Week 6 | Negative Pressure Basics (16180-SP)

Photo of negative pressure therapy applied.

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Topics

1. Definition of negative pressure 

  • Controlled application of sub-atmospheric pressure to a wound surface 

 2. Negative Pressure Information 

  • Modality varies in different settings 
  • Products changing rapidly 
  • Devices/dressings smaller, provide better privacy 
  • Reimbursement is complex 

Please note: 
Information in this module is not all inclusive, but basic principles are covered. It is beyond the scope of this class to teach application of the various devices. Please contact your local vendor for assistance with this. 
 
3. Wound Closure Impediments 

  • Edema 
  • Infection/Colonization 
  • Poor Blood Supply  
  • Paucity of tissue 
  • Scar/Trauma 

4. Therapeutic Benefits of Negative Pressure 

  • Removes unhealthy tissue/cells, maintains clean wound bed 
  • Removes/manages fluid from wound environment 
  • Removes infectious material/controls bacterial burden 
  • Mechanical stretching stimulates cell proliferation and migration 
  • Stimulates granulation tissue formation 
  • Maintains/protects moist wound environment 
  • Decreases frequency of dressing changes 

5. KCI – first to market negative pressure in United States 

6. Product Innovation 

  • KCI with long list of devices, some of which have been retired 
  • KCI uses only foam filler in application process 

7. Steps to Apply Negative Pressure 

  • First is always good assessment of individual 
  • Maximize underlying conditions to provide best opportunity for wound closure 
  • Establish a mutually agreed on goal for negative pressure use 
  • Change the plan of care as needed to move toward the goal 
  • If wound is not improving, change the management plan 

8. Absolute Contra-Indications for NPWT 

  • Slough, necrotic tissue with eschar present 
  • Malignancy in the wound 
  • Untreated osteomyelitis 
  • Non-enteric or unexplored fistula 
  • Exposed anastomotic site 
  • Exposed vasculature 
  • Exposed organs 
  • Exposed nerves 

9. Use Precautions in Certain Patients 

  • Those on or with: 
  • Anticoagulation therapy 
  • Difficult wound hemostasis 
  • Non-compliant/combative patients 
  • Untreated malnutrition 
  • Wounds in close proximity blood vessels or delicate fascia  

10.  Device Structure for Initial Reimbursement 

  • Initial requirements for FDA approval to get billing code included: 
    • Electrical pump 
    • Connecting tubing 
    • Specialized wound dressing 
    • Some newer devices come into facility today as dressing kits 

11. Various Devices 

  • A number of different devices is marketed today, both here and in Europe.  

12. Newer KCI Devices 

  • Acelity/KCI has new application type devices, specific to varying needs of patients 

13. SNaP Application 

  • This device was initially developed by Spiracur  
  • Sold in 12-15 to Acelity/KCI 
  • Works by spring power 

14. Smith and Nephew PICO Device 

  • The PICO was developed as a single use device 
  • Manages low to moderate levels of exudate 

15. When to Stop Any Negative Pressure 

  • When goal of therapy is reached! 
  • When NP is not effective 
  • When patient is unable to comply 
  • When desire less aggressive/expensive approach 

16. The Take Away on Use of Negative Pressure 

  • All patients, situations and needs are different 
  • Devices also vary 
  • Based on patient assessment, select appropriate device 

Objectives for Learning Outcomes

After completing this session, you will be able to:

  1. Discuss negative pressure (NP) history, development and use. 
  2. Identify patient factors that must be evaluated prior to NP placement decisions.
  3. Explain and state the absolute contra-indications of NP. 
  4. Develop plan for goals of wound care using negative pressure.
Course summary
Available: 
03/30/2016
Expires: 
06/30/2017

Betty Hanrahan, MSN, CNS, ARNP-BC, CWCN-AP, CWS, FACCWS, CFCN
Certified Wound Care Nurse; Co-Director, Wound Management Education Program (WMEP) and Wound Management Fundamentals Course (WMFC), Continuing Nursing Education, University of Washington School of Nursing, Seattle; Fellow, College of Certified Wound Specialists

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