Week 1 Negative Pressure Wound Therapy (NPWT) Flashcards
what is NPWT
a closed wound dressing with suction, that gives sub- atmospheric pressure across the entire wound.
what is the pressure of NPWT
0-125 mmHg
what are some of the mechanisms of action and the benefits of NPWT
- removes exudate
- moist environment
- decreased bacterial burden
- reduce edema and excess ISF and increase blood flow
- increased microvascular blood flow
- stimulate granulation tissue
- promotes contracture
- reduces the amounts of time you need to –change the dressing
what is the general equipment needed
- pump to give suction (electric or battery)
- wound filler or cover to transfer pressure across the wound, and allow fluid to move into the canister
- tubing to deliver suction and allow fluids to move
- canister to hold fluid
- occlusive sheeting to give that air tight seal
what are some indications for using NPWT
VI, pressure injuries, traumatic, surgical, burns, mass casualty, high energy injuries, bone or tendon exposure, over grafts, over sutures (the last 3 with protection)
with sutures, what mode of NPWT is contraindicated
intermittent mode
can we do NPWT with pediatrics
yes, but at lower pressures (50-125), based on age and weight and location
what do we need to be concerned about in pediatric and elderly patients
dehydration
can we use NPWT for tissue protection
yes, with protection, because we don’t want to dry them out.
what is less aggressive, white, black or green
white is less aggressive
what are some precautions of using NPWT
- anticoagulants
- unexplored fistulas
- over named structures (without a barrier)
- must monitor for bleeding
- avoid circumferential occlusive sheathing to avoid ischemia
- monitor skin conditions over bony prominences, or hardwares
- debride sharp edges of a wound first.
- notify the doctor if the canister fills within 1 hour, or is more than 2 fill in 24 hours.
can we do NPWT for AI (arterial insufficiency)
no, because compression at wound edges causes 1-2.5 cm of hypo-perfusion
what mode and pressures can we maybe use for AI
low pressures, and intermittent mode.
what are some contraindications for NPWT
- more than 30% slough
- untreated osteomyelitis
- gross infection
- malignancy (unless palliative care)
- blood dyscrasia with leukemia
- directly over exposed vessels bypass grafts, organs, named structures
- ischemic wounds with proximal occlusion
- NO INTERMIT over grafts
- no suction in MRI, hyperbaric O2 chamber,
what are some prerequisites to use with infection
must be free of most systemic s/s of gross infection, necrotic tissue debrided, abscesses drained, combine with silver dressing and wound wash without the removal of the dressing
what are some signs of wound deterioration
- increased peri-wound erythema,
- repeated sharp/surgical debridement
- increased drainage or bleeding
- new infection or necrosis
- increased pain
- bigger wound
- new tracts or undermining.
when can I discontinue NPWT
- goals met
- good granular bed achieved
- no appreciable benefit in the last 48 hours
- deterioration
- new infection
- pt discomfort
- if something else works better
- progress to little or no drainage
- anticoagulants
- sanguineous drainage (more than 1 hour, more than 2 in 24 hours)
what are some examples of wound fillers
black white and green, gauze or JP types, flat, simple disposable stick on dressings
what are the 4 modes of delivery for NPWT
continuous (always on)
intermittent (on and off cycles)
variable (up and down but not off)
combo (continuous at first, then intermittent)
what is the recommendation for continuous on acute wounds and pressure injuries
80-125
what is the recommendation for continuous on grafts first 3-5 days
100-125
what is the recommendation for continuous to give max effects on blood flow
80mmHg
what is the recommendation for continuous on pain
50-75
what is the recommendation for continuous on most chronic wounds
50-75
what is the recommendation for continuous on wounds with decreased circulation
40-50
what is the recommendation for continuous on abdominal wounds, because pf the pressure receptors in the abdomen
75
what is the recommendation for intermittent NPWT
125mmHg, 5 min on 2 off
40-75 for mild arterial wounds.
what is the recommendation for variable NPWT
10-125 depending on etiology and patient comfort
what is the recommendation for combo NPWT
125 mmHg first 24 hours, then 80 intermittent
how can we reduce pain at dressing changes
- goal filler for 3-5 minutes with saline
- protective layer on fragile tissues
- xeroform strips at edges
- pull occlusive sheeting parallel to skin
- skin protectant
- frequent change of dressing )24 hours, not 48)
- granulation ingrowth less likely with gauze
- white foam is less painful than black
- calcium alginate under foam
- pain med
what is the additive under the foam to make it less painful when changing
calcium alginate
how long may pain or discomfort last
20 minutes
how can we educate patients
- basic operation, alarms, and how to patch
- benefits
- device is on 24 hours a day
- no kinks in tube
- 24 hour troubleshooting hotlines
- keep batteries charged
- what to do with bleeding or pain.
