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The V.A.C.® WRN™ Program
An Introduction to V.A.C.® Negative
Pressure Wound Therapy
©2012
Licensing,
Inc. All
rights
reserved.
DSL#12-0044
(Rev 1/12) (Rev 2/12)
©2012KCI
KCI
Licensing,
Inc.
All rights
reserved.
DSL#12-0044
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
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Learning Objectives
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The Wound Healing Cascade
1. Briefly summarize the Wound Healing Cascade
2. Discuss the V.A.C.® Therapy Mechanisms of
Action
3. Describe basic V.A.C.® Therapy System settings
and operation
4. State how to perform V.A.C.® Therapy basic
dressing applications
5. Discuss how to troubleshoot (remove V.A.C.®
Therapy System) potential problems with wound
therapy.
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
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The Wound Healing Cascade
Hemostasis
Occurs immediately after the injury.
The blood begins clotting at the
wound site and vasoconstriction
occurs
Clinical Goal:
• Stop bleeding
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The Wound Healing Cascade
Inflammation
Begins right after the injury and
lasts 4 - 6 days following the injury.
A vascular and cellular response
occurs in which a number of cells,
including platelets, neutrophils and
macrophages, migrate to the
wound site
Clinical Goal:
• Manage excessive inflammation
• Assist wound progression
Hess C. Clinical Guide, Wound Care 5th ed. Lippincott Williams & Wilkins, Philadelphia, PA, 2005; pp 8.
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
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The Wound Healing Cascade
The Wound Healing Cascade
Proliferation
Remodeling
(3 to 21 days)*
(21 days to 2 years)*
Between 3 and 21 days, tissue
reconstruction begins, including
angiogenesis, granulation and
epithelialization
Between 21 days and two years, the
remodeling or maturation phase
occurs as a result of granulation
tissue maturing into scar tissue as
the wound contracts and heals
Clinical Goal:
• Reduce wound volume
• Assist wound progression
• Prepare wound for closure
Clinical Goal:
Increase tissue tensile strength
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
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Barriers to Wound Healing
Barriers to Wound Healing
Nutritional Status
• Necrotic tissue
• Infection
• Hemorrhage
• Mechanical damage
• Medical conditions
–Diabetes
–Vascular diseases
• Age
• Medicines
• Smoking
• Skin dryness
• Nutrition is a critical factor in
wound healing
• Patients who are nutritionally
compromised cannot heal
• Albumin
– Normal range: 3.5 – 5.5 g/dL
– Takes 21 days for changes in
nutrition to change level
• Prealbumin
– Normal range: 16-40 mg/dL
– Takes 3 days for changes in
nutrition to change level
Hess C. Clinical Guide, Wound Care 5th ed. Lippincott Williams & Wilkins, Philadelphia, PA, 2005; pp30-33
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
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What is V.A.C.® Therapy?
• The V.A.C.® Therapy Systems, including the V.A.C.®
GranuFoam™ Dressings, are integrated wound management
systems intended to create an environment that promotes wound
healing
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
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What are the Components?
•
The V.A.C.® Therapy Unit provides softwarecontrolled negative pressure wound therapy
•
The V.A.C.® Canister collects the wound
exudate
•
SensaT.R.A.C.™ Technology monitors and
maintains pressure at the wound site to provide
delivery of prescribed negative pressure
settings
•
The V.A.C.® Drape helps provide a moist
wound healing environment
•
V.A.C.® GranuFoam™ Dressings contract
under negative pressure, providing direct and
complete contact with the wound bed
–
The 400-600 micron reticulated pores help
distribute pressure through the wound bed
–
Facilitate fluid removal
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
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Important Safety Information
• In most cases, unless otherwise indicated, these slides will reference indications and safety
information generally applicable to V.A.C.® Therapy.
• Before using V.A.C.® Therapy, read all safety information which is provided with the therapy
unit, as well as in dressing and canister cartons.
V.A.C.® Therapy
Safety Information
• Certain unique indications, contraindications, warnings, and precautions apply for products
within KCI Negative Pressure Therapy Systems, including the V.A.C.Ulta™ NPWT System,
the V.A.C. Instill® Wound Therapy System, the ABThera™ Open Abdomen Negative Pressure
Therapy System and the Prevena™ Incision Management System. Prior to use, read the
instructions for use provided for the specific therapy unit or disposables for specific product
information.
• Please refer to the V.A.C.® Therapy Clinical Guidelines, A Reference Source for Clinicians
(available at www.kci1.com), for additional information when establishing patient-specific
treatment protocols.
• Additional information and education on KCI Negative Pressure Therapy topics, including
V.A.C.® Therapy, can be found on www.kci1.com. Clicking on the Education & Training link will
provide information on these educational opportunities.
• V.A.C.® Therapy Systems are Rx only devices.
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
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V.A.C.® Therapy Contraindications
V.A.C.® Therapy is indicated for patients with:
• DO NOT place any V.A.C.® Foam Dressings (V.A.C.® GranuFoam™, V.A.C.
Chronic Wounds
GranuFoam Silver ®, V.A.C.® WhiteFoam, V.A.C. VeraFlo™ and V.A.C. VeraFlo
Cleanse™ Dressings) in direct contact with exposed blood vessels,
Ulcers such as:
Acute Wounds
Diabetic
Traumatic Wounds
Venous Insufficiency
Sub-acute Wounds
anastomotic sites, organs or nerves.
Pressure
Partial-thickness burns
Flaps
Dehisced wounds
Grafts
• DO NOT use V.A.C.® Therapy:
when there is malignancy in the wound
with untreated osteomyelitis
with non-enteric and unexplored fistulas
with necrotic tissue with eschar present
• DO NOT use the V.A.C. GranuFoam Silver® Dressing on a patient with a
known sensitivity to silver
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
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V.A.C.® Therapy Warning Categories
Bleeding
To decrease bleeding risks:
 Protect vessels and organs
 Infected vessels are at risk of complications and must be carefully
noted and protected.
