The Kremlin Papers

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• The Kremlin Papers
• A collection of published studies complementing
  the research and innovation of wound care.
• A new modality for Negative Pressure Wound
  Therapy
• Presented By
• Penny E. Campbell, PT, CWS
• Wound Care Solutions
• and
• Shelly Burdette-Taylor, RN, C, MSN, CWCN
• CEO/Curriculum Designer Taylord Health Education

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The Question
Can Negative Pressure be Periodic?
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The Answer

• Pioneers in Russia were instrumental in the use
  of localized negative pressure in the management
  of difficult, heavily draining wounds.
• Periodic negative pressure has also been shown to
  be effective with those wounds having little to
  no exudate or are no longer indicated for
  continuous negative pressure.
• ? Negative pressure with the Kremlin Kit is
  periodic in nature. Suction is applied for
  distinct periods of time versus being applied
  continuously.

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Why Kremlin?

• Using the Suction/Breast Dome Shield increases
  the concentration of the negative pressure at a
  lower setting and allows for periodic treatment
  sessions.
• This allows for more flexible treatment options
  for wound care clinicians and their patients.
• And the treatment is totally non-invasive.

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• Using this method makes it possible to affect
  the walls of the wound tract and the surrounding
  tissues equally. The primary working part of the
  device is an inserted tube with holes and a
  hemispherical chamber attached to a vacuum
  source.
• Davydov, Larichev, Menkov,
  1988

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The Kremlin Kit
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Kremlin Wound Drainage Kits

• Do not require the patient to be tied to a pump
• Are non-invasive
• Are Periodic in nature
• Overcome objections
• Low Pressure Alarm (Does not apply to this
  application)
• Overflow alarm (Does not apply)
• State of the Art
• Progressive wound care clinicians will be very
  interested in trying out this classic Russian
  technology.

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• BlueSky Medical
• offers the
• Kremlin Wound Drainage Kit which contains

• A Wound Drain made of 100 Silicone
• Suction/Breast Dome Shield
• Connecting Tubing
• Stopper
• Stretch Garment

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Kremlin Tutorial
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Step 1

• Insert stopper
• into Suction Dome/
• Breast Shield and
• press firmly.

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Step 2

• Thread wound drain through hole in stopper.

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Step 3

• Cut the drain so that no part of the drain
  comes in contact with the wound. This provides
  100 negative pressure without any physical
  contact with the wound bed.

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Step 4

• Place dome directly over the wound.

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Step 5

• Secure all side of dome with waterproof tape.

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Alternative Methods of Securing Suction/Breast
Dome Shield

• Method 1
• Apply Transparent film to all edges of the
  Suction/Breast Dome Shield.

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• Method 2
• Cut hole in center of a large transparent film
  and fit entire film over Suction/Breast Dome
  Shield

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Step 6

• Connect dome to suction source.

Apply clamp to drain tubing
Connect the end of drain tubing to tubing with
Adaptor Connector
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Continue Step 6
Connect tubing with adaptor connector to Patient
Port on canister.
Turn pump on Continuous setting.
Set pump on 30-40 mm Hg.
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Finished Dressing
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Treatment Duration

• Apply for 1 to 3 hours per treatment session.
• Treatment can be performed more than one time per
  day.
• Recommend 1-2 times/day.

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Who will benefit from periodic negative pressure?

• Patients that are unable to tolerate continuous
  negative pressure.
• Patients that are non-compliant with continuous
  negative pressure.
• Patients that are mobile and have the need to
  carry on with their daily activities without the
  constraints of continuous negative pressure.
• Wounds that are no longer indicated for
  continuous negative pressure.
• - Wounds that have healed to lt 0.4 cm depth
• - Wounds that have little to no drainage

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Case Study 1

• 92 y/o female was admitted with a vascular ulcer
  on her right lateral foot on 6-1-04.
• Wound significantly declined during the period of
  6-1-04 and 6-14-04.
• Her history includes total care, tube fed,
  upper/lower extremity contractures, incontinent
  of bowel and bladder, dx of dementia, DM, Chronic
  Renal failure, HTN, Anemia, and Parkinsons
  disease.
• Treatment 3hrs/day x 7 days/wk on Continuous
  negative pressure _at_ 40mm Hg

Penny E. Campbell, PT, CWS 2004
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Initial Status

• Prior to treatment on 6-14-04
• Wound debrided prior to start of treatment
• Callused area that will require debridement in
  the near future
• 1.4 x 1.5 x 0.4 cm

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6-18-04

• After 2nd debridement and 4 txs.
• 2.5 x 1.5 x 0.4 cm

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6-21-04

• After 1 week of Kremlin treatments
• 1.6 x 0.5 x 0.4 cm

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Side by Side Comparison
6-14-04
From 6-18-04 to 6-21-04 she underwent a 78.6
wound healing
6-18-04
6-21-04
Study ongoing
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The Kremlin Papers Perspectives in Wound Care

• A collection of published studies complimenting
  the research and innovation of wound care.
• The Vacuum Effect in the Surgical Treatment of
  Purulent Wounds
• Vacuum Therapy in the Treatment of Purulent
  Lactation Mastitis
• Active Wound Drainage
• The Bacteriological and Cytological Assessment of
  Vacuum Therapy of Purulent Wounds
• Concepts for Clinical Biological Management of
  the Wound Process in the Treatment of Purulent
  Wounds Using Vacuum Therapy

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Kremlin Wound Drainage Kits

• Exciting new Technology
• Only Available from BlueSky Dealers
• Complete the cycle
• Large wound to small wound to no wound
• V1 with appropriate accessories can close the
  wound