Negative Pressure Wound Therapy in Wound Healing

NPWT

through a closed wound dressing and attached suction, NPWT applies controlled sub-atmospheric pressure to open wounds

benefits of NPWT

cell deformation, protection/moist wound environment, fluid removal, contraction, increase granulation tissue, decrease bioburden

indications for NPWT

acute wounds, traumatic wounds, over at-risk surgical incision, open abdominal wounds, dehisced surgical incisions, flaps/grafts, stage3/4 pressure injuries, enteric fistulas, palliative care, crhonic wounds

the trek pad of a wound vac should be

100% over the foam layer

NPWT for surgical incisions

pulls drainage out for the wound to heal - sent home with pt after surgery

NPWT precautions

active bleeding, anticoagulants, difficulty maintaining seal, uncontrolled pain, nonadherence, unexplored fistulas, special populations

NPWT contraindications

malignancy in wounds, presence of necrotic tissue, untreated infection/osteomyelitis, ischemic wound, exposed arteries/veins/organs, untreated coagulopathy, allergy to dressing

wound filler options

black foam, white foam, antimicrobial gauze, saline moistened antimicrobial gauze

continuous vs intermittent NPWT

recommended to transition from continuous to intermittent therapy after the first 48 hours on acute wounds and pressure ulcers

indications for use of continuous therapy throughout treatment

discomfort with intermittent, difficulty maintaining seal, sternal wounds, abdominal wounds

consider increasing pressure by 25mmHg increments if

wound is large, versafoam is being used, seal is difficult to maintain, drainage is excessive

consider decreasing pressure by 25mmHg increments if

pain is not relieved with aggressive analgesia, wound bed is bruised, pt is elderly and/or nutritionally compromised, pt is on anticoagulants, granulation tissue growth is excessive

considerations with NPWT

dont over pack wound, pack tunneling/undermining, good seal for consistent suction, monitor tubing placement for pressure, modify dressings based on pt, set up device based on manufacturer recs

dressing MUSt be placed

inside tunneling to avoid abscess formation - place all the way for initial dressing, and leave 1cm between dressing and distal tunnel in subsequent dressings

all undermined areas

must be filled with dressing but dont overpack, as granulation increases use less dressing material in undermined areas

in cases where pain is experienced with dressing removal, attempt

premedication, introduce normal saline into tubing and let it soak, inject lidocaine without EPI into dressing and let soak

if fecal contamination has occured

the dressing must be changed immediately

expected NPWT outcomes

beefy red appearance, increase in granulation tissue, decrease in wound size and drainage

signs of wound deterioration

wound appears bruised, darker or grayish, theres increased slough, increased odor evident of infection

steps to take for wound deterioration

rule out osteomyelitis/infection, evaluate dressing chage frequency and pressure setting

discontinue NPWT if

wounds fail to improve, complication develop, poor patient adherence/tolerance or once goals are acheived