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
http://areton-ltd.com/wp-content/uploads/2015/10/healing-by-secondary-intention.jpg
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-useTop Related