Negative Pressure Wound Therapy

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Negative Pressure Wound Therapy

• Jen Agosti, RN, CWCA, CFCN, FACCWS, DAPWCA
• President, Nurse Sharks, Inc.

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Agenda
1. History/Definition of NPWT
2. Approaches to NPWT
3. Indications/Precautions of NPWT
4. The Invia Healing System
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When Did NPWT Begin?
Modern history of NPWT
1947 Russia used suction For post-op wound
Exudate with wall Suction gauze1
1952 closed Suction used Prophylactically Post-
op to reduce complications2
NPWT
1989-2000sNPWT Systems released Medela, KCI,
Smith-Nephew, etc.
1986Kremlin Papers Describe closed suction As
effective to decrease Wound healing times
and Reduce hospitalizations3
1989 Charker Jeter Publish findings of
the Effects of NPWT in Healing wounds4
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Approaches to NPWT
Gauze
Foam
The use of foam as the medium for NPWT was
originated in the United States by KCI. Several
types of foam dressings are available. Each
require a suction level of -125mmHg in order to
compress the foam layer.
The use of saline saturated gauze with NPWT was
the original approach to NPWT. This method in
modern medicine includes a non-adherent contact
layer to prevent tissue growth into the woven
gauze layer.
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Indications for NPWT
Full thickness Pressure ulcers
Surgical wounds
Traumatic wounds
Diabetic Neuropathic wounds
Less than 25 slough Tissue no Attachment To
major Organs or Blood vessels
Dehisced Surgical Wounds no major Organ
or Blood Vessel attachment
Amputations Lacerations Acute wounds
Chronic/ Non-healing Wounds Free of or Being
treated If osteomyelitis Is present
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Contraindications for NPWT
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Precautions for NPWT
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Physiological Benefits of NPWT
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Factors That Effect Healing
Nutrition
Off-loading
Medications
Infection
Co-morbidity
Age
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Healing with NPWT
Research Supports5 that
Wounds Heal up to 61 faster With NPWT
Financial Burden Decreases up To 83 with NPWT
Infection Rates drop As much As 38 with NPWT
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Types of Wounds Indicated for NPWT
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Medela Vario

• Medela Vario
• FDA cleared for topical negative pressure to
  promote wound healing and remove wound exudate
• HCPCs codes for NPWT canister set and wound
  dressing/drain set
• Internal Swiss technology for suction regulation
• Portability with back-up battery

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Medela Liberty

• FDA cleared for topical negative pressure to
  promote wound healing and remove wound exudate
• HCPCs codes for NPWT canister set and wound
  dressing/drain set
• Innovative internal features for completely
  accurate suction regulation
• Downloadable patient information feature
• Lightest NPWT unit on the market currently at 2.2
  
• Battery life of up to 40 hours

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Benefits of Medelas Invia Healing System
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AMD Gauze Benefits

• Effective against
• MRSA other Staph
• VRE
• Pseudomonas
• Proteus
• Enterococcus
• Candida
• Klebsiella

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Invia Application Instructions
Application of the Invia Healing System can be
quick and easy!
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Invia Instructions

• Measure wound and photos (LXWXD)
• Cleanse wound and peri-wound area as indicated by
  MD
• Irrigate the wound bed thoroughly with saline
  unless other solution indicated by physician
• Remove excess drainage from wound and peri-wound
  with sterile gauze.

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• Cut non-adherent contact layer to mimic the size
  and shape of the wound bed.
• Cover entire wound bed with non-adherent contact
  layer.

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• Saturate single layer of gauze with saline and
  place into wound bed
• Trim the drain so it is confined to the wound bed
  and place it directly on top of the gauze in the
  wound. (Slightly different technique with Round
  drain)
• 9. DO NOT place the drain in a fistula tract

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Drain Options
10mm Flat Channel for most wounds
15Fr Round Channel for tunneled wounds
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• Saturate additional gauze with saline, open and
  fluff into the wound to completely cover the
  drain and fill with gauze to skin level

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• Prep the skin up to 2 inches around the wound bed
  using skin prep
• Allow to dry
• Cut transparent dressing 1-2 inches beyond the
  packed wound bed on each side
• Never wrap transparent film completely around
  extremity

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• Apply the transparent dressing starting with the
  side opposite tubing. Adhere the dressing across
  to the entire wound site.
• When you reach the drain tubing, lift it up and
  squeeze the dressing around the tube to create an
  airtight seal.
• Press the dressing down firmly around the entire
  wound to ensure there are no air leaks.

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• Secure the drain tubing to the body with adhesive
  tape.
• Slide the pinch clamp onto the drain tubing.
• This will allow you to retain the negative
  pressure if the patient must be disconnected from
  suction.
• Connect the drain tubing to the suction tubing
  using the Christmas Tree connector attached to
  the 6 connecting tubing.
• Connect the suction tubing to the Medela canister.

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• Set the Vario aspirator to continuous suction
  between 60-80mmHg or as directed by the
  physician.
• When suction is turned on, the dressing should
  contract noticeably. If the dressing does not
  contract, the system may not be sealed.

Goal Wound Closure
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Troubleshooting

• Check the dressing for air leaks and reseal as
  necessary
• Check Seal
• Check Connectors
• Check Tubing
• Check Canister
• Check Pump Settings
• If problem persist, troubleshoot as necessary
  with instructions from the physician

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• Dressing Changes are recommended every 48 hours
  to 3 x week- unless otherwise specified by MD
• Re-evaluate therapy if no progress in 2-4 weeks
  
• Weekly measurements and assessment by wound
  specialist
• Multiple wounds need to be bridged or use a
  Y-connector

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Questions???

• For ordering and clinical support contact
  Continental Health Equipment at [phone]
• Available service and delivery 24/7 and Holidays
• CE programs and ongoing clinical support
  available through Continentals Professional
  Clinical Team Nurse Sharks, Inc.
• Contact Nurse Sharks, Inc at [phone] or
  nursesharks1_at_windstream.net

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Resources

• JAMA, 2001
• JAMA, 2001
• WOCN, 2004
• O-WM, 2005
• JAMA, 2007