 Cover or eliminate sharp edges
 Ensure adequate wound hemostasis
• Increase patient monitoring when:
 Anticoagulants, platelet aggregation inhibitors, aspirin, etc. are
prescribed
 Wounds are related to vascular surgical procedures
 Infection is present in the wound
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
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Considerations for V.A.C.® Therapy Patients
at Increased Risk of Bleeding
• With or without using V.A.C.® Therapy, certain wound care patients are at high risk of bleeding
complications
• Place at-risk patient in a monitored setting as MD deems appropriate
• Are organs or vessels visible and/or exposed?
 Preferably cover with a thick layer of natural tissue
 When natural tissue is not available, multiple layers of a non-adherent material can be used
 Never place any V.A.C.® Dressing foam directly on organs, vessels, nerves, tendons, or ligaments
• Are weak or friable vessels noted in or around the wound?
 Infection, trauma and radiation can weaken vessels, increasing rupture potential
• Vascular surgery repairs (i.e., vessels with sutures, anastomosis, graft, etc.)
 Vessel repairs increase risk for complications regardless of treatment modality
 Require close monitoring when wound close to large vessels (e.g., femoral , brachial)
• Is adequate wound hemostasis present?
 Non-sutured hemostatic agents including spray sealants may dislodge under negative pressure foam
dressing
 DO NOT initiate V.A.C.® Therapy until bleeding is well controlled
• Are medications or co-morbidities present that affect bleeding?
 Closely monitor patients on medications affecting bleeding times
• Clicking on the Education & Training link in www.kci1.com will give you access to the Vascular Surgical
Wounds of Lower Extremity module.
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
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Considerations for V.A.C.® Therapy
V.A.C.® Therapy Warning Categories
Patients at Increased Risk of Infection
Infection
• With or without using V.A.C.® Therapy, certain wound care patients
are at high risk for infection
Infected wounds should be monitored closely and may require more frequent
dressing changes than non-infected wounds.
• Infection-weakened vessels can rupture and result in significant blood loss
If there are any signs of the onset of systemic infection or advancing infection
at the wound site, contact a physician immediately to determine if V.A.C. ®
Therapy should be continued.
 Protect all organs and vessels from direct V.A.C.® Dressing contact
• More frequent V.A.C.® Dressing changes may be required for any suspected infection in
the wound
• Place at-risk patient in a monitored setting as MD deems appropriate
In the event of a clinical infection, V.A.C. GranuFoam Silver® is not intended to
replace the use of systemic therapy or other infection treating regimens.
• Closely monitor patient for worsening condition
• V.A.C.® Therapy should be considered only as an adjunct in the management of wound
infection
V.A.C.®
Therapy should NOT be initiated on a wound with untreated
osteomyelitis.
 Use appropriate anti-infective agents and/or any other appropriate interventions (e.g. debridement, HBO)
to combat wound infection
• V.A.C.® Therapy should be ON (active) for 22 hours out of 24 hours
V.A.C.®
If the
Dressing is in place, but therapy is OFF for more than 2
consecutive hours, the patient’s risk for infection may increase; either change
V.A.C.® Dressing and reinitiate therapy, or apply alternative dressing.
 If V.A.C.® Dressing in place and therapy off for more than 2 hours, notify MD, remove V.A.C. ® Dressing,
clean wound and:
 Replace with new V.A.C.® Dressing or
 Replace with alternate dressing if unable to continue with V.A.C. ® Therapy
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
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Considerations for V.A.C.® Therapy
V.A.C.® Therapy Warning Categories
Patients at Increased Risk for Retained Foam
Foam Dressings
Do not place foam dressings into blind or unexplored tunnels
•
Foam left in the wound for greater than the recommended time period may:
 Foster ingrowth of tissue into the wound,
 Create difficulty in removing foam, or
Help prevent foam dressing complications by:
•

Documenting number and type of materials placed in the wound

Maintaining a 48-72 hour dressing change schedule (no less than 3x week
unless on a skin or skin substitute graft)
 Lead to infection or other adverse events.
•
V.A.C.® Dressings are radiolucent; they are not detectable by X-ray or other radiological methods
•
Document on the drape or the V.A.C.® foam quantity label or ruler (if provided) and in patient’s medical chart: :
 Date, number and type of foam pieces placed in the wound
 Always count the total number of pieces removed and ensure the same number of foam pieces was removed as was
placed
•
Visualize the wound bed completely
 Patient positioning should be consistent for each V.A.C.® Dressing change
 Move redundant tissue to allow wound bed visualization if needed

Using a non-adherent layer between wound bed and foam

Using appropriate dressing in appropriate area of the wound, e.g, V.AC.®
 Careful inspection of the wound to ensure all foam is removed is essential
•
In the absence of infection, change V.A.C.® Dressings at least every 48-72 hours; no less than 3 times a week
 Rapid granulation formation in some wounds/patients may increase risk for foam adherence
WhiteFoam Dressings
only in tunnels
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
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V.A.C.® Therapy Warning Categories
Canister Size • Allergy • Resuscitation • Use in Altered Environment
1000 mL canister is not recommended for
use on patients:
V.A.C.® Therapy Units should not be taken
into a Magnetic Resonance Imaging (MRI)
environment as they are MRI unsafe

At high risk of bleeding or
 Unable to tolerate a large loss of fluid
volume
V.A.C.® Dressings, including V.A.C.
GranuFoam Silver ® Dressings, may be
used safely in the MRI suite
V.A.C.® Therapy products are latex-free
Patients with a known allergy to acrylic
adhesives may react adversely to the
V.A.C.® Drape
Seek medical attention if patient
experiences a severe reaction
However, foam may interfere with quality
of image
V.A.C.®
Therapy Units should not be taken into
a Hyperbaric Oxygen Therapy (HBO) chamber
as they are HBO unsafe
The foam dressing, if in the thoracic area,
may interfere with defibrillation efforts
Joules may need to be adjusted to
compensate or the dressing may need to
be removed
V.A.C.® GranuFoam™ and V.A.C.®
WhiteFoam Dressings have been used
safely in the HBO chamber
Ensure dressing tubing is not clamped
during HBO therapy
The V.A.C.® GranuFoam™ Bridge Dressing
contains additional synthetic materials which
may pose a risk during HBO Therapy
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
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V.A.C.® Therapy Precaution Categories
Standard precautions reduce the risk of
transmission of blood borne pathogens
Bradycardia may occur if foam dressing is
placed close to the vagus nerve
Continuous therapy setting is recommended
for:
First 48 hours of V.A.C.® Therapy
Skin and skin substitute grafts
Highly exudating wounds
Tunnels and undermined areas
Difficult dressing applications
Painful wounds
Intermittent or Dynamic Pressure Control™*
should not be used in the situations
recommended for continuous therapy
Wounds with enterocutaneous (enteroatmospheric) fistula require special dressing
application techniques. Refer to V.A.C.®
Therapy Clinical Guidelines.
