The Essentials of Negative Pressure Wound Therapy (NPWT): Part 2

I have learned quite a bit on my journey to gaining a better understanding of Negative Pressure Wound Therapy (NPWT). In Part 1 of this series, I provided an overview of NPWT, including what it is, how it works and the risks and benefits. In Part 2 of the series I will review the practical application of NPWT including prescribing orders, procedural steps, general patient care, and tips to troubleshoot the device. Let’s jump in!
 
negative-pressure-wound-therapy-2.PNG
 
What are the steps in applying NPWT? Each device has a specific design and manufacturer’s instructions for use that should be reviewed. The following procedural steps provide a general guide.
  1. Pre-medicate the patient for pain as needed and as prescribed.
  2. Prepare the wound by:
    • removing the prior dressing very carefully to avoid tissue damage and bleeding
    • debriding the wound, performed by a qualified practitioner
    • cleansing the wound as needed/prescribed
    • assessing wound size and depth
  3. Cut foam dressing to size and place into the wound. Document the number of foam pieces used; foam acts as a filter to catch blood clots and large tissue particles that might clog the vacuum system.
  4. Trim clear occlusive dressing to size, peel back one side of Layer 1 and place adhesive side down over wound. (see photo 1)
  5. Remove the remaining side of Layer 1 ensuring it creates a tight seal.
  6. Cut a hole into the clear dressing about the size of a quarter (2.5 cm). (see photo 2)
  7. Remove Layer 1 from adhesive pad connected to the pump tubing.
  8. Place pad and tubing directly over hole affixing it to the clear dressing. (see photo 3)
  9. Remove Layer 2 from the adhesive pad.
  10. Connect pad tubing to canister tubing and be sure the clamps are open.
  11. Turn on power to the vacuum device, set the prescribed pressure settings, and confirm that the dressing and foam shrink down. (see photo 4)
NPWT-part-2-photo-1.jpg


NPWT-part-2-photo-2.jpg


NPWT-part-2-photo-3.jpg


NPWT-part-2-photo-4.jpg

 
Wound Care Tips:
  • Use protective barriers, such as non-adherent or petroleum gauze, to protect sutured blood vessels or organs near areas being treated with NPWT. 2
  • Avoid overpacking the wound too tightly with foam; this prevents negative pressure from reaching the wound bed, causing exudate to accumulate. 2
  • Avoid placing the tubing over bony prominences, skinfolds, creases, and weight-bearing surfaces to prevent tubing-related pressure ulcers. 2
  • Count and document all pieces of foam or gauze on the outer dressing and in the medical record, to help prevent retention of materials in the wound; 2 when possible, only use one piece of foam dressing.
  • With a heavy colonized or infected wound, consider changing the dressing every 12 to 24 hours as directed by the prescribing clinician.2

General Patient Care:
  • Assess the patient for wound healing issues, such as poor nutrition (low protein levels), diminished oxygenation, decreased circulation, diabetes, smoking, obesity, foreign bodies, infection and low blood levels.2
  • Assess and manage the patient’s pain; be sure to premedicate as needed before each dressing change.
  • Provide patient education on:
    • Alarms and device ‘noise’
    • Dressing changes
    • Signs of complications (bleeding, infection)
  • Patients should seek medical care if they notice:
    • Significant change in the color of the drainage (cloudy or bright red)
    • Excessive bleeding under the clear dressing, in the tubing or in the canister
    • Increased redness or odor from the wound
    • Increased pain
    • The device has been left off for more than 2 hours
    • Signs of infection, such as fever, redness or swelling of the wound, itching/rash, warmth, pus or foul smelling drainage
    • Allergic reaction to the drape/dressing: redness, swelling, rash, hives, severe itching. Patient should seek immediate medical assistance if they experience difficulty in breathing
Troubleshooting the Device
  • Confirm that the unit is on and set to the appropriate negative pressure, that the foam is collapsed and the NPWT device is maintaining the prescribed therapy and pressure. 2
  • Be sure the negative pressure seal has not been broken and leaks are minimal.4
  • Ensure there are no kinks in the tubing and that all clamps are open.4
  • Address and resolve alarm issues; reasons for the unit to alarm include: canister is full, there is a leak in the system, battery is low/dead, therapy is not activated.
  • Do not leave the device off for more than two hours; while device is off, apply a moist dressing 2 and notify the prescribing clinician immediately.
  • Avoid getting the electrical device wet; educate the patient to disconnect the unit from the tubing and clamp the tubing before bathing.
  • Check the drainage chamber to make sure it is filling correctly and does not need changing.4
While I am not an expert in the field of wound care, I am now more confident and better prepared to manage patients receiving Negative Pressure Wound Therapy. I would love to hear your experiences. Let me know if you have any tips or other suggestions that can help nurses and patients safely operate and maintain these devices.
References:
1. Centers for Medicare and Medicaid Services. (2014). Negative Pressure Wound Therapy Technologies for Chronic Wound Care in the Home Setting. Retrieved from the Centers for Medicare and Medicaid Services: https://www.cms.gov/Medicare/Coverage/DeterminationProcess/Downloads/id96ta.pdf
2. Rock, R. (2014). Guidelines for Safe Negative-Pressure Wound Therapy: Rule of Thumb: Assess Twice, Dress Once. Wound Care Advisor, 3(2), 29 – 33
3. Federal Drug Administration. (2009). FDA Preliminary Public Health Notification: Serious Complications Associated with Negative Pressure Wound Therapy Systems. Retrieved from the Federal Drug Administration: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PublicHealthNotifications/ucm190658.htm#table1
4. Wound Care Centers. (2016). Negative Pressure Wound Therapy. Retrieved from Wound Care Centers: http://www.woundcarecenters.org/article/wound-therapies/negative-pressure-wound-therapy
 Myrna B. Schnur, RN, MSN

 
Posted: 4/22/2016 6:43:57 AM by Lisa Bonsall, MSN, RN, CRNP | with 2 comments


Comments
Mary Gracey-White
Excellent overview/review and comment- Thank you
5/5/2016 11:26:28 AM

Diana M Hickey R.N.
I worked for a negative pressure company for 12 years and I would strongly recommend changing the dressing, especially if black foam is being used, no longer than every 3 days. If you have a healthy patient with adequate nutrition the granulation tissue will grow quickly and move into the foam. Allowing this to happen for more than 48 hours can result in difficulty removing the foam and cause unnecessary pain to the patient. If a wide mesh barrier dressing is used, that can prevent adherence. Vaseline gauze should not be placed in the wound bed, unless over exposed bone or vessels, because it will obstruct the flow of negative pressure.
5/4/2016 7:26:42 PM

Subscribe