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This article outlines the development, implementation and evaluation of a formal training program in skin care and pressure injury prevention and management. The program was developed for assistants in nursing (AINs) at St Vincent's Private Hospital (SVPH), Sydney. SVPH is a not-for-profit, acute care facility with 250 beds. Our current case mix index for January to May 2012 is 1.871. In late 2009 the wound clinical nurse consultant (CNC) identified that the AIN cohort received no formal education in skin and pressure injury prevention and management. In 2010 a tailored program specifically for AINs was developed by the wound CNC in consultation with the Nursing Education Training and Development Council to update and extend AINs' knowledge and skills in this area. With the support of the nurse unit managers (NUM) and clinical nurse educators (CNE), all 19 AINs enrolled completed the course successfully. On review of the 2010 Pressure Ulcer Point Prevalence Audit (PUPPA) results, there was a decrease in the prevalence in pressure injury from 11% to 7%, with the only new pressure injury intervention being the AIN education program. Although we have no true measure as to the effect of the AIN education program, it can be hypothesised this was a significant contributing factor to the reduction of pressure injuries acquired at SVPH. [ABSTRACT FROM AUTHOR]

Lymphoceles and lymphatic fistulas are rare and often serious complications of vascular surgery and procedures that access the groin to expose the femoral artery. The prevalence of lymphoceles and lymphatic fistulas following femoral dissection for vascular surgery or procedures has been reported as 1–4% (Porcellini et al, 2002; Aba et al 2005). 10–18% of all lymphoceles and lymphatic fistulas are reported to be complicated by subsequent wound infections (Giovannacci et al, 2001). Current management, with bed-rest, limb elevation, compression dressings, antibiotics, and/or surgical exploration requires prolonged hospitalisation (Giovannacci et al, 2001; Porcellini et al, 2002; Aba et al 2005). Results with surgical exploration are unsatisfactory, and offending lymphatic channels are often not identified (Wipke-Tevis, 1999; Porcellini et al, 2002). In recent years, vacuum assisted closure (VAC) has been used to control lymph drainage, decrease time to fistula closure, increase patient comfort, facilitate early mobilisation, enhance wound closure, and permit earlier discharge (Greer et al, 2000; Aba et al 2005). The technique consists of placing open cell foam into a wound and sealing the site with an adhesive drape while applying sub atmospheric pressure (125 mmHg) to the wound in a controlled manner. This paper presents the results from five patients who presented with clear, serous drainage appearing spontaneously from the groin and thigh wounds 4, 5, 6, 7, & 9 days after femoral dissection. All patients were managed nonoperatively using a VAC dressing powered by a portable unit. All patients were allowed to resume normal daily activities following VAC portable placement. Once VAC therapy was initiated, wound lymphorrhea ceased in a mean of 11.6 days (7, 10, 11, 12, and 18 days). There were no wound infections after placement of VAC. This experience is limited to St. Vincent's Private Hospital, but, VAC therapy appears to offer improved management of femoral lymphatic fistulae. [ABSTRACT FROM AUTHOR]