Guidelines for safe negative-pressure wound therapy
Practical Issues in Wound, Skin and Ostomy Management
Practical Issues in Wound, Skin and Ostomy Management
This was an awesome article. I’ve done wound vacs about 10 years and this gave me tips for improved documentation.
Thank you Mr. Rock for a “direct” article regarding NPWT.
From an educator’s and ordering clinician’s point of view, one area that you might want to comment on are the indications and contraindications to NPWT.
What are your thoughts along these lines?
Thank you,
Don Wollheim, MD
NWPT is very effective for wound healing and drainage management, unfortunately, a lot of clinicians, including doctors, do not apply the dressing correctly. Black foam should never be applied to intact skin. Most important is applying transparent drape to skin surrounding the wound right to the wound edge. Dermatitis is common when black foam is applied directly to intact skin. When done correctly, dressing can take 1/2-1 hour to apply correctly.
The indications and contraindications for NPWT follow the specific pump manufacturer’s guidelines. They are relatively standard across the industry. See (Risk factors and contraindications for NPWT.) in this article for a partial listing.
Traditionally NPWT is intended to create an environment that promotes wound healing by secondary or tertiary (delayed primary) intention by preparing the wound bed for closure. It can also prepare a wound bed to receive a muscle flap or skin graft. It reduces local and regional edema, removes exudate and assists with wound contraction as the foam collapses.
Some indications however can be as creative as the ordering clinician or the patient’s specific need. Unfortunately they may go contrary to the manufacturer’s guidelines and therefore must be taken into careful consideration before application to avoid an untoward event. Recognition of potential problems should be thoroughly investigated before NPWT dressing application. In those instances my documentation reflects the goal of therapy; rationale and application procedure. Should there be a compromise in the integrity of the dressing there is an understanding of the clinician’s intent should someone else need to change the dressing.
It can also remove vital proteins; growth factors and MMPs. It can collapse capillaries (if pressures are too high), create a fistula and induce pain. It may not work at all if the inherent ingredients for wound healing are not present within the wound bed. Or the therapy may stall should the body acclimate to the prescribed therapy; tissue becomes hypergranular, a biofilm develops infection, etc…too mention a few. It also does little in the way of debridement.
With judicious preparation and anticipation of potential complications, the indications for NPWT can be impressive. Beyond the well established contraindications…if in doubt…don’t.
I really enjoyed your article-I have been doing vacs for 8 years and you can always learn something new–esp on the documentation end. Thank you
Please advise as to why the NPWT foam must be removed from the wound if the power goes of or it must be discontinued.. I have been unable to find any science or evidence as why this is so.
I have been using NPWT for many years …but I am faced with a dilemma.I have a Patient with a skin condition called Hailey Hailey Pemphigus ( top skin layers fragment) who has a large cavity wound on his buttock which is perfect for NPWT but the Surgeon has said not to use NPWT on a patient with this condition.Has there been any clinical trails done on NPWT with a patient with this skin condition.Apparently it flairs up with physical removal of adhesives that are applied to the skin.I am using hyperfix strips to fixate a dressing on the wound and then soak the hyperfix with a adhesive solvent before removing it so as not to cause any ‘pulling” on the skin.