Patient Size and Weight may influence
response to fluid loss and dehydration
Spinal Cord Injury Patients may experience
sudden changes in heart rate or blood
pressure due to autonomic dysreflexia, which
requires removal from V.A.C.® Therapy
Protect periwound skin from foam contact
Circumferential dressings should be
applied loosely – do not tightly stretch drape
as this may impair blood flow
Check circulation distal to dressing
frequently
V.A.C.® Therapy Unit Pressure Excursions
May occur if therapy unit senses blockage
Therapy unit may briefly go to -250mmHg
or higher
* Dynamic Pressure Control ™ provided on V.A.C.Via™
and V.A.C.Ulta™ Therapy Systems.
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
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Precautions for
V.A.C. GranuFoam Silver® Dressing
Topical agents or solutions may adversely
interact with the V.A.C. GranuFoam Silver®
Dressing:
Saline-based solutions may compromise
dressing effectiveness
As with all V.A.C.® Foam Dressings, the
V.A.C. GranuFoam Silver® Dressing should
not be placed indirect contact with
exposed vessels, anastomotic sites
organs, or nerves

Are organs or vessels visible and/or exposed?
 Preferably cover with a thick layer of
natural tissue
 When natural tissue is not available,
multiple layers of a non-adherent
material can be used

Be aware that a protective dressing may
create a physical barrier that can interfere
with silver ion delivery to the wound bed
V.A.C.® Therapy Creates an Environment
That Promotes Wound Healing
The application of uniform negative pressure delivered by V.A.C.® Therapy induces a physical
response (Macrostrain) and a biological response (Microstrain).
.
Dressings containing oil-based solutions
may compromise the delivery of silver to
the wound bed
Macrostrain draws wound edges together, removes
exudate and infectious material, reduces edema, and
promotes perfusion
Microstrain creates tissue microdeformation, causing cells to
stretch. Cell stretch leads to cell migration and proliferation
that result in the formation of granulation tissue.
Electrodes or conductive gel should not
be in contact with GranuFoam Silver®
Dressing during electronic monitoring
(e.g. EKG)
6) In vitro studies
show that cell
stretch under
negative pressure
tthat results in
granulation tissue
formation2
1) Draws
wound
edges
together
Interference with diagnostic imaging
may occur in certain imaging situations
with the V.A.C. GranuFoam Silver®
Dressing in place
5) In vitro/in vivo
studies show that foam
contact with tissue
under negative
pressure creates tissue
micro-deformation that
leads to cell stretch1,3
2)
Removes
infectious
material
The 10% elemental silver in the V.A.C.
GranuFoam Silver® Dressing may cause
tissue discoloration as seen with other
silver-based dressings
3) Reduces
edema
4) Promotes
perfusion
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
1. Saxena SM, et al. Vacuum Assisted Closure: Microdeformations of Wounds and Cell Proliferation.
Plastic & Reconstructive Surgery, 2004;114(5):1086-1095
2. McNulty: AK, et al. Effects of negative pressure wound therapy on the fibroblast viability, chemotactic
signaling and proliferation in a provisional wound (fibrin) matrix. Wound, 2007; 15:838-846
3. McNulty AK, et al. Effects of negative pressure wound therapy on cellular energetics in fibroblasts
grown in a provisional wound (fibrin) matrix. Wound Repair and Regeneration. 2009 Mar;17(3):192-9.
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
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V.A.C.® Therapy System Dressings
V.A.C.® Therapy Publication Numbers as of January 9, 2012
1000
900
27
Articles (877)
Peer Reviewed Articles (717)
800
Abstracts (856)
700
600
500
Book References (71)
Veterinary Articles (15)
Related Articles (562)
Non-English Language Articles (172)
400
Peer Reviewed Non-English Articles (54)
300
200
100
0
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
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V.A.C.® Therapy Pressure Settings*
The therapy settings in this presentation are general recommendations. You
may wish to vary the pressure settings to optimize V.A.C. ® Therapy based on
individual patient need upon physician order.
Adjusting the pressure settings
For recommended pressure settings for specific wound types, refer to the
wound-specific recommandation sections of the V.A.C.® Therapy Clinical
Guidelines*.
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V.A.C.® Therapy Pressure Settings
Consider titrating the V.A.C.® Therapy System pressure
up by 25mmHg increments for the following conditions:
• Excessive drainage
• Large wound volume
• Use of V.A.C.® WhiteFoam Dressing; tenuous seal
The pressure setting for the V.A.C.® Therapy System ranges from -25 to
-200 mmHg, depending on the unit model. The default setting for V.A.C.®
Therapy is -125 mmHg on a continuous setting, but these settings may be
individualized to the patient’s needs based upon physician order.
*Refer to the V.A.C.® Therapy Clinical Guidelines for recommended therapy settings by wound type.
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
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V.A.C.® Therapy Pressure Settings
Continuous vs. Intermittent Therapy
The V.A.C.® Therapy System pressure setting may be titrated
down by 25 mmHg increments for the following situations:
Continuous therapy is recommended for the first 48 hours in all wounds.
