Nursing Practice Innovation Tissue viability


Keywords: Tissue viability/Negative pressure wound therapy/Chronic wounds


●This article has been double-blind peer reviewed


Complex wounds may benefit from negative pressure therapy. Consideration must be given to appropriate patient selection and dressing application


Using negative pressure therapy in wound healing


In this article...


Types of wound for which negative pressure wound therapy is suitable Considerations for patient selection Using negative pressure wound therapy in the community


Author Heidi Guy is tissue viability clinical nurse specialist and honorary lecturer, East and North Herts Hospital Trust and University of Hertfordshire; Lorraine Grothier is clinical nurse specialist tissue viability, Central Essex Community Services, Maldon. Abstract Guy H, Grothier L (2012) Using negative pressure therapy in wound healing. Nursing Times; 108; 36, 16-20. Negative pressure wound therapy, also referred to as topical negative pressure therapy, is a useful treatment for a variety of acute and chronic wounds and, unlike many other wound treatments and dressings, has a relatively good evidence base to demonstrate its effectiveness. This article considers its application in both primary and acute care.


become chronic. Negative pressure wound therapy (NPWT) can be used to aid healing in acute, chronic, closed incisional, closed skin graft and open abdomen wounds. Unlike many other wound treatments and dressings, it has a relatively good evi- dence base to demonstrate its effective- ness, but manufacturers list some con- traindications and situations requiring caution (Box 1). Negative pressure (suction) is applied to


W


the wound bed through a foam or gauze contact medium using an electrically, bat- tery or mechanically powered pump; this involves achieving an airtight, vacuum, seal. The benefits of NPWT include:


ound healing does not always follow a simple path; some acute wounds fail to heal and some


enhanced healing and granulation tissue formation (Othman, 2012; Schintler, 2012); management of highly exuding wounds (Schintler, 2012; Mouës et al, 2011); reduced dressing changes compared with more con- ventional dressings (Wu and Armstrong, 2008); reduced nurse time (Dowsett et al, 2012); reduced costs (Othman, 2012); and improved quality of life (Othman, 2012). The treatment is thought to assist


healing by providing a moist environment and removing interstitial fluid and exu- date (Schintler, 2012; Mouës et al, 2011); and enhancing granulation tissue formation (Schintler, 2012), angiogenesis (Mouës et al, 2011) and tissue perfusion (Schintler, 2012; Mouës et al, 2011). Others have reported fluctuations in blood flow (Borgquist et al, 2011; Malmsjö et al, 2009a), which may be useful in patients with com- promised vascularity. Until recently, funding for NPWT was


restricted to the acute sector, but it is increasingly available in the community due to the introduction of competing devices, the availability of consumable dressings on prescription, and the drive to prevent hospital admissions and facilitate early discharge. However, access in com- munity setting is variable (Othman, 2012).


Dressings A range of studies evaluating gauze-based and foam-based NPWT have considered the difference in tissue formation (Malmsjö et al, 2012; Fraccalvieri et al, 2011a) and defor- mation (Malmsjö et al, 2012), healing rates (Dorafshar et al, 2012); pain at dressing change (Dorafshar et al, 2012; Fraccalvieri et al, 2011b), contraction (Anesäteret al, 2011;


16 Nursing Times 04.09.12 / Vol 108 No 36 / www.nursingtimes.net


5 key points


therapy has been found to aid healing in many complex wounds


1


2 3 4


carefully to avoid damaging the wound bed or causing pressure damage to the surrounding skin


5


The therapy can be used in


both acute and community settings


Practitioners using NPWT


must be trained to use the specific device


Patient selection must


involve assessing a range of factors in addition to the wound requiring treatment


NPWT must be applied


Negative pressure wound


Promoting wound healing using a gauze-based dressing


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40