NPWT Flashcards
what is NPWT?
application of a vacuum (neg pressure) to a wound through suction to draw edges of a wound together while providing a moist environment to promote healing and collect wound fluid
how does NPWT work?
1) The removal of excess interstitial fluid decreases edema and concentrations of inhibitory factors and increases local blood flow.
2) Stretching and deformation of the tissue by the negative pressure is believed to disturb the extracellular matrix and introduce biochemical responses that promote wound healing.
what is the extracellular matrix?
comlex structure that surrounds cells in all tissues of body. exact biochemical composition arise from tissue to tissue. it is integral to each phase of wound healing, interacting with cells and growth factors
plays key roles in stimulating cell proliferation and differentiation, guiding cell migration and modulating cellular
does NPWT form or take away granulation tissue?
form
can NPWT close the wound?
yes, it prepares the wound for closure
what does the equipment consist of?
the pump, dressing set, drainage tubes
what kind of foam can you use ?
black/white or silver
is NPWT delivered continuously or intermittently more often?
continuously
what is the target negative pressure for wound healing?
-50 mmHg to -175 mmHg
cont setting of -125 mmHg is more common
when is the average dressing change?
q48 hr or 3 times/week depending on wound
what does the wound look like as it heals?
base becomes redder, granulation tissue lines surface initially and wound has stippled or granulation apperance
what do paler areas on wound mean?
healing and indicates increase in fibrous tissue
when do you use instillation therapy?
it is an innovate dual system that is used for infected wounds that fail to show clinical improvement
what kinds of install solutions can you use for instillation therapy?
cleansers, antibiotrics, antifungals, and antiseptics
how does instillation therapy benefit wound healing?
provides moist healing env’t
- decreases bacteria bioburden and improves perfusion
- rapid growth of granulation tissue
- shorter time required
what is an example of instillation therapy?
VAC veraflo
what is the procedure?
asess wound
protect periwounn area (skip prep) or use pieces of drape
-protect vital structures (bone, vessels) with non adherent dressing such as mepitel
-fill the wound depth with foam (do not cut over the wound)
-bridge wounds if needed
-aply dressing and trim as needed to cover an additional 3-5cm border of intact tissue
-make hole in drape size of a toonie and apply pad
-connect, monitor, assess
what pressure might you start off with?
lower neg pressure like -75mmHg and slowy titrate to more neg presure
how far over the intact tissue do you trim the foam?
3-5 cm
what types of wounds would you use this for?
dehisced wound diabetic foot ulcer pressure ulcer vascular ulcer burn wounds surgical wounds (especially infected sternal wounds or trauma induced)
what are some contraindications?
- Chronic wounds with exposed vital organs
- Inadequately debrided wounds
- Untreated osteomyelitis or sepsis near a wound
- Non-enteric & unexplored fistula
- Untreated coagulopathy
- Necrotic tissue with eschar
- Malignancy within a wound
- NPWT therapy is not appropriate for fragile neonatal skin.
- Use with caution with geriatrics due to fragile skin
advantages of NPWT?
- It improves patient comfort.
- It reduces the frequency of dressing changes (e.g. with children as it can be traumatic experience).
- Control of exudate.
- Reduce infection risk.
- Rapid wound granulation & epithelization (by stimulating new tissue growth).
- Reduces odour and pain at dressing change which promote the general well-being.
- Reduced treatment cost.
what happens if your wound appears inflamed and tender, drainage has increased and odor is present?
notify health care provider, obtain wound culture, inc freq of dressing changes
what happens if your patient reports increase in pain?
pain assessment
consult with the wound care nurse/doctor
- instill NS to moistem foam/filler dressings to allow them to loosen from granulation tissue
- decrease pressure setting
- change from intermittent to continuous cycling
what happens if there is wound hemorrhage?
stop NPWT immediately and notify health care provider
what happens if neg pressure seal has broken?
How to maintain an airtight seal:
- Choose a wound suitable for therapy.
- Clip hair around wound.
- Cut transparent film to extend 2.5 to 5 cm beyond wound perimeter.
- Frame the periwound area with skin sealant, skin barrier, hydrocolloid, or transparent film dressing.
- Fill uneven skin surfaces with a skin barrier product (stoma strip paste).
- Cut or mold transparent dressing to fit wound.
- Avoid wrinkles in transparent film.
- Identify any air leak with a stethoscope and repair with a sealant dressing
- Avoid adhesive remover because it leaves a residue that hinders film adherence
special consideration for paediatric ?
- NPWT therapy is not appropriate for fragile neonatal skin.
- Encourage Parents’ participation and provide teaching as needed .
- Acknowledge the child age and involve him/her accordingly.
special consideration for geriatric?
- fragile skin
- implement measures to protect periwound tissue such as using skin protectant
- therapy may need to start with lower eng pressures such as -75mmHg and slowly titrate to more neg pressure
special consideration for home care?
freq visits to inc patient and family comfort and initial treatment is being monitoring
teaching about care of equipment and proper disposal
is the pump stationary or portable?
both