Intermittent therapy may be used following this 48 hour period. Some
patients may be better served on continuous therapy for the duration of the
treatment
Note: V.A.C.Via™ Therapy Units have Dynamic Pressure Control™ (DPC)
therapy, which is the next evaluating intermittent therapy
• Extremes of age
• Compromised nutrition
• Risk of excessive bleeding (e.g., patients on anticoagulation
therapy)
• Circulatory compromise (e.g., peripheral vascular disease)
• Excessive granulation tissue growth
• Pain or discomfort not relieved by appropriate analgesia
• Periwound or wound bed ecchymosis
Continuous therapy after the first 48 hours is indicated where:
•
•
•
•
•
•
•
Patients are at increased risk of bleeding.
Patients experience significant discomfort during intermittent therapy
It is difficult to maintain an airtight seal (e.g., perianal or toe wounds)
There are tunnels or undermined areas, as continuous therapy helps to hold the wound
closed, collapsing the edges and promoting granulation
There are high levels of drainage from the wound after the first 48 hours (it is better to
wait until the amount of drainage tapers off before switching to intermittent mode)
There are grafts or flaps with the need to prevent shear
A splinting effect is desired (e.g., sternal or abdominal wounds)
Refer to the V.A.C.® Therapy Clinical Guidelines for guidelines on indications for continuous and intermittent therapy.
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
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V.A.C.® Therapy System
Basic Dressing Application
SensaT.R.A.C.® Pad and Tubing
1.
Cut V.A.C.® GranuFoam™
Dressing to dimensions
that will allow the foam to
be placed gently into the
wound without overlapping
intact skin
2.
Trim and place the V.A.C.®
Drape to cover the V.A.C.®
GranuFoam Dressing and
an additional 3-5 cm
border of intact periwound
tissue
V.A.C.® Drape
V.A.C.® GranuFoam® Dressing
3.
Pinch the drape and cut a
2.5 cm hole through the
drape and apply the
SensaT.R.A.C.™ Pad
©2012 KCI Licensing, Inc. All rights reserved. DSL#12-0044 (Rev 2/12)
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1
NEGATIVE PRESSURE WOUND THERAPY
Below is an overview of negative pressure wound therapy for your reference. The skills
validations document can be found on page 15-16. Please bring a copy to class.
OVERVIEW
Negative-pressure wound therapy (NPWT) is an advanced wound care therapy utilizing
an occlusive wound dressing, tubing, and a powered vacuum unit with a collection
canister. Other terms found in the literature for negative-pressure wound therapy include
topical negative pressure therapy (TNP) or vacuum assisted closure (VAC) and
subatmospheric (negative) pressure. The purpose of NPWT is to apply controlled,
negative pressure to the wound bed for stimulation of granulation tissue and edema
reduction, thus enhancing wound healing.
There are many different Food and Drug Administration (FDA)-approved vacuum units
on the market for NPWT.10 The Agency for Healthcare Research and Quality (AHRQ)
provides review of current NPWT manufacturers.14 Frequently, the two most common
devices seen in the acute care practice setting are: Vacuum-Assisted Closure (V.A.C.)
therapy (Kinetic Concepts, Inc, San Antonio, TX) and EZCARE® (Smith & Nephew,
Largo, FL).10V.A.C. utilizes a patented open-cell foam wound contact dressing, whereas
EZCARE® (as well as other newly developing units on the market) utilizes the vacuumpack method, which is an antimicrobial gauze packing dressing. The use of moistened
gauze wound interface in addition to the VAC dressing has also been reported in the
literature as an effective dressing for NPWT.6
Most randomized, controlled studies and case studies on NPWT have been conducted
using the V.A.C. therapy. There are no randomized, controlled trials comparing the
effectiveness of various NPWT techniques or systems.14 Further clinical research to
evaluate wound closure outcomes with the different NPWT units is needed.7,9-10
NPWT assists with wound closure by applying a controlled, negative pressure evenly
over a wound bed. This mechanical stress creates a noncompressive force on the wound
bed that dilates the arterioles, increasing the effectiveness of local circulation and
enhancing the proliferation of granulation tissue.1,4,5 NPWT enhances lymphatic flow and
removal of excessive fluid, decreasing wound edema and bacterial load at the wound site,
further aiding wound healing.1,2,4,5,12,13
Wound healing is best achieved through adequate cleansing and dressing of the wound
bed based on characteristics of the patient and the wound. Wounds heal by either primary
or secondary intention. Most clean surgical wounds heal by primary intention. Suturing
each layer of tissue approximates the wound edges. These wounds typically heal quickly
and require minimal wound care.
2
Contaminated surgical or traumatic wounds (open wounds) heal by secondary intention.
Wounds healing by secondary intention granulate from the base of the wound to the skin
surfaces and care must be taken to allow for uniform granulation and prevention of open
pockets or tunneling. Openly granulating wounds heal more slowly and must remain
moist to enhance tissue granulation. Wound care for these wounds focuses on decreasing
the patient’s pain and maintaining a moist environment that is free of necrotic tissue.
Open wounds may have excessive wound drainage, requiring application of absorptive
dressings, protection of periwound skin, and more frequent dressing changes to facilitate
healing. NPWT provides wound drainage management as well as decreased frequency of
dressing changes (most NPWT dressing changes are three times per week), with
improved pain management for the patient.
NPWT has been approved by the FDA for the following wounds:
Acute wounds
•
•
•
•
•
Orthopedic trauma wounds
Partial-thickness burns
Abdominal wounds
Surgical dehisced wounds
Flaps and grafts
Chronic wounds
•
•
•
Diabetic wounds
Pressure ulcers
Leg ulcers
Goals of NPWT in the management of wounds may include wound bed preparation for
skin grafts, full wound closure, decrease in wound size, removal of wound edema for
delayed primary closure, and increased perfusion to marginally viable flaps.
The effectiveness of NPWT should be evaluated with each dressing change to include a
comprehensive wound assessment and weekly wound measurements. If wound
measurements have not improved at least 15% after 2 weeks of therapy, reevaluate the
continuation of NPWT with reassessment of wound-healing variables.16
Wounds with infections should have systemic antibiotic treatment before initiation of
NPWT. If continued deterioration of the wound and/or infection persists, consider
discontinuing NPWT, with possible evaluation by the practitioner for surgical drainage of
infection. Wounds treated with NPWT develop a characteristic, beefy-red granulation
bed. Pale, friable tissue that bleeds easily is a secondary sign of infection and may be
more reliable than the traditional indicators of infection.3,5
3
Dehisced, infected sternal wounds utilizing NPWT require effective debridement of
infected bone and a specific nonadherent wound contact layer before a NPWT dressing is
placed.
