Clinical Update TEN TOP TIPS Using negative pressure wound therapy effectively


the surrounding tissue and provide adequate offloading to reduce external pressure on the wound/dressing. If the amount of wound fluid increases, look for potential causes, such as dependent oedema. Increasing exudate may also be a sign that the wound is infected.


Leaks Avoid the use of skin care products containing glycerine, surfactant, or dimethicone as these can prevent adhesion of the drape and cause leaks. Alcohol-free barrier products (e.g. Cavilon [3M Healthcare]) are recommended for use with NPWT to protect intact skin. Keep the amount of drape material to a minimum[14] or hydrocolloid dressings[14]


. Barrier strips[15] placed around the


wound may help to maintain an adequate seal, in particular, in difficult-to-dress areas. It may be helpful to cut a hole in the dressing, to frame the wound, before applying the NPWT device. If therapy is interrupted for >2 hours at any


given time, the dressing must be removed to prevent the development of an infection. A new dressing must then be reapplied and therapy reinitiated[8]


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CONSIDER INSTILLATION THERAPY TO REDUCE WOUND BIOBURDEN


For wounds that are colonised or infected, NPWT can be combined with fluid instillation (V.A.C. VeraFlo™ Therapy [KCI][16]


. This ). This delivers a


wound instillation solution to the wound bed, which is left to rest for a short period of time and then removed during a cycle of NPWT[17]


method has been shown to reduce the number of operating room visits for surgical debridement on patients with infected wounds and may decrease the time to closure, while increasing the number of wounds closed[16] of granulation tissue produced[18]


and the volume . This therapy


option may also have a potential role in biofilm removal in complex wounds[19]


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PROVIDE APPROPRIATE TRAINING ON DEVICE USE


When applied correctly, NPWT is an effective option for managing complex wounds in a variety of healthcare settings. Appropriate training should be given to staff on how to apply the device as well as recognising and managing potential complications. When discharging patients home with NPWT in situ, all patients/ carers should be given printed instructions and know who to contact in an emergency. Care arrangements need to be transferred effectively


and treatment status, aims and goals clearly described. For complex patients, a face-to-face handover of care may be appropriate. It is also important to ensure that the patient’s home circumstances are appropriate for this form of care. Remember, NPWT looks simple, but may not be


simple. Always seek advice from the lead clinician when in doubt. n


REFERENCES 1. World Union of Wound Healing Societies. Principles of Best Practice: Wound Infection in Clinical Practice. An International Consensus. MEP: London, 2008


2. Willy C. Breakthrough ideas leading to new futures: prologue. Int Wound J 2013; 10(Suppl 1): 1–2


3. Riley S, Tongue J, Strokes S, et al. Using negative pressure wound therapy as an aid to debridement. Wounds UK Conference, Harrogate: 9–11 November, 2009


4. Back DA, Scheuermann-Poley C, Willy C. Recommendations on negative pressure wound therapy with instillation and antimicrobial solutions – when, where and how to use: what does the evidence show. Int Wound J 2013; 10(Suppl 1): 32–42


5. Hawkins Bradley B. Top ten tips for negative pressure wound therapy dressing applications, 2012 Available at: http://bit. ly/1ePz7cw (accessed 20.04.2014)


6. Malmsjö M, Borgquist O. NPWT Settings and Dressing Choices Made Easy. Wounds International 2010; 1(3): 1–6


7. Rock R. Get positive results with negative-pressure wound therapy. Wound Care Advisor 2012; 1(2): 15–9


8. Henderson V, Timmons J, Hurd T, et al. NPWT in Everyday Practice Made Easy. Wounds International 2010; 1(5): 1–6


9. Borgquist O, Ingemansson R, Malmsjö M. The influence of low and high pressure levels during negative pressure wound therapy on wound contraction and fluid evacuation. Plast Reconstr Surg 2011; 127(2):551-9


10. Borgquist O, Gustafsson L, Ingemansson R, Malmsjö M. Micro- and macromechanical effects on the wound bed of negative pressure wound therapy using gauze and foam. Ann Plast Surg 2010; 64(6): 789–93


11. McNulty A, Spranger I, Courage J, et al. The consistent delivery of negative pressure to wounds using reticulated, open cell foam and regulated pressure feedback. WOUNDS 2010; 22(5):114-20.


12. Malmsjö M, Ingemansson R, Martin R, Huddleston E. Wound edge microvascular blood flow: effectics of negative pressure wound therapy using gauze or polyurethane foam. Ann Plast Surg 2009; 63(6): 676–81


13. Malmsjö M, Gustafsson L, Lindstedt S, et al. The effects of variable, intermittent and continuous negative pressure wound therapy, using foam or gauze, on wound contraction, granulation tissue formation, and ingrowth into the wound filler. Eplasty 2012; 12: e5


14. Filiatrault A. Chapter 42: Wound VAC: tips and tricks. In: Podiatry Institute (eds) Podiatry Institute Update 2006. Available at: http://bit.ly/1he1xHW (accessed 20.04.2014)


15. Hartley CP, Villanueva B. Managing difficult negative pressure wound therapy sites with barrier strips. J Wound Ostomy Contin Nurs 2003; 30(3): s13


16. Powers KA, Kim PJ, Attinger CE, et al. Early experience with negative pressure wound therapy with instillation in acute infected wounds. Poster presentation, Symposium on Advanced Wound Care, Denver, CO: 1–5 May 2013


17. Rycerz A, Vowden K, Warner V, Jorgensen B. V.A.C.Ulta™ NPWT System Made Easy. Wounds International 2012; 3(3): 1–6


18. Brinkert D, Ali M, Naud M et al. Negative pressure wound therapy with saline instillation: 131 patient case series. Int Wound J 2013; 10(Suppl 1): 56–60


19. Willy C. Breakthrough ideas leading to new futures. prologue. Int Wound J 2013; 10(Suppl 1): 1–2


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


Acknowledgement: This article has been supported by KCI.


“When applied correctly, negative pressure wound therapy is an effective option for managing complex wounds in a variety of healthcare settings. Appropriate training should be given to staff on how to apply the device as well as recognising and managing potential complications.”


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Ten Top Tips


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