Not All Days are Magically Delicious

Wound Vac ink & pastel on paper 2010 by JParadisi

        When I was a pediatric critical care nurse working in busy trauma centers, my duties included wound care. I have salved and wrapped burns, and limbs ravaged by meningococcemia. I’ve dressed the fingers of a child whose surgeon successfully used leeches to regain their circulation.  As an adult oncology nurse, I occasionally float to the wound care area and change dressings. 

       A few weeks ago, I changed a wound vac dressing. A wound vac is a small mechanical device in a fanny bag, worn by the patient 24/7.  Black sponge is packed into the wound and covered with an adhesive, transparent film. A suction tube connects the dressing to a canister attached to the wound vac. When the wound vac is turned on, it sucks all the air out, compressing the sponge tightly into the wound. There is barely any sound as the machine “vacuums” the wound’s drainage into the canister. The suction stimulates healthy tissue, often reducing healing time dramatically. If an air leak is present, there is a loud sucking noise when the machine powers on, and the sponge will not compress. This means it needs more transparent covering to seal it. If that fails, the entire dressing comes off and redone, which is not very comfortable for the patient. 

     The patient I was seeing dreaded the dressing changes. I sat on a rolly stool, listening to him express his feelings about the progress he was making. I used my best communication skills. We connected, and he trusted me with the dressing change. 

     His wound was shaped like one of the marshmallows in a box of Lucky Charms cereal. Its complex shape made cutting the bulky, black sponge to fit difficult. Nope, there wasn’t a template from the previous dressing changes, but that would have been nice. The wound’s location made keeping the sponge in place challenging. Using tricks, I managed to get everything in place. The patient tolerated the procedure well. I turned on the wound vac. 

     The machine made a loud sucking noise and the sponge did not compress. I looked at my patient and the disappointment in his eyes matched my own. I was unable to make an airtight seal by reinforcing suspicious areas with more transparent film. My patient said, “You’re not going to redo the dressing, are you?” It sounded more like a statement than a question. I knew he had reached his limit of tolerance, and I felt terrible.  “Let me try one more thing first,” I said. I stepped into the hallway and looked for help. Fortuitously, one of my WCON friends was out there, holding her lunch sack.  Also a nurse, she has advanced certification in wound and ostomy care.  “I need help, I can’t get a seal on a wound vac,” I pleaded. She put away her lunch and in five minutes she found the leak, fixed it, and the wound vac powered on in silence. The black sponge fully compressed. My patient went home. 

     I was not the hero I wanted to be that day. Someone else stepped in for me. That’s why I like being part of a team, because not all days are magically delicious.

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