Positive Outcomes withNegative Pressure Wound
Therapy
Laurie S. Stelmaski BSN,RN,CWOCN
ObjectivesUnderstand the healing science
behind negative pressure wound therapy (NPWT).
Identify the indications and contraindications for use of NPWT in acute and chronic wounds.
Identify treatment endpoints for NPWT.
NPWT – How Does It Work?
The use of subatmospheric pressure to promote wound healing.
Subatmospheric pressure causes mechanical stress to the tissue and the wound is drawn closed.
Basic components of a NPWT system include the dressing, sealing mechanism, tubing and a suction pump.
NPWT – Mechanisms of Action
Stimulation of wound edge retraction
Moist wound environmentDecrease in peripheral edemaIncrease in local circulation at the
site of the woundReduced bacterial loadStimulation of granulation tissue
formation
Indications for NPWTAcute woundsChronic woundsTraumatic woundsPartial-thickness burnsDehisced woundsPressure ulcersDiabetic ulcersFlaps and skin grafts
Contraindications for NPWT
Malignancy in the woundUntreated osteomyelitisNon-enteric or unexplored fistulas
Necrotic tissue with eschar or slough present
Exposed blood vessels or organs
Patient CandidatesAppropriate patient selection will
prevent complications and ensure success of NPWT.
Need to optimize the patient’s ability to heal:◦Manage comorbidities ◦Hemodynamic stability◦Nutritional status◦Blood sugar◦Infection
Safe Use of NPWTPatient assessment
◦Physician ordersWound preparation
◦Debridement and cleansingDevice application
◦DocumentationMonitoring and assessment
◦Procedure and protocol
Treatment EndpointsBased on wound progress and/or
achievement of treatment goal.Planned surgical closure with flap
or skin graft.Healing by secondary intentionFailure to progress after 2-4
weeks of NPWT.
Case Study #1
Case Study #2
ReferencesGupta, S. (2004). Guidelines for managing pressure ulcers with negative pressure wound therapy. Advances in Skin & Wound Care, 17(S2), 2-16.Long, M.A. & Blevins, A. (2009). Options in negative pressure wound therapy: Five case
studies. Journal of Wound Ostomy and Continence Nursing, 36(2), 202-211.
Martindell, D. (2012). The safe use of negative-pressure wound therapy. American
Journal of Nursing, 112(6), 59-63.