Negative Pressure Wound Therapy(NPWT)
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1 Negative Pressure Wound Therapy(NPWT) Mark Goetcheus BSN, RN, CWON, CFCN, CDE Wound, Ostomy, Limb Preservation & Amputee Services Harborview Medical Center
2 DISCLOSURES Mark Goetcheus, BSN, RN No relevant financial relationship reported
3 Negative Pressure Wound Therapy (NPWT) KCI Mölnlycke Medela Smith & nephew DeRoyal
4 Negative Pressure Wound Therapy (NPWT) Negative pressure only Reduce Edema Promotes granulation tissue formation & perfusion Removes exudate & infectious material Instillation Vacuum assisted drainage and controlled delivery of topical wound treatment solutions over wound bed
5 Instillation Therapy Negative Pressure + Instillation of fluids NS Dakins Mafenide Fluids: pharmacy Cleanses wound Treats w/ above fluids Ensure you have correct foam
6 Precautions Pts receiving anticoagulation therapy or difficulty w/ hemostasis after debridement Wounds that may contain hidden vessels Do not use 1000mL canister on Pt.s w/ risk for bleeding S/sx of systemic infection or advancing infection at wound site Protect tendons, ligaments, & nerves to avoid direct contact with granufoam (cover w/ non-adherent dressing) Never hook tubing to wall suction Avoid use of circumferential dressings if at all possible
7 Precautions
8 Contraindications Malignancy in wound bed Untreated osteomyelitis Non-enteric & unexplored fistulas Necrotic tissue at wound base Never leave dressing in place without active therapy for more than 2 hours Do not place foam dressings directly in contact with sensitive structures such as exposed blood vessels, anastomotic sites, organs, or nerves.
9 Additional Contraindications for Instillation Do not use with: Octenisept Hydrogen peroxide Solutions that are alcohol based/contain alcohol Do not deliver fluids to thoracic or abdominal cavity due to potential risk to alter core body temp. & potential for fluid retention in cavity. Do not use unless wound has been thoroughly explored.
10 Communication Who is going to change the dressing? RN? MD? ARNP? PA? PT? How frequently is dressing to be changed? Will change occur in the OR? What is the goal of therapy? Closure Operative/Non-operative Exudate management Decrease frequency of dressing changes/pt. comfort Palliative Care patients where closure is not the goal
11 Black vs White Foam Most commonly used Hydrophobic-open pore system Facilitates exudate removal Non-adherent High tensile strength Good for tunneling & undermining Increased density Decreases risk of granulation in-growth. Helps protect delicate underlying structures.
12 Dressing Application Irrigate/cleanse wound w/ NS (or ordered cleansing agent) Dry peri-wound skin Apply skin protectant and allow to dry Window pane peri-wound skin w/ drape Place foam Black is most commonly used White for tunneling, undermining, or fragile/painful areas Instillation has different foam dressing! Cover w/ drape and cut 2.5 cm hole in drape Apply trac pad Hook tubing to unit Be sure dressing is secured/check seal
13 Things to keep in mind: Bridge away from bony prominences or areas Pt. will be laying on. T.R.A.C. pad should not sit directly on skin. Pt s are not to be discharged w/ hospital V.A.C.s. Write date/time dressing changed, how many pieces and what type of foam used, & your initials on dressing to help out the next person who provides care & decrease risk of retained foreign bodies.
14 Incisional Negative Pressure Wound Therapy (inpwt) Purpose: Decrease risk of surgical dehiscence and infection Placed in the OR and left on for 7 days Disposable handheld VAC machine Can be connected to ULTA( more expensive) Assessment: Leaks Sx of infection ú Drainage, peri-wound skin, pain Keep the unit charged
15 Pt Education Incisional Negative Pressure Wound Therapy (inpwt) Leak Alert Check connection, Patching w/drape Canister Full Contact provider Sleeping position tubing to avoid kinking Showering/Bathing Light showering is permissible (with physician approval) Bathing in tub is not recommended Protect therapy unit from getting wet Low Battery Alert will shut off after 7 days Keep unit charged Signs of infection: contact provider
Introduction. Follow standard infection control precautions
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