Best Practices

“Ouch! That hurts!”

By Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS

Wound pain can have a profound effect on a person’s life and is one of the most devastating aspects of living with a wound. In addition to pharmaceutical options, wound care clinicians should consider other key aspects of care that can alleviate pain. Here is a checklist to ensure you are thorough in your assessment.

Skin protection

✓   Offload bony prominences to reduce ischemic and traumatic pain.
✓   Use a bed cradle to lift the weight of bed linens off the patient’s hypersensitive areas.
✓   Use splinting to immobilize injured tissues.
✓   Use transfer-assist devices to reduce pain during transfers.
✓   Use lift sheets to avoid friction shear pain.
✓   Protect periwounds from maceration and epidermal striping by using skin sealants and moisture barriers.

Dressing changes

✓   When removing tape, pull the tape parallel to the skin, towards the dressing. Pull slowly and keep your hand low. If the tape is over hairy areas, remove it in the direction of hair growth.
✓   Minimize sensory stimulus; for example, decrease wound manipulation
✓   When possible, allow the patient to perform his or her own dressing changes.
✓   Schedule dressing changes when the patient is feeling best.
✓   Minimize the number of dressing changes.
✓   Soak dried dressings before trying to remove them.
✓   Avoid overpacking the wound with dressing. For tips on wound packing, watch the video “Clinical Wound Packing.”
✓   Use low-adhesive dressings.
✓   Line the wound with a low-adherent
liner to avoid trauma when removing the packing or foam.

Wound V.A.C.® considerations

A Wound Vacuum Assisted Closure (V.A.C.®) device can ease pain, but it’s important to care for it properly.
✓   Instill 10 to 30 mL of normal saline solution into the V.A.C.® tubing to soak underneath the foam. Let the saline solution sit for 15 to 30 minutes before gently removing the dressing.
✓   Saline solution also can be injected directly into the foam while low vacuum is applied to the dressing. Clamp the tube once the saline solution starts to flow into the dressing tube. Wait 15 to 30 minutes before gently removing the dressing.
✓   Cut the V.A.C.® sponge to the exact size of the wound. Avoid overlapping of the sponge onto good skin unless bridging is necessary to prevent skin maceration.
✓   If granulation tissue is growing into the sponge, increase the frequency of the dressing changes.
✓   Line the wound bed with a white, polyvinyl alcohol soft-foam sponge, a nonadherent oil-emulsion type dressing, a contact layer dressing, and a thin layer of amorphous hydrogel or calcium alginate before the gray sponge
application.

For more information, access “Wound V.A.C. dressing change” from U.C. Davis Health System.

Reduce edema

✓   Elevate legs to reduce edema-related pain.
✓   Use appropriate vascular compression wraps to control edema and reduce pain.

Complementary therapies

Consider using the following complementary therapies:
✓   Relaxation and massage therapy—These help reduce tension and anxiety, which can improve the patient’s pain tolerance by breaking the anxiety-pain cycle. Read more about relaxation techniques.
✓   Visualization and imagery—Focus the patient’s attention away from the painful stimulus by creating images that are
either consciously selected (visualization) or spontaneously occurring from the unconscious (imagery).
✓   Distraction—Use a specific physical stimulus, such as television, music, or conversation, to draw attention away from the pain.

Psychological/teaching

✓   Teach the patient and significant others about pain management and wound treatment plans.
✓   Evidence shows that how people think about pain can change their sensitivity to it along with their feelings and reactions, so try such tactics as holding the patient’s hand, offering reassurance, acknowledging the pain, explaining all
interventions, restoring a sense of self-control, and having the patient help with dressing changes by holding the dressing in place or cutting tape.
✓   Allow for breaks during painful procedures so the patient can rest.

Donna Sardina is Editor-in-Chief of Wound Care Advisor and cofounder of the Wound Care Education Institute in Plainfield, Illinois.

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Wound Care Advisor

32 thoughts on ““Ouch! That hurts!””

