15 October 2021
It's been a little busier than usual around here. And a little more difficult.
Late yesterday Apria brought a new Wound VAC on the assumption Joyce somehow didn't have one yet and some basic supplies but not the ones Kevin the RN had ordered. I took anything with drape in it anyway.
And the canisters. Joyce was down to her last two.
The new wound dressing has been causing problems but only at night. In the middle of the night we hear incessant leak alarms from the Wound VAC. But I've been unable to find any leak.
I tested the canister by plugging the tube leading into it and it seals fine. And I covered the wound with more drape even though I didn't hear any hissing. I even replaced the lily pad. No improvement.
I've actually had to shut the pump down to stop the alarms and get some sleep. Not recommended but we had to sleep. It's been off from three to six hours, less than the maximum eight.
When Joyce wakes up in the morning, she turns it on and there are inexplicably no alarms all day.
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TODAY I ASKED Cat the Physician's Assistant to investigate. She pointed out that the home nurses were using too large a sponge. She had used medium sponges and they cut down a large sponge. The sponge was overlapping the skin, causing maceration and leaking. It was the only thing I didn't dare change.
As it happened, today Joyce had a new LVN do the dressing change as soon as we got home. Cat had close the wound with a wet-to-dry dressing because she only wanted to inspect the wound. It's no worse, she said, and that's good.
We got to the house just before Quoia (short for Sequoia) the LVN. Kevin the RN had planned to join us but couldn't. No matter, Quoia was more than competent. She's a Wound VAC expert.
I briefed her on the dressing Cat had ordered: Lidocaine, petroleum dressing, black foam, bridge. And I explained the thinking behind each of them. She knew exactly what I was talking about.
But she had her own approach. They all do.
In her case, she likes to "frame" the wound with thin pieces of drape to protect the skin. "Would you like me to do that?" she asked. Oh yeah, let's try it.
She put Lidocaine on the wound first (and made sure we could get more). Then she put the petroleum dressing on (whose position she confirmed with me).
Then she cut a medium sponge to fit the wound. It was quite a difference from cutting down the large sponge. And she carefully applied the drape over it, minimizing any air pockets to get a good seal later. That's the trick.
She built a bridge by cutting slices off a large sponge and then put the lily pad on. When she connected the VAC, it took a while to seal but when I suggested she press on it as Kevin had, it finally caught, getting 125 pounds and holding it easily. The pump doesn't run continuously when you get that right.
I took photos and texted them to Salwa so she knows what Quoia did. And later, after confirming the pump was behaving better, I texted Quoia our thanks.
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MEANWHILE in Daly City, Mom's friend Annette visited for the first time in 20 months, bringing some prosecco to celebrate. But she texted me that Mom's leg was quite swollen and weeping.
I contacted my mother's nursing service to ask them to send her nurse over to have a look and dress any wound.
Then we had dinner. Sushi tonight because it was too hot to turn on the stove.
Alice texted shortly after to say she had been talking to Mom when they were cut off and she wasn't able to reach her again. A little while later, Mom called her to tell her she was all right.
So there's a fire burning on that front too.
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JOYCE DID TAKE a walk this afternoon around the block. And yesterday she took a longer one down the hill and around that much longer block. Today we also went to the market for the first time to get that sushi.
She's moving slowly but she's moving. And with a more comfortable dressing, she should be able to do more. This one stays in until Monday when Salwa will try to duplicate what Quoia did.
And I'll be there to coach her.