DPT 5381: Negative Pressure Wound Therapy (NPWT)

what does NWPT apply?

controlled suction via subatmospheric pressure to open wounds

what is NWPT used for?

acute and chronic wounds

when <30% wound bed is necrotic tissue

what is necessary with NPWT?

airtight seal with suction, foam/other medium

what does NPWT increase?

- moist wound healing

- local tissue perfusion

- wound edge approximation

- stim granulation tissue and cell proliferation

- angiogenesis

what does NPWT reduce?

- edema and interstitial fluid

- bacterial load

- need for dressing changes

what are the 6 principles of NPWT?

1. occlusion

2. cellular deformation

3. fluid removal

4. circulation

5. contraction

6. bioburden

what are the indications for NPWT?

- acute trauma/surgical

- grafts and flaps

- full thickness wounds

- chronic wounds

- diabetic ulcers

- pressure ulcers

precaution or contraindication?

anticoagulants

precaution

precaution or contraindication?

low platelet count

precaution

precaution or contraindication?

nonenteric and unexplored fistulas

precaution

precaution or contraindication?

over some structures

precaution

precaution or contraindication?

monitor for bleeding

precaution

precaution or contraindication?

avoid circumferential occlusive sheeting application

precaution

precaution or contraindication?

dressing over bony prominences/hardware

precaution

precaution or contraindication?

debride sharp edges/exposed bone

precaution

precaution or contraindication?

heavy, sanguineous exudate

precaution

precaution or contraindication?

wound with >30% slough/necrotic tissue

contraindication

precaution or contraindication?

untreated osteomyelitis

contraindication

precaution or contraindication?

gross infection with/without frank pus/sepsis

contraindication

precaution or contraindication?

malignancy

contraindication

precaution or contraindication?

lack of hemostasis

contraindication

precaution or contraindication?

blood dyscrasia w/ leukemia/hemophilia

contraindication

precaution or contraindication?

over exposed vessels, bypass grafts, organs

contraindication

precaution or contraindication?

ischemic wounds w/ proximal occlusion

contraindication

precaution or contraindication?

high potential for graft disruption

contraindication

precaution or contraindication?

suction devices/pumps, flammable anesthetics

contraindication

precaution or contraindication?

wounds with negative response to initial treatment

contraindication

what are strip dressings?

covers linear wounds over suture lines

specialty design

are indwelling or exdwelling drains more difficult to obtain a seal with?

indwelling

does a continuous or intermittent setting stim quicker granulation tissue formation?

intermittent

why are intermittent wounds not always optimal?

- highly exudating wounds

- painful wounds

- difficult seals

describe gauze dressing

- decreased tissue ingrowth and pain with removal

- slower tissue growth (better quality)

- easier for undermining/tunneling

- less scarring

describe foam dressing

- faster growth into foam

- pain with removal

- fast tissue growth (poor quality)

rapid closure

- difficult to place

what technique should be used?

sterile technique

how often do infected wounds need to be changed?

12-24 hours

standard dressing

how often do non-infected wounds need to be changed?

48-72 hours

what can be added to increase time between changes?

antimicrobial

what foam is used for the most effective stimulation of granulation and contraction?

black, polyurethane

what foam is used to cover exposed structures?

white, poly-vinyl-alcohol

what do pressure setting typically start at?

125 mmHg

when are pressure settings titrated up 25 mmHg?

- excessive drainage

- serous drainage

- large wound volume

- tenuous seal

when are pressure settings titrated down 25 mmHg?

- pain

- bruising

- elderly

- excessive bleeding

- hypergranulation

- exposed arteries/veins

what is the most widely used and studied device?

KCI Vac

what pressure are KCI Vac dressings set at?

125 mmHg

why is foam useful with KCI Vac Veraflo with instillation?

hydrophilic, allows solution to remain in foam

what does KCI Vac Veraflo with instillation decrease?

trips to OR

frequency of changes

PICO:

no canister, all-in-one dressing with multiple sizes

what is a typical intermittent setting?

5 min on, 2 min off

what is the average pressure setting?

25-200 mmHg

when are lower pressure settings used?

pediatrics

over vital structures

what does bridging allow for?

2 wounds to be connected to 1 drain

where should a drain be palced?

between 2 wounds or over cleanest of the 2