The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [649]
Procedure
4 Use aseptic technique and sterile equipment (as listed above).
To prevent infection (Fraise and Bradley 2009, E; Pudner 2005, E; Walker 2007, E).
5 To remove the NPWT dressing, put on a pair of non-sterile gloves.
To reduce the risk of cross-infection (Fraise and Bradley 2009, E).
6 Clamp the dressing tubing and disconnect it from the canister tubing. Allow any fluid in the canister tubing to be sucked into the canister. Switch off the pump and clamp the canister tubing.
To prevent spillage of body fluid waste from the tubing or canister. E
7 Remove and discard the canister (if full or at least weekly).
To prevent pump alarming and for infection control. E
8 Carefully remove the occlusive film drape by gently lifting one edge and then stretching the drape horizontally and slowly pulling up from the skin.
To prevent damage to the peri-wound skin. E
9 Carefully remove the foam dressing from the wound bed. Irrigate with sterile 0.9% sodium chloride if required.
To prevent damage to newly formed tissue within the wound bed and prevent pain. E
10 Clean the wound with sterile 0.9% sodium chloride.
To prevent infection and remove surface debris/necrotic tissue (Dealey 2005, E).
11 Debride the wound if applicable.
To remove loose necrotic tissue that may be a focus for infection (Vowden and Vowden 2002, C).
12 To apply the dressing, cut the NPWT foam to fit the size and shape of the wound, including tunnelling and undermined areas.
The foam should fit the wound exactly to ensure full benefit of the negative pressure therapy (Beldon 2006, E).
13 Avoid cutting the foam over the wound bed.
To prevent loose particles of foam falling into the wound. E
14 Place the foam into the wound cavity.
The whole wound bed must be covered with foam. If the foam is touching, it will transfer the negative pressure to the next piece. E
15 If the wound bed is friable/granulating and likely to bleed, Mepitel may be used under the foam to protect the extracellular matrix (ECM).
The ECM requires a trauma-free dressing removal and once exudates subside, the wound bed may become less moist (alternatively, white foam, slightly damp, is recommended by KCI (KCI 2007, C).
16 Cut the occlusive film drape to size and apply over the top of the foam, ensuring a 3–5 cm border onto intact skin, NPWT gel strip or hydrocolloid. (NB: do not compress the foam into the wound.)
To obtain a good seal around the wound edges. E
17 Choose a location on the sealed occlusive film drape to apply the tubing where the tubing will not rub or cause pressure. Cut a hole through the film, approximately 2 cm in diameter, leaving the foam intact.
To reduce the risk of pressure injury to skin. E
18 Place the TRAC pad on the film with the hole in the centre of the elbow joint directly over the hole in the film drape. Gently press around the TRAC pad (KCI 2007).
To ensure correct position and seal of the pad. (NB: TRAC is used for the vacuum-assisted closure (VAC) system; follow manufacturer’s individual instructions) (KCI 2007, C).
19 To commence the NPWT, insert the canister into the pump until it clicks into place.
Indicates the canister is positioned correctly and is secure (Beldon 2006, E).
20 Connect the dressing tubing to the canister tubing and open clamps.
The pump will alarm if the tubing is clamped or not connected. E
21 Press POWER button and follow the on-screen instructions to set the level and type of pressure required according to instructions from the patient’s medical/surgical team.
To ensure the therapy is set to the individual requirements of the patient. E
22 Start the pump by pressing THERAPY ON/OFF: the foam should contract into the wound.
Any small air leak will prevent the foam dressing from contracting and reassessment is required. E
Postprocedure
22 Document the dressing and setting in the patient’s notes.
To provide a record (NMC 2009, C).
Postprocedural considerations
Ongoing care
Careful monitoring of the peri-wound area for signs