Successful management of enteric fistulas with NPWT using special application
techniques has been reported in case studies, but there are no clinical trials at this time.
See NPWT device manuals for specific techniques in the management of fistulas.
Rapid formation of granulation tissue with NPWT can lead to enhanced development of
abscesses. The surgically dehisced wound with NPWT should be monitored closely for
abscess formation, particularly in patients with large, irregular wounds with undermining
present.
Transcutaneous oxygen pressure (TcPO2) evaluation should be considered before
initiation of NPWT to lower extremity wounds because of vascular flow requirements
that are needed for optimal wound healing with NPWT.
Contraindications to the use of NPWT include the following:
•
•
•
•
Malignancy in the wound
Untreated osteomyelitis
Nonenteric and unexplored fistulas
Necrotic tissue with eschar present10,13
See manufacturer’s NPWT manual and consult wound specialist and patient’s physician
for special precautions required with exposed blood vessels, organs, tendons, and nerves.
Precautions should be used for wounds with active bleeding, difficult wound hemostasis,
or patients taking anticoagulants.11
For optimal NPWT with the V.A.C. device, at least 22 of 24 hours daily of uninterrupted
therapy should be delivered. The newer vacuum units (i.e., EZCARE®) do not have
research evidence at this time for required time duration of uninterrupted therapy for
optimal wound healing. NPWT dressings are usually changed every 48 hours.4,7,9,12,13
However, infected wound beds may require more frequent dressing changes (every 12 to
24 hours), and dressings over grafts may be changed less frequently (every 3 to 5 days).4,9
The wound bed should be free of necrotic tissue and debris before applying the NPWT
dressing.
In highly exudative wounds, drainage from the wound bed may be significant in the first
24 to 48 hours of therapy. Studies have not suggested direct fluid replacements as
necessary for ensuring homeostasis in highly exudative wounds.1,3,5 Excessive bleeding
amounts should be noted for discontinuation of therapy.
Nutritional requirements for wound healing are great. These needs must be assessed, met,
and monitored frequently, because poor nutrition can impede successful NPWT wound
healing.
4
Two NPWT units, V.A.C. and EZCARE®, have home units (with increased portability
due to smaller size and increased battery-operated options), allowing for continuation of
therapy outside of the acute hospital setting.
SUPPLIES
Will be reviewed in class
PATIENT AND FAMILY EDUCATION
•
•
•
•
Assess patient's and family's readiness to learn and any factors that may affect
learning; identify the patient's preferred learning strategies (auditory,
visualization, return demonstration)
Provide information about NPWT, the procedure, and the equipment
Explain the procedure and the reason for changing wound dressing
Discuss patient's role during the dressing change procedure and in maintaining
the NPWT system
ASSESSMENT AND PREPARATION
Assessment
1. Fully assess wound with documentation of wound measurements,
characteristics, and appropriateness for the procedure.
2. Assess for signs and symptoms of wound infection, including the following:
a. Periwound erythema
b. Increased periwound warmth
c. Wound edema
d. Increased pain associated with wound
e. Increased odor and amount of wound exudate
f. Elevated temperature and white blood cell count
3. Determine baseline pain assessment.
4. Determine baseline nutritional and fluid volume status.
5. Assess past medical history, especially as related to bleeding problems, fistula
formation, or malignancy.
6. Assess current medications specifically related to anticoagulant use.
7. Assess current laboratory values, especially coagulation studies and protein
levels.
Preparation
1. Verify correct patient using two identifiers.
2. Ensure the patient’s and family’s understanding of the procedure. Reinforce
teaching points as needed.
3. Validate presence of patent IV access.
5
4. Position the patient in a manner that will ensure the patient's comfort and
privacy, and facilitate dressing application.
5. Administer prescribed analgesics if needed.
PROCEDURE
General principles of NPWT are consistent across devices; however, wound-specific and
device- specific guidelines need to be reviewed before NPWT. This procedure outlines
steps in the use of K.C.I. V.A.C. Therapy for Wounds; V.A.C. Application. Procedure
steps 1 through 7 (below) are generic to all NPWT applications.
1. Perform hand hygiene and don gloves and appropriate personal protective
equipment.
2. Position the patient to facilitate cleansing and dressing application.
Rationale: Provides for the patient's comfort and allows for visualization and
access to the wound.
3. Assess, measure wound, and assemble supplies as indicated.4,5 (Table 1) (Level
D: Peer-reviewed professional organizational standards with clinical studies
to support recommendations)
Rationale: Select NPWT dressing type with appropriate size approximating
wound size.
V.A.C.-specific dressings (There are multiple types of V.A.C. specialty size
dressings [refer to manufacturer's manual]).
a. Black polyurethane foam (GranuFoam® has larger pores and is
considered to be more effective in stimulating granulation tissue
formation and wound contraction. It is the most frequently used
dressing.
The black V.A.C. dressing does not hold moisture but allows
exudates to pass through the dressing and be removed. Its design
results in rapid growth of new granulation.
b. White polyvinylchloride foam (VersaFoam®) is more dense,
premoistened, and with increased tensile strength. Because of its higher
density, it requires higher pressure to obtain the same granulation rate as
black foam.
The white V.A.C. dressing holds moisture but also allows exudate to
be removed through it. It is nonadherent and therefore less painful
and damaging.15 It can be used in tunnels and shallow undermining
because of its higher tensile strength.
6
c. Black polyurethane foam GranuFoam Silver® has antimicrobial silver
and may reduce infections in wounds.16
4. Cleanse the wound according to orders and/or institutional protocol. (Level B:
Well designed, controlled studies, with results that consistently support a
specific action, intervention, or treatment) Cleansing of wound with normal
saline and flushing technique is most often practiced.
