Positive Outcomes withNegative Pressure Wound

Therapy

Laurie S. Stelmaski BSN,RN,CWOCN

Objectives

Understand 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 Endpoints

Based 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.