PLACE LABEL HERE
NEGATIVE PRESSURE WOUND THERAPY
ORDERS
Gwinnett Extended Care Center
The following orders will be implemented. Orders with a “q” are choices and are NOT implemented unless checked.
Initial all handwritten order modifications. Complete signature section at bottom.
1. Initial Negative Pressure Therapy applied to:
Location: ______
Date: ______By: ______
2. Wound Care Nurse to change wound vacuum dressing changes q ______
3. Settings: q Continuous therapy q Intermittent therapy
q 100 mg Hg q 125 mm Hg q 150 mm Hg q 175 mg Hg q Other: ______
4. Change wound vacuum canisters when full and dispose in Biohazard bag
5. Monitor color of drainage every shift.
6. Troubleshooting air leaks/device has no suction:
· Check on/off button and device settings
· Check all tubing to ensure clamps are open and tubing is not clamped off
· Auscultate the wound dressing with a stethoscope to help identify area of leak
· Place clear plastic drape over existing dressing and seal off area of leak
· Check device settings to see if negative pressure has been resumed
7. If Wound Vacuum fails to maintain seal and suction for more than two hours:
· Remove dressing and sponges from wound bed
· Clean wound with normal saline
· Apply saline soaked gauze to wound bed
· Cover with dry 4 x 4s and/or abdominal pads
· Secure with paper tape or gauze wrap
· Change wet/dry saline dressing every day and as needed
· Notify Wound Care Nurse that wound vacuum needs to be reapplied
8. Further instructions for applying sponge to wound bed: ______
______
9. Do not allow dressing area to get wet. Showering allowed only on scheduled dressing change day, no more than 2 hours prior.
10. Do not turn off wound vacuum for any reason except # 7 or # 9 above.
______
Date Time Physician Signature PID Number
*1-43225* FORM 1-43225 INITIATED 09/2017 Page 1 of 1