Understanding and Using Negative Pressure to Manage Wounds

Transcription

1 Understanding and Using Negative Pressure to Manage Wounds Betty Hanrahan MSN, ARNP-BC, CNS, CWCN-AP, CWS, FACCWS, CFCN Session Objectives Discuss negative pressure history, development and use Describe patient factors, underlying conditions to determine appropriate use of NP State absolute contraindications of NP Participate in application/termination of NPWT facility guidelines Compare cost issues across product lines Negative Pressure Wound Therapy Controlled application of sub-atmospheric pressure to a wound using an electrical pump to intermittently or continuously convey sub-atmospheric pressure through connecting tubing to a specialized wound dressing. HCPCS Code 2000 University of Washington School of Nursing - uwcne.org 1

2 Negative Pressure Overview This is a modality that is different in different countries of the world. Products used to manage wounds are changing rapidly. Devices /dressings used today are smaller and provide better privacy for the patient. Reimbursement regulations are complex and changing also. Information in this module is not all inclusive, but basic principles are covered. History How much do you know about NPWT??? It really IS negative pressure. Term wound VAC or just VAC is a trademarked name. Russian System for Applying Negative Pressure to Breast Abscess Used on a large scale Reduced edema, stimulated blood flow, cleaned wound Used 2-3 hours per day Davydov et al. Vacuum therapy in the treatment of purulent lactationmastitis. Vestnik Khirurgii 1986; 9:66-70 University of Washington School of Nursing - uwcne.org 2

3 Russian System for Applying Negative Pressure to Breast Abscess. Used on a large scale Reduced edema, stimulated blood flow, cleaned wound Used 2-3 hours per day Davydov et al. Vacuum therapy in the treatment of purulent lactationmastitis. Vestnik Khirurgii 1986; 9:66-70 Translated Original Research Articles 5 comparative research papers on NPWT published human, 1 animal study Large sample sizes demonstrated efficacy of negative pressure as compared with alternative therapy Application of NPWT to purulent wounds in various clinical settings Evidence of long history of NPWT prior to vacuum assisted closure (VAC) Negative Pressure Therapy Marketing in U.S. KCI received FDA clearance to market in First commercial system marketed by Louis Argenta, MD & Michael Morykwas, PhD from Wake Forest University School of Medicine in Winston-Salem, NC. Used in multiple settings with success KCI has sold to venture company changes made University of Washington School of Nursing - uwcne.org 3

4 FDA Requirements To be assigned HCPCS number for billing: Dressing Canister Pump Otherwise, the device is not considered to be negative pressure, but a dressing instead. In 1995 KCI marketed the only device in this country Today, there are many some devices, some dressings Negative Pressure Wound Therapy Recommended pressure 125mmHg Foam Suction Pump Sealed System Dressing Kit Gauze Wound Interface Recommended pressure mmhg How Negative Pressure Wound Therapy is Used Create soft tissue for non-surgical candidates Decrease tissue edema Decrease bacterial colonization Granulation tissue formation Granulation tissue - in delayed primary closure, or lesser surgical procedure University of Washington School of Nursing - uwcne.org 4

5 Goals for Use Establish goal for use and remove device when goal is met Goal should be based on needs of individual patient Many vendors sell negative pressure devices Facilities usually have contract with single vendor When patient is discharged to another facility, they may be exposed to a different negative pressure system Patient education should be done before patient is discharged to another facility Making the Decision to Apply Negative Pressure Absolute Contraindications for NPWT Exposed vasculature Malignancy in the wound Untreated osteomyelitis Non-enteric or unexplored fistula Slough, necrotic tissue or eschar Exposed anastomotic site Exposed organs Exposed nerves Pediatric patients (per the FDA) *****Stay abreast of FDA updates 15 Product Innovation: V.A.C. Therapy Advancements V.A.C. Classic - Introduced in 1995 Retired Core product of V.A.C. portfolio MiniV.A.C. - Introduced in 1998 Retired Portable unit for Home Care V.A.C. ATS - Introduced in 2002 Acute & Extended Care, features T.R.A.C. technology V.A.C. Freedom - Introduced in 2004 Portable unit for Home Care/SNF market, features T.R.A.C. technology InfoV.A.C. Introduced in 2007 Acute Care, features SensaT.R.A.C. technology ActiV.A.C. Introduced in 2007 Portable unit for Home Care, features SensaT.R.A.C. technology University of Washington School of Nursing - uwcne.org 5

