Unit before beginning Wound Preparation NOTE f a V A C VeraT R A C Pad or V A C VeraT R A C Duo Tube Set is currently in place on the dressing consider using the Dressing Soak tool of the V A C Ulta Therapy Unit to hydrate the dressing with sterile water normal saline or an approved topical solution This hydration is intended to facilitate removal of the dressing while potentially reducing patient discomfort during dressing change Refer to the V A C Ulta Therapy System User Manual for instructions on using the Dressing Soak tool 1 Remove and discard previous dressing per institution protocol Thoroughly inspect wound to ensure all pieces of dressing components have been removed NOTE f the dressing being removed is V A C Dressing or a V A C VeraFlo Therapy Dressing ensure removal of all pieces of foam The Log tool on the V A C Ulta Therapy Unit can be used to review the number of foam pieces used in the wound if previously entered Refe
35. t increased risk of bleeding associated with V A C VeraFlo Therapy due to the potential for disruption of clots or dilution of clotting factors Do not use V A C VeraFlo Therapy where hemostatic agents have been used in the wound bed V A C ULTA THERAPY SYSTEM 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 10 Continuous Versus DPC Dynamic Pressure Control V A C Therapy Continuous 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 exudating wounds fresh flaps and grafts and wounds with acute enteric fistulae y NOTE VA C VeraFlo Therapy due to the controlled delivery of wound irrigation and treatment solutions provides intermittent Therapy and is not recommended in the above wound types or conditions Patient Size and Weight The size and weight of the patient should be considered when prescribing V A C Therapy or V A C VeraFlo Therapy Infants children certain small adults and elderly patient
36. tant hydrocolloid or other transparent film Multiple layers of the V A C Advanced Drape may decrease the moisture vapor transmission rate which may increase the risk of maceration If any signs of irritation or sensitivity to the drape foam or tubing assembly appear discontinue use and consult treating physician To avoid trauma to the periwound skin do not pull or stretch the drape over the foam dressing during drape application Extra caution should be used for patients with neuropathic etiologies or circulatory compromise Circumferential Dressing Application Avoid use of circumferential dressings except in the presence of anasarca or excessively weeping extremities where a circumferential drape technique may be necessary to establish and maintain a seal Consider using multiple small pieces of V A C Advanced Drape rather than one continuous piece to minimize the risk of decreased distal circulation 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 circumferential drape applications it is crucial to systematically and recurrently palpate distal pulses and assess distal circulatory status If circulatory compromise is suspected discontinue therapy remove dressing and contact treating physician 11 Pressure Points Periodically assess and monitor the location of tubing connectors caps clamps or other
37. terrupted for more than two hours refer to Keep V A C Therapy and V A C VeraFlo Therapy On above NOTE f using V A C VeraFlo Therapy ensure that irrigation fluid or treatment solutions are fully removed from the dressing prior to stopping negative pressure wound therapy The V A C GranuFoam Silver Dressing has been shown to pose no known hazards in an MR environment with the following conditions of use Static magnetic field of 3 Tesla or less Spatial gradient field of 720 Gauss cm or less and Maximum whole body averaged specific absorption rate SAR of W kg for 15 minutes of scanning Non clinical testing under these same conditions produced a temperature rise of lt 0 4 C MR image quality may be compromised if the area of interest is in the same area or relatively close to the position of the V A C GranuFoam Silver Dressing Hyperbaric Oxygen Therapy HBO Do not take the V A C UIta Therapy Unit into a hyperbaric oxygen chamber The V A C UIta Therapy Unit is not designed for this environment and should be considered a fire hazard After disconnecting the V A C UIta Therapy Unit either i replace the V A C Dressing or V A C VeraFlo Therapy 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 or V A C VeraFlo Therapy Dressing inclu
38. tion 6 Remove V A C Canister from packaging and insert into the V A C Ulta Therapy Unit until it locks into place Fig 24 NOTE f the canister is not fully engaged the V A C Ulta Therapy Unit will alarm 7 Connect the V A C line of the V A C VeraT R A C Pad or SensaT R A C Pad tubing if using V A C VeraT R A C Duo Tube Set to canister tubing Fig 25 8 Ensure both tubing clamps are open and are positioned appropriately to prevent pressure points and or skin irritation 25 9 10 11 Turn on power to the V A C Ulta Therapy Unit select the prescribed therapy settings and initiate therapy Refer to the V A C UIta Therapy System User Manual for detailed instructions NOTE The Test Cycle tool on V A C Ulta Therapy Unit may be used to confirm that the system was set up correctly Refer to the V A C Ulta Therapy System User Manual for instructions on how to set up therapy and use the Test Cycle tool The V A C VeraFlo Cleanse Dressing should have a wrinkled appearance shortly after therapy is initiated There should be no hissing sounds If there is any evidence of leaks check the seals around the V A C VeraT R A C Pad or V A C VeraT R A C Duo Tube Set pads V A C Advanced Drape tubing connections canister connections and V A C VeraLink Cassette connections Ensure all tubing clamps are open NOTE The Seal Check tool on the V A C Ulta Therapy Unit may b