Rationale: Wound bed cleansing and irrigation prepares the wound bed for
application of dressing.3,5
5. The practitioner may debride necrotic tissue or eschar if applicable.
Rationale: NPWT will assist with autolytic and mechanical debridement of
surface slough; it should not be used as a primary means of debridement. Sharp
debridement of necrotic tissue should be performed by a wound specialist or
physician and before initiation of therapy for optimal healing with NPWT.4,16
If extensive debridement is necessary, surgical debridement in the
operative suite may be necessary.
6. Prepare the periwound by cleansing with solution. Clip the hair around the
wound. Dry the skin and prepare the periwound tissue with a barrier protective
film.5 (Level D: Peer-reviewed professional organizational standards with
clinical studies to support recommendations)
Rationale: Moisture from perspiration, oil, or body fluids may interfere with
the drape's adherence. Barrier films act as a protectant against periwound
maceration.
There is potential for folliculitis with multiple removals of transparent
drape; may irritate hair follicles.
7. Remove gloves, perform hand hygiene, and don clean gloves.
8. Open intact package and cut the V.A.C. foam with sterile scissors; do not cut
foam directly over the wound.13 (Level E: Multiple case reports, theory-based
evidence from expert opinions, or peer-reviewed professional organizational
standards without clinical studies to support recommendations)
Rationale: Prevents small particles of dressing from falling into the wound. The
dressing should be cut to fit the size and shape of the wound, including tunnels
and undermined areas. Tunneling can result in a cyst or abscess when vacuum
pressure or granulation closes the entrance to the tunnel. Bacterial invasion and
impaired healing result from unfilled dead space.3
7
Any exposed tendons, nerves, or blood vessels should be protected by
placing a layer of nonadherent dressing over them.
9. Gently place foam into wound, ensuring contact with all wound surfaces. Do
not force foam dressing into any area of the wound. Always note total number
of foam pieces used, with notation on transparent drape and in the patient's
chart. (Level E: Multiple case reports, theory-based evidence from expert
opinions, or peer-reviewed professional organizational standards without
clinical studies to support recommendations)
Rationale: Capillaries can be compressed if dressings are packed too tightly,
and pressure on newly formed granulation tissue may prevent or delay
healing.13
More than one dressing may be used to fill the wound bed. Foam pieces
should be in contact but not overlapping each other to allow
equalization of negative pressure applied to the wound bed by the
suction device.1,5
10. Trim and place the V.A.C. transparent drape to cover the foam dressing and an
additional 3 to 5 cm of intact periwound skin. Avoid stretching the drape over
the wound.13 (Level M: Manufacturer's recommendations only)
Rationale: Avoids tension and shearing forces on surrounding tissue.
Bridging of wounds can be done for more than one wound of similar
pathology in close proximity utilizing one vacuum pump. See
manufacturer's specific instructions.
11. Cut a 2-cm hole in the transparent drape for fluid to pass through. Cut a hole
rather than a slit, because a slit may self-seal during therapy. Apply the
T.R.A.C.® pad with tubing directly over the hole in the transparent drape.
Apply gentle pressure around the pad to ensure complete adhesion.13 (Level M:
Manufacturer's recommendations only)
Rationale: The vacuum will not function without an occlusive seal. The drape
may also help maintain a moist wound environment. The drape is vaporpermeable and allows for gas exchange. It also protects the wound from
external contamination.
The foam will contract into the wound bed if seal is obtained. If foam
does not contract, reassess outer dressing for possible leaks in the
system or dressing seal.1,5
12. Ensure that the position of the T.R.A.C. tubing is not over bony prominences.13
(Level M: Manufacturer's recommendations only)
8
Rationale: This will minimize the risk of pressure related to tubing placement.
Extra foams with drape can be used under the tubing to reduce
pressure and stabilize the tubing.
13. Remove V.A.C. canister from packaging and insert into the vacuum unit.
Connect T.R.A.C. pad tubing to canister tubing and ensure clamps are open.
Rationale: Closed clamps prevent activation of the negative therapy.
14. Turn on power to vacuum unit and select prescribed therapy setting. Assess
dressing to ensure seal integrity. The dressing should collapse with a wrinkled
appearance and no hissing sounds.4 (Level E: Multiple case reports, theorybased evidence from expert opinions, or peer-reviewed professional
organizational standards without clinical studies to support recommendations)
Rationale: Setting options include continuous or intermittent negative-pressure
therapy. The settings are determined by type of wound, exudate, and goals as
ordered by the practitioner.
If dressing does not collapse, check tubing and transparent drape for
leaks. Use additional drape to seal leaks as necessary.
15. Assess pain according to institutional standard.
Rationale: Identifies need for management of discomfort associated with
wound and/or NPWT system. Patient may require lower vacuum setting to
reduce pain.11
Report inability to manage the patient's pain.
16. Label the dressing with date and time of application and number of foam pieces
placed in wound.
Rationale: V.A.C. foam dressings are not bioabsorbable. Ensure all pieces of
foam are removed from the wound with each dressing change. Foam left in
wound for greater than recommended time period may foster ingrowth of tissue
into the foam and create difficulty in removing foam pieces from wound, or
lead to infection.13
Reportable condition(s): Foam left in wound for greater than
recommended time period
17. Discard used supplies, remove gloves and perform hand hygiene.
9
18. Document the procedure, materials used (including type of foam dressing and
number of foam pieces), wound assessment, measurement, pain level, and
tolerance of the procedure in the patient’s record.
V.A.C. Dressing Removal Procedure
1. Verify correct patient using two identifiers.
2. Perform hand hygiene and don gloves and appropriate personal protective
equipment.
3. Assess need for pain management intervention.
4. To remove the dressing, raise the tubing connector above the level of the
vacuum unit and tighten clamps on the dressing tubing. Disconnect the two
tubes at the connection point.
Rationale: Removes any remaining fluid from the tubing for purposes of
infection control and preventing leakage.
5. Allow the vacuum unit to pull the exudate through the canister tubing into the
canister, then tighten clamp on the canister tube. Turn off vacuum unit.