  1. sonja tabbert says:

    I hah tripple heart surgery and after nurse home dis not properly care for wound. Dr decided to put wound wac on. Wound is healing but process is very slow. Especially since I am also diabetic. If nursing home would have properly took care of wound I would be healed by now.it has been 2 months plus.is it normal to have vomiting when vac is changed 3 times a week ???

  2. Leo K says:

    I have been on VAC treatment for a leg wound for the past 9 days. For the first six days I was in hospital on IV antibiotics. The antibiotics were discontinued three days ago.

    I have noticed that where the wound meets the foam, the flesh is a pinkish colour all round. Yesterday the visiting nurse said the wound looked very clean.

    Is the pinkish flesh all around the wound normal and likely to be just caused by the suction, or could it be a sign of infection?

    Thank you for any advice

  3. Joshua Wigginton says:

    I will be getting a wound VAC tomorrow. The wound in question is in a bad area, being on the upper part of the crack between my buttocks. I am worried about pain severely. I recently watched an online video of the application and changing of the dressing. It seems to me that those actions will be very painful. I am not sure what to expect. I’d there any advice as to minimizing pain? My doctor has assured me that it will not be painful only uncomfortable. That is the same thing I was told about a catheter. That itself hurt severely. Thanks.

  4. Ian Paice says:

    I had the “pleasure” of utilizing the wound vac for an inner thigh necrotizing faciitis post operative care in 2012. While the wound healed nicely, the pain was unbearable, until the outpatient wound care nurse suggested a 50-50 mixture of NS and lidocaine being applied to the dressing 15 mins prior to dressing change. Prior to this, 8mg of hydromorphone would not touch the pain from the dressing changes, of which I can only describe as 1 million tiny fishhooks being ripped from my flesh. By the second dressing change utilizing the lidocaine mixture, I was removing the sponge dressing on my own, with minimal nursing assistance until the replacement of the dressing and covering.

  5. Thomas says:

    I am extremely sick in my stomach that VAC isn’t working for my dad diabetic ulcer. His ulcer is just over a month and already debridement more than 10 times once qith jet and twice using operating room surgery. I guess next step is amputation.

  6. Gary Donahoo says:

    This is the second time I have had a KCI wound vac. I am a T-4 paraplegic and my wound is on my left buttock. The problem I am having is not pain from putting the VAC on or taking it off, I have excruciating burning pain after the VAC has been on for a while. When the VAC is put on I’m all right for 12 to sometimes 20 hours depending how many Percocet’s I take but after that the wound starts to burn so bad I cannot stand it and have to take the VAC off. They have my VAC scheduled for change every other day or two.
    I don’t know how to handle the pain I am going through. From what I have read this VAC is not supposed to hurt the way it does.
    Because of the pain I am going through my wound is not healing the way it’s supposed to. Anyone else have this type of pain with the Wound VAC if so how did they handle it or what changes were made to stop the pain?

  7. Susan says:

    I’ve had a wound vac for about a week and a half now. I have fortunately had no pain with it, although that is from the diabetic neuropathy in my foot. (I had my big toe removed.) I’ve had the dressing changed once, no problem. My concern is that some of the skin under the dressing is staying wet. It was wet when the dressing was removed, and as it was only off for twenty minutes or so that skin couldn’t really dry out. Right now I’m getting it changed once a week, as its an hour drive each way to the doctor’s office. I just don’t like that damp skin, but don’t see how to dry it with the wound vac on.

  8. stacia says:

    My dr recommended the vac well lets just say if i could turn back time there would be no way i would be going through this pain,, i had to have my inner thigh removed and just had my first dressing change ,, ive never experienced pain like that in my life,, i delivered twins vaginally and would do it twice a day compared to the pain associated with the vac. Im more stressed out about the dresssing chNge tomorrow all i can think is just sedate me. Am happy i found this site and reading everones comment tomorrow iam taking a shower and peeling that tape off myself and drenching the foam with saline solution ..

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