Newletter+2015+August

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** CCRMC Perinatal Newsletter: Post Cesarean Wound Care **


 * What is with this wound vac on a post op cesarean patient? **

Most likely this is a prophylactic wound vacuum called a **Prevena**. The vacuum dressing is placed over the closed incision (staples or subcuticular suture) in an effort to promote healing and prevent infection in very high risk patients such as those with BMI > 50 or difficult to control DM.

The Prevena is supposed to: Take tension off the wound Keep out evil bacteria with a vacuum seal Prevent bacterial growth with silver in the dressing Compress the lymphatics to prevent seroma formation.

The Prevena comes with a portable suction device about the size of a book that has a one week battery life. The device has a canister that collects fluid.


 * What is my job in clinic? **

If it is 6-7 days post cesarean, you must remove the Prevena. Hold down the round button on the front of the battery pack until it shuts off
 * Peel off the dressing. Ignore any odor—this usually does not indicate infection.
 * Check the wound. If staples are present, remove them and place steri-strips.
 * Any problems call an OBGYN Attending on-call or OB Dept member present at your site
 * The device is disposable. If you return it to L and D we will submit it to the recycling program.

If it is 3-5 days post cesarean and she is coming in because of a problem with the Prevena consider the following:
 * 1) 1. If the battery pack is beeping, hold down the button until it turns off. Hold down this same button to turn it back on.
 * 2) 2. Check the seal around the dressing. It can be reinforced and the device turned back on
 * 3) 3. Check connection to batter pack. Tighten and try turning the device back on
 * 4) 4. Check the canister—this can be replaced although the replacements are available only at the hospital
 * 5) 5. Try turning it back on.
 * 6) 6. Call an OB Attending on-call or present at your site, or at L and D 925-370-5608
 * 7) 7. If unable to trouble shoot, remove the Prevena by peeling it off the wound.


 * My patient doesn’t have a Prevena but she does have the dressing ** **still over the incision**

This is likely an **Optifoam** dressing. The dressing has a light colored foam pad in the center and clear silicon around the edges. This dressing should be removed after a week (patients are instructed to do it themselves). It peels off without difficulty. It can be put back down if you look under it at the wound. It adheres to dry skin without using a tape adhesive. If it is not sticking, just remove it. Any questions, call an OB Attending.

We have been decreasing the wound infection rate for our patients who deliver by cesarean section. Other measures include:
 * An anti-bacterial cleaning at home prior to coming to the hospital
 * An anti-bacterial wipe whenever the situation suggests a potential cesarean birth
 * Modification of the wound prep and allowing adequate time for it to dry
 * Increased dose of pre-incision antibiotics
 * Attention to the time it takes to complete the surgery
 * Special dressings to prevent contamination of the wound postpartum


 * If you are see problems with cesarean wounds or dressings please email via lotus notes Judy Bliss or Grace Cavallaro. **


 * Please Remember: **
 * ** Rhogam at 28 weeks and if bleeding during the pregnancy **
 * ** Record all ultrasounds in the dating section with any relevant comments to let others know you reviewed the ultrasound report **
 * ** Urine GC/chlamydia with third trimester labs if h/o infection in pregnancy, or otherwise at increased risk for infection late in pregnancy. **
 * And **


 * Welcome our new OBGYN Dept member __Rachna Vanjani, MD__ coming to us from Boston, MA recently and Washington DC previously. **
 * She is a National Health Scholarship recipient and dedicated to helping the underserved. She has a particular interest in providing health care to incarcerated women. In addition to English, she speaks Spanish and Hindi. **