Remove canister from vacuum unit and discard.
Rationale: Allows exudate to be contained. Canister should be discarded per
institutional policy.
6. Allow foam to decompress. Gently stretch transparent drape horizontally to
release adhesive from the skin. Do not peel vertically. Gently remove foam
dressing from wound.10
Rationale: Decreases the patient’s discomfort and the potential for skin and
wound trauma. Instillation of sterile water or NS onto the foam facilitates
sponge removal and eases pain of removal.
If dressing adheres to wound, instill 10 to 30 mL of normal saline (NS)
or sterile water into vacuum unit tubing to soak the foam and wait 15
to 30 minutes before gentle removal of dressing.8 Ensure all foam is
removed from wound bed. Reevaluate use of current dressing type and
consider use of interface or white foam dressing. NS should not be used
with GranuFoam Silver®. (Level M: Manufacturer's recommendation
only)
7. Discard used supplies, remove gloves and other personal protective equipment,
and perform hand hygiene.
MONITORING AND CARE
10
1. Assess location of V.A.C. T.R.A.C. tubing to avoid excessive pressure on
surrounding tissue/structures.
Rationale: Excessive pressure may result in tissue breakdown from tubing over
bony prominences.
Reportable condition(s): Tissue breakdown
2. Assess patency of V.A.C. system. Ensure that the drape has an occlusive seal,
the tubing is patent, and the foam is compressed.
Rationale: The V.A.C. foam should be collapsed when seal is maintained and
negative pressure is being delivered in a consistent manner. Alarms on the
device will indicate loss of seal; raised foam dressing indicates loss of
negative-pressure therapy.
Reportable condition(s): Loss of seal, raised foam, or wound drainage
suddenly decreasing in amount or stopping
3. Assess the amount and type of drainage.
Rationale: Color of drainage can suggest bleeding, and rate of canister filling
can alert the caregiver to wound problems
Reportable condition(s): Bright red blood or rapid filling of the
canister
4. Monitor condition of wound bed and periwound skin with dressing changes;
observe for signs of wound infection.
Rationale: Identifies any evidence of wound healing or any changes or
abnormalities indicative of complications.
Reportable condition(s): Periwound erythema, heat, edema, pain,
elevated temperature and white blood cell count, cloudy or foulsmelling wound drainage, excess bleeding, changes in tissue color
within wound bed, macerated periwound skin, new tunneling or
undermining, stool in the wound bed
5. Change the foam every 48 hours. If infection is present, increase the frequency
of foam change to every 12 to 24 hours.4 (Level D: Peer-reviewed professional
organizational standards with clinical studies to support recommendations)
Rationale: Removes infectious material from the wound bed. If dressing
adheres to the wound base, consider interfacing a single layer of nonadherent
porous material (e.g., silicone-type dressing) between the dressing and the
11
wound when reapplying the dressing. If previous dressings were difficult to
remove and painful, consider instillation of a topical anesthetic agent, such as
1% lidocaine without epinephrine, into the tubing or dressing, as ordered by the
practitioner.11
Reportable condition(s): Erythema, heat, odor and type of drainage
change, fever
6. Monitor the mode (continuous or intermittent) and level of suction (50-175 mm
Hg). (Level E: Multiple case reports, theory-based evidence from expert
opinions, or peer-reviewed professional organizational standards without
clinical studies to support recommendations)
Rationale: Removal of edema and debris alleviates compressive forces, thus
improving perfusion. Suctioning fluid from within the wound may remove
wound fluid factors that inhibit healing.3,5 Application and release of negative
pressure on the wound bed stimulates cell proliferation and protein synthesis.
Mechanical stretch on the tissue by the negative pressure draws the wound
toward the center, closing the defect.13
Reportable condition(s): Patient's discomfort, excess granulation tissue
overgrowth into the dressing when removed, continued edema within
wound bed
7. Maintain an airtight seal.13 (Level M: Manufacturer's recommendations only)
Rationale: Loss of an airtight seal can result in a decreased amount of drainage
removal and in desiccation of the wound.
8. Keep canister position level.
Rationale: Controls odor.
9. Monitor amount of wound drainage.4 Turn off V.A.C. therapy for excess
sanguineous drainage. (Level D: Peer-reviewed professional organizational
standards with clinical studies to support recommendations)
Rationale:If a wound produces excessive fluid, the patient may experience a
fluid imbalance, requiring fluid replacement via IV line. Excess drainage may
also result in increased protein loss. A nutritional consult to replace protein loss
from wound exudates may be indicated.
Reportable condition(s): Wound drainage becoming foul smelling and
cloudy
12
10. Monitor level of pain with NPWT. Pain can be associated with application of
dressing, initiation of initial therapy, intermittent cycling, and/or removal of the
dressing.
Rationale: Use of analgesics at dressing changes can reduce the pain. Also,
lowering the initial amount of negative pressure or maintaining the pressure at
continual versus intermittent levels can assist in pain control.3,5,7
11. Document system patency, amount and description of wound fluid, pain level,
and tolerance of NPWT in the patient’s record.
EXPECTED OUTCOMES
•
•
•
•
•
Wound healing and granulation enhanced by consistent negative-pressure
therapy; early signs of contraction of wound margins
Decreased volume of wound exudate (over time) and absence of foul odor or
color
Enhanced wound healing because of effective wound fluid/edema removal
Decrease in size of wound with ability for surgical closure with flap/graft or
skin graft; complete healing of wound
Decreased time to satisfactory healing (may decrease hospital length of stay
and cost)
UNEXPECTED OUTCOMES
•
•
•
•
•
•
•
•
•
•
Infection
Bleeding
Fistula formation
Disruption of underlying tissue/structures
Pain
Misplacement over exposed vessel, ligaments, other structures
Lack of improvement in wound after 1 to 2 weeks of therapy
Tissue loss
Ischemia and necrosis
Periwound maceration
DOCUMENTATION
•
•
•
•
•
•
•
Patient and family education
Patient's tolerance of the procedure
Condition of the wound bed and periwound skin description
Characteristics and amount of wound drainage
Degree of suction (millimeters of Hg) and continuous or intermittent mode
Nursing interventions
Premedication given and patient's response to pain medication
13
•
•
•
•
Wound debridement procedure (if applicable), wound-cleansing procedure
completed, dated and timed
Size of the wound measured by length, width, and depth (consider obtaining a
photograph of the wound, depending on institutional policy)
Size and type of V.A.C. foam dressing applied and total number placed in the
wound
Unexpected outcomes, reportable conditions
REFERENCES
1. Argenta, L.C., & Morykwas, M.J. (1997). Vacuum-assisted closure: A new
method for wound control and treatment: clinical experience. Ann Plast Surg,
38(6), 563-576. (classic reference)*
2. Armstrong, D.G. et al. (2004). Proceedings from the 2003 national V.A.C.
education conference, Ostomy Wound Management, 50(Suppl 4A).
