Reviewed and updated by Myrna Buiser Schnur, MSN, RN: January 25, 2024
I have learned quite a bit on my journey to gaining a better understanding of Negative Pressure Wound Therapy (NPWT). In
Part 1 of this series, I provided an overview of NPWT, including what it is, how it works and the risks and benefits. In Part 2 of the series I will review the practical application of NPWT including prescribing orders, procedural steps, general patient care, and tips to troubleshoot the device
. Let’s jump in!
What should the NPWT orders include?
- Wound dressing material (foam or gauze) and wound adjunct (protective non-adherent, petroleum or silver dressing)
- Negative pressure setting (-20 to –200 mm Hg), typically set at –125 mm Hg
- Therapy setting (continuous, intermittent, or variable)
- Frequency of dressing change
What are the steps in applying NPWT? Each device has a specific design and manufacturer’s instructions for use that should be reviewed. The following procedural steps provide a general guide. Please also refer to your facility's policies and procedures regarding NPWT dressing changes.
- Pre-medicate the patient for pain as needed and as prescribed.
- Prepare the wound:
- Remove the prior dressing very carefully to avoid tissue damage and bleeding
- Verify the number of removed pieces of dressing as documented in the patient's medical record.
- Debride the wound, performed by a qualified practitioner
- Cleanse the wound as needed/prescribed (i.e., irrigate with normal saline)
- Assess wound size and depth, presence of tunneling, tissue loss, odor, warmth, edema, drainage, signs and symptoms of infection.
- Use sterile technique for the dressing change
- If using foam, cut foam dressing to size and place into the wound.
- Document the number of foam pieces used; foam acts as a filter to catch blood clots and large tissue particles that might clog the vacuum system.
- If using gauze, apply a single layer of nonadherent gauze across the wound bed. Then apply saline-moistened antimicrobial gauze loosely onto the wound.
- Document the number of gauze pads or rolls used.
- Avoid overpacking the wound as this may delay healing.
- Trim clear occlusive dressing to size, peel back one side of Layer 1 and place adhesive side down over wound. (see photo 1)
- Remove the remaining side of Layer 1 ensuring it creates a tight seal.
- Cut a hole into the clear dressing about the size of a quarter (2.5 cm). (see photo 2)
- Remove Layer 1 from adhesive pad connected to the pump tubing.
- If you aren't using a pre-attached system, place pad and tubing directly over hole affixing it to the clear dressing. (see photo 3)
- Remove Layer 2 from the adhesive pad.
- Connect pad tubing to canister tubing and be sure the clamps are open. Anchor the drain tubing a few inches from the dressing to prevent tension or dislodgement of the tubing.
- Label dressing with date, time, and number of dressings used.
- Turn on power to the vacuum device, set the prescribed pressure settings, and confirm that the dressing and foam shrink down. (see photo 4)
- Ensure alarm limits are set appropriately.
Wound Care Tips (Lippincott Solutions, 2023)
- Use protective barriers, such as non-adherent or petroleum gauze, to protect sutured blood vessels or organs near areas being treated with NPWT.
- Avoid overpacking the wound too tightly with foam; this prevents negative pressure from reaching the wound bed, causing exudate to accumulate.
- Avoid placing the tubing over bony prominences, skinfolds, creases, and weight-bearing surfaces to prevent tubing-related pressure ulcers.
- Count and document all pieces of foam or gauze on the outer dressing and in the medical record, to help prevent retention of materials in the wound; when possible, only use one piece of foam dressing.
- With a heavy colonized or infected wound, consider changing the dressing every 12 to 24 hours as directed by the prescribing clinician.
General Patient Care (Lippincott Solutions, 2023)
- Assess the patient for wound healing issues, such as poor nutrition (low protein levels), diminished oxygenation, decreased circulation, diabetes, smoking, obesity, foreign bodies, infection and low blood levels.
- Assess and manage the patient’s pain; be sure to premedicate as needed before each dressing change.
- Provide patient education on:
- Alarms and device ‘noise’
- Dressing changes
- Signs of complications (bleeding, infection)
- Patients should seek medical care if they notice:
- Significant change in the color of the drainage (cloudy or bright red)
- Excessive bleeding under the clear dressing, in the tubing or in the canister
- Increased redness or odor from the wound
- Increased pain
- The device has been left off for more than 2 hours
- Signs of infection, such as fever, redness or swelling of the wound, itching/rash, warmth, pus or foul-smelling drainage
- Allergic reaction to the drape/dressing: redness, swelling, rash, hives, severe itching. Patient should seek immediate medical assistance if they experience difficulty in breathing.
Troubleshooting the Device (Lippincott Solutions, 2023)
- Confirm that the unit is on and set to the appropriate negative pressure, that the foam is collapsed and the NPWT device is maintaining the prescribed therapy and pressure.
- Be sure the negative pressure seal has not been broken and there are no leaks in the system.
- Ensure there are no kinks in the tubing and that all clamps are open.
- Address and resolve alarm issues; reasons for the unit to alarm include: canister is full, there is a leak in the system, battery is low/dead, therapy is not activated.
- Do not leave the device off for more than two hours; while device is off, apply a moist dressing and notify the prescribing clinician immediately.
- Avoid getting the electrical device wet; educate the patient to disconnect the unit from the tubing and clamp the tubing before bathing.
- Check the drainage chamber to make sure it is filling correctly and does not need changing.
Nursing documentation should include the following (Lippincott Solutions, 2023):
- Date and time of dressing changes
- Wound assessment as described above
- Pain assessment, patient tolerance to the procedure, and interventions performed
- Weight of soiled dressing (if appropriate)
- Type and number of dressings used; verification of components removed from the wound
- Patient and family education provided
While I am not an expert in the field of wound care, I am now more confident and better prepared to manage patients receiving Negative Pressure Wound Therapy. I would love to hear your experiences. Let me know if you have any tips or other suggestions that can help nurses and patients safely operate and maintain these devices.
Tags :