Caring - Dartmouth-Hitchcock

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When it comes to advanced wound care
management, few nurses have the
expertise of Nancy Karon, RN, and her
colleague Melissa Garland, RN, DHMC
inpatient surgery clinical coordinators.
“As the clinical nurse leaders on 4
West (general surgery), we’re often the
ones that are asked by the physician
teams and nursing staff to help evaluate
and treat difficult wounds,” says Karon.
“The larger and more complex they are,
the more closely we get involved.”
Applying VAC Dressings
Karon and Garland specialize in applying
negative pressure dressings to
patient wounds utilizing a VAC (vacuum
assisted closure) device.
“We use it on all of our varied surgical
services patients when there is an
indication for it,” says Karon. “It can be
very helpful in cases such as surgical
wounds (left open because of an infection),
ulcers, or split-thickness skin grafts.”
The sponge-like VAC dressing can be
cut exactly to fit inside the patient’s
wound bed, leaving the healthy tissue
surrounding it undisturbed. The wound
area is then covered with a sticky wrap
to make the dressing air-tight.
A tube or suction catheter connects
the dressing with a machine that contains
a collection canister. “With wall suction,
the sponge compresses, pulling away
excess fluid, and increasing blood supply
to the area,” explains Karon. “The pressure
also creates a physical pull on the
tissue that stimulates cellular growth.”
Improving Patient Care
In addition to improving the healing
process for wounds and reducing the time
required for skin grafting, the VAC dress-
ing offers a number of other advantages.
“Patients have fewer dressing
changes,” Karon says. “The VAC dressing
can be changed three times per
week versus three times per day, as with
other types of dressings. That means less
pain for patients, and fewer times they
may need to be medicated. And with
drainage contained, they have a better
sense of well-being.”
Nursing Expertise Aids Wound Care Management
“As the clinical nurse
leaders on 4 West
(general surgery), we’re
often the ones that are
asked by the physician
teams and nursing staff
to help evaluate and
treat difficult wounds.”
For some patients, it can also mean
getting a long-awaited shower sooner.
“A couple of years ago, we had a young
patient who had been in a bad car accident
and had a severe leg wound,” says
Karon. “His dressing was very complex—it
took three of us to do it. He
came to us in late December and we
weren’t able to discharge him to rehab
until early February—he hadn’t had a
shower in all that time. Shortly before he
left for rehab, we were able to get him
into the shower. He was in heaven.”
“He’s a patient that I’ll never forget,”
she says. “I know that nursing’s time and
dedication spent attending to his dressings
played an integral role in his recovery.
He’s had some reconstructive
surgery, and he always pages us when
he comes back, to say ‘hello.’ I just smile
every time he’s been here—it’s very satisfying
when you know you’ve made a difference
in a patient’s life.”
Wound Team Established
According to Karon, DHMC has formed
a surgical wound team consisting of Drs.
Horace Henriques and Paul Kispert,
Garland and Karon, and nurse specialists
from the trauma, plastic surgery, and
discharge planning departments.
“We’ve just begun to meet on a
weekly basis to evaluate the large or