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et al. 2008). Pressures are set at the level best suited to the wound type and can be set on continuous or intermittent according to the therapy required (Benbow 2006). Maintaining the vacuum seal is essential in providing this therapy. It has proven to be cost efficient, safe and effective as a treatment modality for wound care (KCI 2007). The benefits to chronic wound healing of using NPWT versus other treatments have been shown in a number of clinical trials, but further research is needed with fewer methodological flaws and clearer reporting of infection rates and length of hospital stay (NICE 2009, Ubbink et al. 2008).

Indications

NPWT is indicated for:

chronic wounds

pressure ulcers

dehisced wounds and incisions

partial-thickness burns

flaps and grafts.

(KCI 2007)

See Figure 15.7 for an example of a patient with a wound being treated with the NPWT device.

Figure 15.7 Negative pressure wound therapy: right inguinal wound.

Contraindications

Negative pressure wound therapy is contraindicated in grossly contaminated wounds, malignant wounds, untreated osteomyelitis, non-enteric and unexplored fistulae or necrotic tissue with eschar present and areas with exposed tendons (KCI 2007).

Precautions should be exercised when there is active bleeding in the wound, difficult haemostasis or when the patient is taking anticoagulants (Benbow 2006). The wound site must be carefully assessed to ensure that NPWT is indeed the appropriate treatment modality. If signs of infection or complications develop, the therapy should be discontinued (KCI 2007). There is currently not enough evidence to recommend NPWT for open abdominal wounds (NICE 2009).

Preprocedural considerations

Consulting the appropriate company representative for training is essential as application and approach are individually determined and KCI, for example, have their own comprehensive clinical guidelines (KCI 2007). If the wound is bigger than the largest foam dressing, more than one piece of foam may be used as long as the edges of the foam are in contact with each other. KCI also has recommendations for changing the type of foam once the exudates decrease (KCI 2007). Using several smaller pieces of film to cover the area is recommended for larger wounds as they are easier to apply and maintaining an air-tight seal is more successful (KCI 2007).

Equipment

Figures 15.7, 15.8 and 15.9 show the vacuum-assisted closure or VAC therapy system (KCI International). See the Websites and useful addresses at the end of the chapter for contact details for VAC and KCI, amongst others. Other methods for NPWT are available and use similar principles (Hampton and Collins 2004). All equipment used should be the manufacturer’s recommended materials for the relevant system (KCI 2007).

Figure 15.8 Negative pressure wound therapy: VAC dressing.

Figure 15.9 Negative pressure wound therapy: VAC pump.

Procedure guideline 15.8 Negative pressure wound therapy

Essential equipment

NPWT unit

NPWT dressing pack

NPWT canister and tubing

Sterile scissors

Sterile gloves

Apron

Dressing procedure pack

Sterile 0.9% sodium chloride for irrigation (warmed to approx. 37°C in a jug of warm water)

Clamp (Spencer Wells forceps)

Optional equipment

Extra semi-permeable film dressings to seal any leaks

Non-adherent wound contact layer to prevent foam adhering to wound bed

Alcohol-free skin barrier film to protect any fragile or macerated skin around the wound

Preprocedure

Action Rationale

1 Explain and discuss the procedure with the patient.

To ensure the patient understands the procedure and other options available and gives their valid consent (NMC 2008a, C).

2 Provide routine analgesia prior to dressing procedure.

To prevent unnecessary procedural pain. E

3 Ensure there is adequate lighting and the patient is comfortable and in a position where the wound can be accessed and viewed easily. Assemble all necessary equipment (Beldon 2006, C).

To allow access to area for dressing change. Dressing application can be complicated and take a long time so the patient