Vacuumed Assisted Closure

Transcription

1 Vacuumed Assisted Closure Louise Morris Lead Nurse in Tissue Viability Jackie Stephen-Haynes Consultant Nurse and senior Lecturer in Tissue Viability 2009

2 Aims and Objectives To develop an awareness of some common applications for VAC therapy Introduce the theoretical and practical issues associated with TNP Understand the importance of patient assessment prior to treatment Define Topical Negative Pressure (TNP) and mode of action Explore types of TNP available Examine Vacuumed Assisted Closure (VAC) Operation Application Types of System and Consumables Indications / Contraindications For staff to be able to discuss the wider management issues related to New therapies

3 Definition of TNP Controlled application of subatmospheric pressure to a wound using a therapy unit to intermittently or continuously convey negative pressure to a specialized wound dressing to help promote wound healing An active therapy rather than a wound dressing ( Baxter 2001)

4 Topical Negative Pressure Argenta Morykwas technique of TNP - subatmospheric pressure applied to open cell foam dressing positioned in a wound The Chariker-Jeter technique consists of a porous wound dressing, a drainage tube placed adjacent to or inserted into the dressing, an occlusive transparent film sealing the wound and the drainage tube, and a connection to a vacuum source

5 History First used in 1988 by Professor Argenta using pigs Fist used on humans in 1989 Fisrt used in UK in 1994

6 Clinical Benefits Controlled, localised sub atmospheric pressure to wound bed Removal of interstitial fluid, allowing tissue decompression and enhancing blood flow Increased blood flow and promotion of granulation tissue in a closed moist environment Reduction in bacterial colonisation Enhances dermal perfusion Exudate management Reduces wound volume

7 Clinical Benefits Removes excess exudate and promotes a moist rather than a wet healing environment Promotes granulation through increased angiogenesis Reduces bacterial count at wound bed Reduces oedema in surrounding tissues ( Joseph 1997) Removes some of the local barriers to wound healing, including bacteria, MMP s Promotes flap survival and graft uptake Cost effective Suitable for a variety of acute & chronic wounds

8 Mode of action Foam acts as wound contact layer Connected to suction tube and canister which fits on side of vacumn pump unit Whole system is reliant on an effective seal around the dressing achieved with the film drape Pump delivers intermittent pressure Normal therapeutic pressure is 125 mmhg.

9 Summary VAC Benefits

10 TNP in Worcs PCT Care and management of a patient undergoing TNP will be performed by a registered Health care professional who has completed theoretical and practical competencies or is supervised by a competent practitioner.

11 Which patient- PCT? Diabetic foot ulcers with adequate perfusion Dehisced wounds Pressure ulcers at discretion of TVN Skin graft fixation Exceptional cases at discretion of TVN Max 4 weeks funding A TNP audit and referral form to be used to request funding from the PCT. Audit data to be obtained initially, during and on completion of treatment which should be submitted top the Consultant Nurse in TV

12 Types of Wound- Acute Pressure ulcers Diabetic foot ulcers Pilonidial Dehisced abdomen Sternal Extravasation injuries Necrotising fascitis

13 Care Holistic assessment Nutrition assessment Waterlow risk assessment Verbal consent for treatment 2cm area of intact skin around wound to ensure seal or consider bridging, mushrooming. TNP to be administered in accordance with the guidelines Once TNP has been selected the therapeutic aim should be clearly identified and progress carefully monitored.

14 Contra-Indications The patient declines Malignancy in the wound Untreated osteomyelitis Non-enteric and unexplored fistulas Necrotic tissue with eschar present Exposed blood vessels or organs require particular knowledge and skill Difficult wound haemostasis/ active bleeding Sensitivity to silver if TNP GranuFoam Silver Dressing only is considered

15 Limitations to practice Patients anti-coagulated with 4-6 minutes clotting time ( INR check) Proximity to blood vessels and organs.. Greater care in respect to weakened, irradiated or sutured vessels or organs Bone fragments or sharp edges that may puncture the seal Availability of competent staff

16 Patient assessment PMH Treatment options to date Underlying aetiology Pt Understanding Nutritional support Location of care and commitment Pain Mobility Personal hygiene Wound assessment TIME

17 VAC Portfolio An Advanced Therapy System for Wound Healing (ATS) The V.A.C. ATS System is designed for higher acuity wounds for patients in acute care and long-term care facilities The V.A.C. ATS System features patented Therapeutic Regulated Accurate Care (T.R.A.C. ) technology for safe, controlled wound healing

18 VAC Portfolio V.A.C. Freedom System A portable system for advanced wound healing The is lightweight and portable, helping patients return to work and daily activities It features patented Therapeutic Regulated Accurate Care (T.R.A.C. ) technology for safe, controlled wound healing

19 VAC Portfolio The InfoV.A.C. Therapy System Designed to make using V.A.C. Therapy even easier and to keep Health Care professionals more informed about their patients progress This includes new features, like SensaT.R.A.C. Technology, including Seal Check,Therapy History Reports and Digital Wound Imaging

20 VAC Portfolio The ActiV.A.C. Therapy System Designed to make it easier for patients to resume their activities of daily living while helping to provide and document proper V.A.C. Therapy usage New features include SensaT.R.A.C. Technology, Seal Check and the Therapy History Report

21 Types of VAC Foam

22 Therapeutic Regulated Accurate Care (T.R.A.C. ) technology

23 VAC Canisters

24 VAC Drape

25 VAC Y TRAC Connector

26 VAC Gel Strips

27 VAC Bridge Dressing

28 VAC Abdominal Dressing

29 Application of dressing Assess the wound bed Cleanse the wound Cut foam to size and shape of wound Line wound with non-adherent dressing as necessary protect peri-wound Insert foam into wound Suction tubing applied over foam Check dressing has a good seal Set pump according to patients needs Release clamps Ensure patient comfort DOCUMENTATION

30 Removal of the dressing Analgesia as required Apply clamps Turn off pump unit Release any retention bandaging Irrigate foam dressing to assist removal Assess the wound bed, peri-wound and surrounding skin

31 What if? TNP dressing adheres to wound bed Dressing does not collapse Very large wound 2cm peri-wound area not available Tubing causes damage Patient complains of pain End Cap Test test machine

32 Benefits of VAC for Pilonidal Disease Post surgery, VAC offers a safe and reliable alternative: It affords fewer dressing changes, Allows mobility and permits earlier return to activities of daily living. Reduced treatment time compared to the standard surgical treatment with local wound care (one study - 8 weeks vs 11 to 24 months) Improved healing rates

33 Cost to patient? Reduced hospital stay or prevention of admission Reduced dressing times Greater freedom Reduced risk of surgical intervention.

34 Contra-Indications Bleeding complications: Weakened or friable blood vessels or organs in or around the wound Inadequate wound haemostasis Patients on anticoagulants or platelet aggregation inhibitors Patients who do not have adequate tissue coverage over vascular structures Do not place foam dressings on anastomotic sites, organs, or nerves

35 Summary Effective option for the management of many types of wound The decision to use depends on the patient, contra-indications to use, Consultant, medical appropriateness, availability and agreement to funding New PCT-Acute Commissioning Policy and local guidelines address these issues to ensure timely, appropriate and cost-effective use

36 Thank You Worcestershire Acute Hospitals and PCT also wish to express their thanks to for all their support with undertaking sessions on TNP