39. to come in contact with EKG or other electrodes or conductive gels during electronic monitoring or when taking electronic measurements Diagnostic Imaging The V A C GranuFoam Silver Dressing contains metallic silver that may impair visualization with certain imaging modalities Dressing Components Application of products containing silver may cause temporary tissue discoloration Additional warnings and precautions apply to certain V A C specialty dressings and V A C Therapy Units Please refer to the specific product instructions for use prior to use If there are any questions regarding the proper placement or usage of V A C Therapy please refer to the V A C Therapy Clinical Guidelines for more detailed instructions or contact your local KCI representative For additional and most current information please see KCI s website at www kci1 com US or www kci medical com OUS 13 APPLICATION INSTRUCTIONS DRESSING DESCRIPTION V A C VERAFLO CLEANSE DRESSING SYSTEM The V A C VeraFlo Cleanse Dressing System is intended for use with V A C VeraFlo Therapy as provided by the V A C UIta Therapy Unit The V A C VeraFlo Cleanse Dressing allows the clinician flexibility in addressing wounds with varying geometries Dressing demonstrated the following tensile and tear strength results Preclinical testing compared the V A C VeraFlo Cleanse Dressing to the V A C VeraFlo Bench testing condu
40. ure durations as low as clinically relevant NOTE The V A C GranuFoam Silver Dressing is not intended to be used with V A C VeraFlo Therapy because instillation solutions may negatively impact the benefits of the GranuFoam Silver Dressing Canister Changes Monitor fluid level in canisters frequently during use of the V A C VeraFlo Therapy Frequent canister changes may be necessary depending on volume of fluid instilled and wound exudates At a minimum the canister should be changed weekly and disposed of according to institutional protocol 12 ADDITIONAL PRECAUTIONS FOR V A C GRANUFOAM SILVER DRESSING Topical Solutions or Agents The V A C GranuFoam Silver Dressing is not intended to be used with V A C VeraFlo Therapy because instillation solutions may negatively impact the benefits of the V A C GranuFoam Silver Dressing Protective Layer As with all V A C Foam Dressings the V A C GranuFoam Silver Dressing should not be placed in direct contact with exposed blood vessels anastomotic sites organs or nerves refer to section on Protect Vessels and Organs Intervening non adherent layers may be placed between the V A C GranuFoam Silver Dressing and the wound surface however these products may compromise the effectiveness of the V A C GranuFoam Silver Dressing in the area covered by the non adherent layer Electrodes or Conductive Gel Do not allow V A C GranuFoam Silver Dressing
41. used prior to foam dressing placement in order to facilitate future dressing removal If adjunct materials are utilized under the V A C VeraFlo Cleanse Dressing they must be compatible with solution to be instilled and meshed porous or fenestrated to allow for effective fluid and exudate removal Document on the drape on the supplied Foam Quantity Label attached to the V A C VeraT R A C Pad or if used V A C VeraT R A C Duo Tube Set tubing Fig 7 and in the patient s chart to ensure removal with subsequent dressing changes 19 2 If desired carefully tear the V A C VeraFlo Cleanse Dressing along the perforations to separate the dressing into two halves Fig 3 CAUTION Do not cut or tear the foam over the wound as fragments may fall into the wound Fig 5 Fig 6 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 NOTE The V A C VeraFlo Cleanse Dressing is provided in a pre cut tubular configuration that can be split and or cut to best conform to the geometry of the wound being treated The foam may be applied in the full tube half tube or custom cut configuration The goal of foam placement should be to maximize foam to tissue contact without over packing the wound while using the fewest number of foam pieces as possible Gently place foam into wound cavity covering the entire wound base and sides tunne
42. ver Dressing may be used to provide a barrier to bacterial penetration Refer to the section titled Additional Precautions for V A C GranuFoam Silver Dressing Osteomyelitis V A C Therapy and V A C VeraFlo Therapy should NOT be initiated 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 Tendons Ligaments and Nerves Tendons ligaments and nerves should be protected to avoid direct contact with V A C Foam Dressings or V A C VeraFlo Therapy Foam Dressings These structures may be covered with natural tissue or meshed non adherent material to help minimize risk of desiccation or injury Foam Placement Always use V A C Dressings or V A C VeraFlo Therapy Dressings from sterile packages that have not been opened or damaged Do not place any foam dressing into blind unexplored tunnels The V A C WhiteFoam Dressing may be more appropriate for use with explored tunnels The V A C VeraFlo Cleanse Dressing System may be more appropriate for use with explored tunnels when using V A C VeraFlo Therapy where robust granulation tissue formation is not desired Do not force foam dressings into any area of the wound as this may damage tissue alter the delivery of negative pressure or hinder exudate and foam removal Always count the total number of pieces of f
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