3. Bergstrom, N. et al. (1994). Treatment of pressure ulcers. Clinical practice
guideline, No.15. Rockville, MD: U.S. Department of Health and Human
Services, Public Health Service, Agency for Healthcare Policy and Research.
AHCPR Publication No. 95-0652. (classic reference)*
4. Bovill, E. et al. (2008). Topical negative pressure wound therapy: A review of
its role and guidelines for its use in the management of acute wounds. Int
Wound J, 5(4), 511-529.
5. Broughton, G. et al. (2006). Wound healing: An overview. Plast Reconstr
Surg, 117(7S), 1e-S-32e-S.
6. Chariker, M.E., Gerstle, T.L., & Morrison, C.S. (2009). An algorithmic
approach to the use of gauze-based negative-pressure wound therapy as a
bridge to closure in pediatric extremity trauma. Plast Reconstr Surg, 123(5),
1510-1520.
7. Gupta, S. (2007). Differentiating negative pressure wound therapy devices: An
illustrative case series. Wounds, 19(1 Suppl), 1-9.
8. KCI Licensing Inc. (April 2010). V.A.C. Therapy Clinical Guidelines.
Retrieved from http://www.kci1.com/KCI1/vactherapyformsandbrochures
9. Koehler, C. et al. (2008). Wound therapy using the vacuum-assisted closure
device: Clinical experience with novel indications. J Trauma, 65(3), 722-731.
10. Long, M.A., & Blevins, A. (2009). Options in negative pressure wound
therapy: Five case studies. J Wound Ostomy Continence Nurs, 36(2), 202-211.
11. Sibbald, R.G., Mahoney, J., V.A.C. Therapy Canadian Consensus Group.
(2003). A consensus report on the use of vacuum-assisted closure in chronic,
difficult-to-heal wounds. Ostomy Wound Manage, 49(11), 42-66.
12. Smith and Nephew Negative Pressure Wound Therapy (NPWT). (2007).
Clinical case reports, St. Petersburg, FL, USA.
13. Smith, A.P.S. (2006). V.A.C. therapy clinical guidelines: A reference source
for clinicians. KCI Licensing, San Antonio, TX.
14. Sullivan, N. et al. (2009). Negative pressure wound therapy devices:
Technology assessment report. Project ID: WNDT1108. Retrieved September
14
15, 2009, from Agency for Healthcare Research and Quality web site:
http://www.ahrq.gov/clinic/ta/negpresswtd/
15. Sussman, G. (2010). Technology update: Understanding foam dressings.
Wounds International, 1(2). Retrieved from
http://www.woundsinternational.com/article.php?issueid=301&contentid=129
&articleid=8816&page=1
16. World Union of Wound Healing Societies (WUWHS). (2008). Principles of
best practice: Vacuum assisted closure: Recommendation for use. A consensus
document. London: MEP Ltd.
*In these nursing skills, a “classic” reference is a widely cited, standard work of
established excellence that significantly affects nursing practice and may also represent
the foundational research for practice.
Excerpted and adapted from Wiegand DL, editor: AACN procedure manual for critical
care, ed 6, Philadelphia, 2011, Saunders.
15
Washington Hospital Center
Department of Nursing
Population Based Skills Acquisition
Negative Pressure Wound Therapy
Name:___________________________________________________________
Employee ID#__________________________________ Unit: ______________
Directions for Skills Acquisition:
For skills acquisition, the method of validation is simulation in the classroom setting. Indicate that
the nurse has “met” or “not met” each performance criteria/ key element by placing a √ in the
appropriate column. Place the date and validator initials in the column and place the validator initials
and signature at the bottom of the form.
Return this form to your Nursing Director for placement in your file.
Performance Criteria or Key Elements
Performs positive patient identification using 2 identifiers
Obtains orders and correct supplies before starting
States how are orders obtained and anticipated supplies required for
basic NPWT dressing change.
States appropriate pre-dressing change procedures for the
patient.
(Accurate orders, correct patient, indication/education for dressing, and
pre-medication for pain if indicated)
Demonstrates correct position of patient, or if using model states
appropriate positioning.
States contraindications / careful consideration for NPWT
(Malignancy, exposed structures, necrotic tissue, bleeding, untreated
osteomylitis)
Measures wound correctly
Prepares foam dressing and applies dressing and adjuncts to
wound bed correctly (States indications for non-adherent layer
and white foam)
Applies pad and inserts tubing into dressing correctly
(States rational for quarter-sized hole in drape)
Sets up machine with canister and tubing properly with recommended
pressure and intensity settings
Initiates NPWT and determines whether or not it is working properly
Troubleshooting:
1. Leak / Therapy interrupted and states corrective action
Met
Not
Met
Date & Initials of
Validator
16
Performance Criteria or Key Elements
2. Low pressure alarm and states corrective action
3. Blockage / Occlusion / Therapy interrupted and states corrective
action with timeline
4. Canister change / states corrective action / demonstrates canister
change
5. Low battery / states corrective action
States accurate documentation to includes: wound measurements,
description of wound bed, number of foam dressings next dressing
change and criteria for discontinuing NPWT
Initials & Signature of Validator(s):
______________________________________________
Met
Not
Met
Date & Initials of
Validator