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Basics of negative pressure wound therapy (NPWT): Part 2

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Basics of negative pressure wound therapy (NPWT): Part 2

I actually have learned rather a lot on my journey to raised understand negative pressure wound therapy (NPWT). In Part 1 of this series, I provided an summary of NPWT, including what it’s, how it really works, and the risks and advantages. In Part 2 of this series, I’ll review the sensible application of the NPWT, including prescribing recommendations, procedural steps, general patient care, and suggestions for troubleshooting the device. Let’s get into motion!

  • Dressing material (foam or gauze) and wound additive (protective, non-adherent, kerosene or silver dressing)
  • Vacuum setting (-20 to –200 mm Hg), typically set to –125 mm Hg
  • Therapy settings (continuous, intermittent or variable)
  • Frequency of dressing changes
Each device has a particular design and manufacturer’s instructions to be used, which needs to be read. The following procedural steps provide a general guide. Please also review your facility’s policies and procedures regarding NPWT dressing changes.

  1. If mandatory and as really useful, the patient should initially be treated with analgesics.
  2. Prepare the wound:
    • Remove the previous dressing very fastidiously to avoid tissue damage and bleeding
      • The variety of pieces of dressing removed needs to be checked in accordance with the patient’s medical records.
    • Have the wound cleaned by a professional doctor
    • Clean the wound as needed/directed (i.e., rinse with normal saline)
    • Assess wound size and depth, presence of tunnels, tissue loss, odor, heat, swelling, drainage, signs and symptoms of infection.
  3. Sterile technique needs to be used when changing the dressing
    • If using a foam dressing, cut the froth dressing to size and place it on the wound.
      • Document the variety of pieces of froth used; the froth acts as a filter to capture blood clots and huge tissue particles that would clog the vacuum system.
    • If using gauze, apply a single layer of non-adherent gauze to the wound bed. Then loosely apply an antibacterial gauze moistened with saline to the wound.
      • Document the variety of gauze pads or rolls used.
    • Avoid over-dressing the wound as this may occasionally delay healing.
  4. Cut the clear occlusive dressing to size, peel off one side of Layer 1 and apply it to the wound, adhesive side down.
  5. Remove the remaining side of Layer 1, ensuring it creates a good seal.
  6. Cut a hole concerning the size of 1 / 4 (2.5 cm) within the clear dressing.
  7. Remove layer 1 from the adhesive pad connected to the pump tube.
  8. If you should not using a pre-attached system, place the pad and tubing directly over the outlet, securing it to the clear dressing.
  9. Remove layer 2 from the adhesive pad.
  10. Connect the washer tube to the canister tube and ensure that the clamps are open. Anchor the drain tube just a few inches from the dressing to stop stress or dislocation of the tube.
  11. Mark the dressing with the date, time and variety of dressings used.
  12. Turn on the ability to the vacuum device, set the really useful pressure and check whether the dressing and foam shrink.
  13. ​​Make sure alarm limits are set appropriately.

  • Protective barriers comparable to non-adherent gauze or petroleum jelly needs to be used to guard sutured blood vessels or organs near areas undergoing NPWT.
  • Avoid applying foam to the wound too tightly; this prevents negative pressure from reaching the wound bed and accumulation of exudate.
  • To prevent drain-related pressure ulcers, avoid placing the drain over bony prominences, skin folds, creases, and weight-bearing surfaces.
  • Count and document all pieces of froth or gauze on the external dressing and medical records to stop materials from retaining within the wound; if possible, use just one piece of froth dressing.
  • For wounds with heavy colonization or infection, consider changing the dressing every 12 to 24 hours as directed by the prescriber.

  • Assess the patient for wound healing problems comparable to poor nutrition (low protein), decreased oxygenation, decreased circulation, diabetes, smoking, obesity, foreign bodies, infection, and low blood levels.
  • Assess and manage the patient’s pain; If mandatory, premedication needs to be applied before each dressing change.
  • Provide patient education on:
    • Alarms and device “noise”.
    • Dressing changes
    • Symptoms of complications (bleeding, infection)
  • Patients should see their doctor in the event that they notice:
    • Significant change in drainage color (cloudy or vivid red)
    • Excessive bleeding under a transparent dressing, tubing or canister
    • Increased redness or unpleasant odor from the wound
    • Increased pain
    • The device has been turned off for greater than 2 hours
    • Signs of infection comparable to fever, redness or swelling of the wound, itching/rash, feeling of heat, pus or foul-smelling drainage
    • Allergic response to the drape/dressing: redness, swelling, rash, hives, severe itching. The patient should seek immediate medical attention if respiratory difficulties occur.

  • Verify that the device is turned on and set to the suitable vacuum pressure, that the froth is collapsed, and that the NPWT device is maintaining the prescribed therapy and pressure.
  • Make sure the vacuum seal isn’t damaged and there are not any leaks within the system.
  • Make sure the tubing isn’t kinked and all clamps are open.
  • Address and troubleshoot alarms; Device alarm causes include: tank full, system leak, battery low/discharged, therapy not activated.
  • Do not leave the device turned off for greater than two hours; with the device turned off, apply a moist dressing and notify your prescriber immediately.
  • Avoid getting the electrical appliance wet; Instruct the patient to disconnect the device from the tubing and clamp the tubing before bathing.
  • Check the drainage chamber to make sure it’s filling properly and doesn’t should be replaced.
  • Date and time of dressing change
  • Wound assessment as described above
  • Pain assessment, patient’s tolerance to the procedure and interventions performed
  • Weight of soiled dressing (if applicable)
  • Type and variety of dressings used; verification of elements faraway from the wound
  • Patient and family education provided

Although I’m not an authority in wound care, I’m now more confident and higher prepared to treat patients undergoing negative pressure wound therapy. I’d love to listen to your experiences. Let me know if you’ve any suggestions or other suggestions which may help nurses and patients safely operate and maintain these devices.

Lippincott Solutions (2023, February 20). Negative pressure wound therapy. Lippincott’s solutions. https://procedures.lww.com/lnp/view.do?pId=858844&hits=terapia,negative,wound,wounds,pressure

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