Clinical Update TEN TOP TIPS Using negative pressure wound therapy effectively


“Continuous


negative pressure is the most


commonly used setting ... However, intermittent or


dynamic/variable mode may help to speed up


granulation tissue formation and


encourage blood flow at the


wound edge.”


wound filler and ensure it is visible in the open wound base. Our preferred method is to use the white foam in these regions of the wound due to its less adherent properties. Always count the number of foam pieces used in the wound and document on the label of the tubing and in the records.[5]


A wound diagram, with notes on dressing placement, can be helpful. 4


USE A WOUND CONTACT LAYER TO PROTECT UNDERLYING


STRUCTURES AND PREVENT PAIN


A fenestrated wound contact layer should be placed underneath the wound filler to protect vulnerable structure (e.g. exposed blood vessels, organs or tendons). This can prevent disruption to the wound bed and reduce pain at dressing changes.[6]


Consider the use of white foam,


which is softer and has a different pore structure to black foam, making it less adherent and ideal for use in tunnels and cavity wounds. It may also be considered where there are exposed structures in the wound bed.


5


CONSIDER THE WOUND LOCATION AND BRIDGE TO OFFLOAD


If a wound is over a bony prominence or on a weight-bearing area (e.g. plantar surface of the foot), it is important to use a pressure-relieving or offloading device.[7]


Bridging allows the


tubing to be placed on a non-pressure bearing surface away from a wound (e.g. a posterior or lateral surface). To minimise the risk of pressure ulceration, check the patient’s position when lying in bed to prevent the pad or tubing applying pressure to areas of the body. Bridging may also be used when wounds are in close proximity to one another, allowing just one dressing kit to be used. Ensure the bridge material is wide enough to prevent collapse and that the underlying intact skin is protected.


6


TAKE YOUR TIME AT DRESSING CHANGES


Taking time to apply and remove NPWT dressings can reduce pain and increase patient comfort. Switch off the machine for half an hour before removing the dressing; this allows time for the pressure to equalise in the wound bed and for the dressing to separate from the tissues. Injecting saline solution under the dressing may also help to reduce pain at dressing changes and facilitate atraumatic removal.


14


7


EACH TIME A DRESSING IS CHANGED, CONSIDER THE


PRESSURE SETTING AND MODE


There are currently no detailed clinical guidelines regarding the choice of pressure setting for individual wounds; the level of suction is based on individual assessment of the wound.[8]


Higher


levels of negative pressure (e.g. -125mmHg) have been shown to have a positive effect on wound contraction,[9]


regional blood flow[10] the formation of granulation tissue[9] and . However,


these higher levels can sometimes cause pain and therefore a reduction in negative pressure could be an option (e.g. >-75mmHg). There is a risk of reduced negative pressure in the wound bed when the transportation of fluids has to go against gravity (e.g. when the wound is on the leg and the unit is placed on the trouser belt of the mobile patient)[11]


. Continuous negative pressure is the most


commonly used setting and is recommended for use over unstable structures to provide a splinting effect. However, intermittent (suction pump switches on and off) or dynamic/variable mode (amount of suction rotates between the target pressure and a minimum low level of negative pressure) may help to speed up granulation tissue formation and encourage blood flow at the wound edge[10,12,13]


. 8


TAKE STEPS TO AVOID COMPLICATIONS


Pain Some patients may experience pain during treatment or dressing changes. Consider reducing the negative pressure to a lower level that is acceptable for the patient. Take your time applying and/or removing the dressing (see Top Tip #6). In addition, a non-adherent fenestrated wound contact layer placed below the wound filler may help reduce pain but it may also reduce the formation of granulation tissue. Do not stretch the drape and do not apply it to the skin under tension. Analgesia or anaesthesia should be considered prior to dressing change and time allowed for this to take effect. Pain will reduce as the wound heals.


Maceration Do not use too many layers of drape as this can decrease the moisture transmission rate. Ensure there is sufficient wound filler in the wound and that there is a good overlap of drape material, ensuring that the wound filler does not extend onto intact periwound skin. Protect


Wounds International Vol 5 | Issue 2 | ©Wounds International 2014 | www.woundsinternational.com


Ten Top Tips


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