Positive Outcomes with Negative Pressure Wound Therapy

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Positive Outcomes with Negative 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. - PowerPoint PPT Presentation

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Positive Outcomes with Negative Pressure Wound Therapy

Positive Outcomes withNegative Pressure Wound Therapy

Laurie S. Stelmaski BSN,RN,CWOCN1ObjectivesUnderstand 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.2NPWT 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.RESULTS IN QUICKER CLOSING AND HEALING

DRESSING IS AN OPEN RETICULATED FOAM OR GAUZE

SEALING MECHANISM = SEMIOCCULUSIVE DRESSING SIMILAR TO TEGADERM3NPWT Mechanisms of ActionStimulation of wound edge retractionMoist wound environmentDecrease in peripheral edemaIncrease in local circulation at the site of the woundReduced bacterial loadStimulation of granulation tissue formationDRAWS EDGE OF THE WOUND TOGETHER

ADHESIVE DRAPE SUPPORTS SEMIOCCLUSIVE ENVIRONMENT THAT SUPPORTS MOIST WOUND HEALING

TISSUE SURROUNDING WOUND USUALLY HAS A BUILDUP OF INTERSTITIAL FLUID THAT COMPROMISES CIRCULATION AND THE LYMPHATIC SYSTEM IMPEDES OXYGEN AND NUTRIENT DELIVERY TO TISSUE AND SUPPORTS BACTERIAL GROWTH.

EVACUATING THIS FLUID INCREASES CIRCULATION

ENHANCED CIRCULATION AND OXYGENATION TO COMPROMISED TISSUES IMPROVES RESISTANCE TO INFECTION

GRANULATION TISSUE FORMS A MATRIX OF BLOOD VESSELS AND CONNECTIVE TISSUE THAT SUPPORTS MIGRATION OF EPITHELIAL CELLS ACROSS THE WOUND BED.

GRANULATION TISSUE FORMATION IS ENHANCED BY NPWT SECONDARY TO INCREASED CIRCULATION.4

5Indications for NPWTAcute woundsChronic woundsTraumatic woundsPartial-thickness burnsDehisced woundsPressure ulcersDiabetic ulcersFlaps and skin grafts6Contraindications for NPWTMalignancy in the woundUntreated osteomyelitisNon-enteric or unexplored fistulasNecrotic tissue with eschar or slough presentExposed blood vessels or organs7Patient CandidatesAppropriate patient selection will prevent complications and ensure success of NPWT.Need to optimize the patients ability to heal:Manage comorbidities Hemodynamic stabilityNutritional statusBlood sugarInfectionHTN DIABETES IMMUNOSUPPRESSION

BLEEDING DISORDERS ANTICOAGULATION

MAXIMIZE NUTRITIONAL STATUS

CONSISTENT MANAGEMENT OF BLOOD SUGARS

TREATMENT OF INFECTION8Safe Use of NPWTPatient assessmentPhysician ordersWound preparationDebridement and cleansingDevice applicationDocumentationMonitoring and assessmentProcedure and protocol9Treatment 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.10Case Study #1

11Case Study #2

12ReferencesGupta, 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), 59-63.13

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