Description
A supernumerary nurse was working with me for the first week of their familiarisation period. Our patient was a thirty-nine year old woman, Ms LC, who had undergone a laparoscopic peritonectomy. She had a midline abdominal wound that showed slow wound healing. The wound clinical nurse consultant and the doctors during their ward round decided to introduce NPWT to Ms LC’s wound, as this would allow faster healing of her wound.
It was Ms LC’s first time to have NPWT on her wound, patient education was provided ensuring a thorough understanding about the procedure. At the same time, a verbal consent was obtained before commencing on NPWT making sure that Ms LC was fully aware of the process and the possible interventions that can be used throughout the treatment, which Ms LC consented to go ahead. We applied an NPWT using a non-touch sterile technique, started by slowly cleaning the surrounding skin before NPWT was applied. …show more content…
We trimmed the foam and placed the fitted foam in Ms LC’s wound. Upon securing the foam, we covered it with drapes and made a small hole at the centre of the dressing to place the vacuum connector and turned on the NPWT. We waited for some time until the indicator on the machine displayed no air leakage. We also documented in the progress notes what we have performed, filled out the wound chart, and informed the nurse in-charge on the frequency of dressing change in a week.
On the following day during our patient’s handover, we checked the NPWT and it was still in its original place. However, the NPWT was producing a beeping sound, which Ms LC thought was normal. According to Ms LC, it had made noise overnight but did not bother telling the night nurse on duty. We told Ms LC that the NPWT should not make any alarms otherwise troubleshooting was needed. Upon checking on the NPWT machine indicator, it showed an air leak description on the display. Feelings I was alarmed and concerned knowing that NPWT has not been working properly, which could affect the process of wound healing that can lead to further complications such as wound dehiscence and infection. I felt intimidated to ask the night shift nurse because she was more experienced than me; and I did not want to make her felt incompetent. On the other side, I also did not want to make Ms LC felt anxious and upset knowing that there had been something wrong with NPWT. I felt that I have a shortfall in providing Ms LC on one of the most essential information and that was on what to do when NPWT alarms. I also needed to reflect on what else I missed with patient education that I should have done. During our break, I spoke to our educator about the incident. She recommended that I have to speak to the night shift nurse about the incident. Our educator also left a note for the night shift nurse who looked after Ms LC, and asked her if she was aware about what had happened to the NPWT during her shift. When we saw the nigh shift nurse the following day, she was worried about that event. She said that she had been busy with her sick patient and had not thought about checking why the NPWT alarms. Evaluation The whole procedure of NPWT dressing took a lot of time to prepare and set up. I felt that there was a time constraint because I needed to assist my supernumerary, and at the same time to provide all the necessary explanation to the patient to facilitate full understanding about the procedure. NPWT was the most appropriate type of surgical wound dressing for the patient especially if there were signs of slowed healing, such as infection and redness. In the articles of Nain et al (2011) and Suissa, Danino and Nikolis (2010) they claimed that NPWT was safe and effective when compared to any other standard wound care. After the application of the pressure dressing, we need to assess and closely monitor the wound three times in a week. The progress of wound healing can be identified through the presence of granulation and healthy skin. We also need to make sure that the dressing must have no
A supernumerary nurse was working with me for the first week of their familiarisation period. Our patient was a thirty-nine year old woman, Ms LC, who had undergone a laparoscopic peritonectomy. She had a midline abdominal wound that showed slow wound healing. The wound clinical nurse consultant and the doctors during their ward round decided to introduce NPWT to Ms LC’s wound, as this would allow faster healing of her wound.
It was Ms LC’s first time to have NPWT on her wound, patient education was provided ensuring a thorough understanding about the procedure. At the same time, a verbal consent was obtained before commencing on NPWT making sure that Ms LC was fully aware of the process and the possible interventions that can be used throughout the treatment, which Ms LC consented to go ahead. We applied an NPWT using a non-touch sterile technique, started by slowly cleaning the surrounding skin before NPWT was applied. …show more content…
We trimmed the foam and placed the fitted foam in Ms LC’s wound. Upon securing the foam, we covered it with drapes and made a small hole at the centre of the dressing to place the vacuum connector and turned on the NPWT. We waited for some time until the indicator on the machine displayed no air leakage. We also documented in the progress notes what we have performed, filled out the wound chart, and informed the nurse in-charge on the frequency of dressing change in a week.
On the following day during our patient’s handover, we checked the NPWT and it was still in its original place. However, the NPWT was producing a beeping sound, which Ms LC thought was normal. According to Ms LC, it had made noise overnight but did not bother telling the night nurse on duty. We told Ms LC that the NPWT should not make any alarms otherwise troubleshooting was needed. Upon checking on the NPWT machine indicator, it showed an air leak description on the display. Feelings I was alarmed and concerned knowing that NPWT has not been working properly, which could affect the process of wound healing that can lead to further complications such as wound dehiscence and infection. I felt intimidated to ask the night shift nurse because she was more experienced than me; and I did not want to make her felt incompetent. On the other side, I also did not want to make Ms LC felt anxious and upset knowing that there had been something wrong with NPWT. I felt that I have a shortfall in providing Ms LC on one of the most essential information and that was on what to do when NPWT alarms. I also needed to reflect on what else I missed with patient education that I should have done. During our break, I spoke to our educator about the incident. She recommended that I have to speak to the night shift nurse about the incident. Our educator also left a note for the night shift nurse who looked after Ms LC, and asked her if she was aware about what had happened to the NPWT during her shift. When we saw the nigh shift nurse the following day, she was worried about that event. She said that she had been busy with her sick patient and had not thought about checking why the NPWT alarms. Evaluation The whole procedure of NPWT dressing took a lot of time to prepare and set up. I felt that there was a time constraint because I needed to assist my supernumerary, and at the same time to provide all the necessary explanation to the patient to facilitate full understanding about the procedure. NPWT was the most appropriate type of surgical wound dressing for the patient especially if there were signs of slowed healing, such as infection and redness. In the articles of Nain et al (2011) and Suissa, Danino and Nikolis (2010) they claimed that NPWT was safe and effective when compared to any other standard wound care. After the application of the pressure dressing, we need to assess and closely monitor the wound three times in a week. The progress of wound healing can be identified through the presence of granulation and healthy skin. We also need to make sure that the dressing must have no