Negative Pressure

Wound Therapy

Identify NWPT systems used at VMC (Wound Vac Ulta, Variflo, Abthera and Prevena)

Describe purpose, benefits and contraindications of each NPWT system

Describe the complications of NPWT and nursing interventions to prevent them

Identify resources for NPWT including 24 hour support number and where to find supplies

Describe NPWT patient education

Demonstrate the steps of a NPWT dressing change

Describe the process for initiating discharge of a patient with a NWPT system

Goals of this training:

Purpose and benefits of NPWT

Assists healing by secondary intention

Suction reduces edema

Removes exudate and infectious materials

Promotes rapid granulation

Leads to accelerated wound closure

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Complications of NPWT

Hemorrhage

Frank bleeding: visible clots and/or red blood in canister

If bleeding, stop therapy and notify provider

Leave dressing in place, apply pressure

Anaerobic infection

Do not leave therapy off more than 2 hours

Peri-wound skin breakdown

Keep black foam off of peri-wound skin

Window pane with VAC drape around wound

Do not stretch drape material when applying

Position tubing to avoid bony prominences

Foam retention

Always count number of foam pieces placed in wound

Document number of pieces placed on dressing and in chart

Contraindications of NWPT

Exposed blood vessels and anastomotic sites, nerves or organs- can lead to excessive bleeding

Malignancy in the wound- can stimulate the growth of cancer cells (with the exception of palliative care to enhance quality of life)

Untreated osteomyelitis

Non-enteric or unexplored fistulas

Necrotic tissue or eschar obscuring the wound bed

Silver allergy (if silver based dressing used)

Open fascia

Components of a NPWT system

Therapy Unit- controls the suction pressure

Canister- Collects the fluid

SensaT.R.A.C.™ Pad and Tubing- removes the drainage to the canister

Foam dressing- dressing material, allows the drainage to pull through to the tubing

V.A.C.® Drape- clear adhesive layer that covers the entire dressing

Negative Pressure Wound Therapy Systems V.A.C.® Negative Pressure Wound Therapy

Standard system

Image: Kci/Acelity

http://secure.ucdmc.ucdavis.edu/cppn/resources/clini

cal_skills_refresher/wound_vac_dressing_change/image

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http://www.orthohyd.com/

Negative Pressure Wound Therapy Systems V.A.C. VERAFLO™ Instillation Therapy

Irrigates wound

Wound care nurse will set up

Images:

Kci/Acelity

http://www.podiatrytoday.com/files/pt0914npwt2.png

Negative Pressure Wound Therapy SystemsPREVENA™ Negative Pressure Incision

Used on a closed incision to prevent infection and dehiscence

Dressing contains silver- anti microbial

Placed in OR over the closed incision in a sterile environment

Can hold: 45ml or 150ml (Prevena Plus)

Can be connected to the VAC Ulta therapy unit while in hospital

Stays in place 2-7 days, times out after 8 days

Patient returns to clinic for dressing removal and returns unit for disposal

Not intended for open or dehisced surgical wounds

Image:

Kci/Acelity

BENEFITS

• Holds incision edges together

• Reduces the likelihood of surgical dehiscence

• Reduces lateral tension and edema

• Protects the surgical site from external infectious sources

Negative Pressure Wound Therapy Systems ABTHERA™ Open Abdomen Negative Pressure

Used on critically ill patients with open abdomens

Used for delayed closure

Image: Kci/Acelity http://abthera.com/images/casefour.png

Nursing Care of the Patient with NPWT

Monitor for bleeding

Assess machine/dressing every 2 hours:

Check dressing-should be compressed, no fluid leaks

Check tubing-should be free of kinks, connections secure, not trapped under the patient (check skin)

Confirm settings match orders

Check canister – note drainage color, should be serosanguinous, not purulent; and no active bleeding.

Record output q shift in LDA. Dressing changes- MWF

Document assessment

Do not leave the system off for more than 2 hours

If therapy is stopped for 2 hours or more, a new dressing must be placed

Change to “Freedom VAC” for home use at discharge

Change to wet to dry gauze dressing if transferring to another facility

Managing the system Keep plugged in except when ambulating

“Leak detected”

Check connections

Inspect dressing, try to find source of leak

Patch/reinforce with drape or tegaderm

“No Suction”

Check canister (may be full or may not be engaged in pump)

Check connections, clamps should be open

“Canister full”

Change canister weekly or when full (obtain new canister from SPD – ext1166)

Pause machine, clamp, disconnect luer lock, push “disengage” button, remove full canister and replace. Dispose in biohazard. Ensure machine is turned back on after canister change

Image: Kci/Acelity

Patient educationPREVENA™ (Handbook comes with it)

Dressing stays on 2-7 days

Remove at post op appt- clinic will dispose of canister

Notify Provider: bleeding, full canister, S/S infection, allergic reactions

Do not turn off unless: provider instructs, bleeding, allergic reaction

V.A.C.® ULTA therapy

While in hospital:

Notify nurse about pain, alarms

Freedom Unit (education handout available)

At home

Review check list with patient

When to notify provider

S/S infection, bleeding, assess drainage

Image: Kci/Acelity

Dressing change steps 3x a week MWF

Pre-medicate as ordered for pain

Turn off NPWT system, clamp tubing

Instill saline into packing using blunt needle until dressing is saturated, let stand 5-10 minutes

May use topical lidocaine 4% with order

Remove old dressing, confirm number of foam pieces removed (should be documented on dressing)

ASSESS and DOCUMENT: photo, measure

Window pane peri-wound skin with VAC drape

Use large pieces of foam

Do not cut foam over wound (prevents foam from being left into the wound)

Count number of foam pieces as they are placed

Follow the numbers for drape

Cut hole quarter sized hole for SensaTRAC pad. Place so that tubing will not be trapped under patient

Document date, time, initials and number of foam pieces used on dressing

May titrate suction level up to 125mmHg after dressing change for comfort

Need Help?

Ask your educator or wound care nurse

Where can you get 24 hour support for troubleshooting?

Quick reference guide, attached to therapy unit

24 hour telephone support at 1-800-ASK-4KCI

Where do you get more NPWT dressings and canisters?

SPD – ext 1166

Need more info?

http://www.acelity.com/healthcare-professionals/instructions-for-use

Search kciwoundcare on YouTube for instructional videos

http://www.acelity.com/healthcare-professionals/instructions-for-use