6 Marketing of Newer KCI Devices Prevens VAC VIA AbThera V.A.C. Disposables Foam Portfolio Standard Standard Ease of Use (NEW) Anti Microbial Specialty Dressings V.A.C. GranuFoam Small Dressing V.A.C. Simplace Small Dressing V.A.C. GranuFoam Silver Small Dressing V.A.C. GranuFoam Abdominal Dressing Advanced dressing for managing the open abdomen V.A.C. GranuFoam Medium Dressing V.A.C. Simplace Medium Dressing V.A.C. GranuFoam Silver Medium Dressing V.A.C. GranuFoam Hand Dressing Designed inserts to fit contours of the hand V.A.C. GranuFoam Large Dressing V.A.C. GranuFoam Silver Large Dressing V.A.C. GranuFoam Heel Dressing Contoured shape to fit the heel V.A.C. GranuFoam X Large Dressing (PVA) WhiteFoam TM V.A.C. GranuFoam Thin Dressing ½ standard foam thickness to accommodate shallow wounds V.A.C. GranuFoam Round Dressing Circular shape accommodates many pressure ulcer sizes Peer-reviewed Journal Article Chariker-JeterTM Dressing Technique Developed in 1985 by Mark E. Chariker, M.D. and Katherine F. Jeter, Ed.D Shows NPWT with gauze contributes to: Improved granulation tissue and wound contracture Increased rate of epithelialization Enhanced patient comfort Ease of use Reduced costs University of Washington School of Nursing - uwcne.org 6

7 Chariker Jeter Dressing System Negative Pressure Uses gauze instead of foam Utilizes lower pressure vacuum settings (60 80 mm Hg) Offers multiple choices in drain types or port dressing without drain Includes a double lumen drain for instillation of medications A renaissance in negative pressure wound therapy. A time for new thinking, innovation, and a fresh perspective. The beginning of a new era of scientific understanding and clinical value RENASYS F/P RENASYS G/P Trademark of Smith & Nephew RENASYS Dressing Kit Options Exercise your full clinical judgment based on the needs of the patient, the wound and the care setting. RENASYS F/P RENASYS G/P University of Washington School of Nursing - uwcne.org 7

8 Dressing Application Cleanse wound, pat dry Use skin prep around edges Apply saline moistened gauze to fill wound Cover with transparent dressing Cut opening for port Apply port suction to fit over hole in transparent drape 23 Finished Dressing Standard pressure for gauze is 80mmHg Finished and leak-free dressing should be firm to the touch New Smith&Nephew Negative Pressure Dressing Products PICO Open Abdomen University of Washington School of Nursing - uwcne.org 8

9 Spiracur s Snap-IT Mechanically powered negative pressure Small device operates with negative pressure created by mechanical means (uses a spring), rather than battery or electrical power. Blue foam was added to provide better visualization of exudate. Kalypto Dressing Applications Pressure settings from mmhg Kalypto NPWT Technology Integrated Dressing Layers Wound contact layer with bactericidal Silverlon Absorbent layer Fluid and bacteria barrier to protect the pump and patient Filter Window Indicators (#5) Gel gasket technology for airtight seal University of Washington School of Nursing - uwcne.org 9

10 When to Stop Negative Pressure Therapy Remember: Each patient is an individual with individual healing potential/outcome goals. Consider stopping negative pressure when there is Achievement of goal of therapy Significant progress toward wound closure, and desire to be less aggressive Adequate preparation for surgical intervention No progress in wound healing for 1-2 weeks and applied solutions have failed Noncompliance by the patient with NPWT University of Washington School of Nursing - uwcne.org 10