Can Negative Pressure Wound Therapy Improve Wound Condition?
Literature Review
The wound care clinicians are expertly facilitating have a wide array of available treatment options to manage and help heal acute and chronic complex wounds that require a systematized and comprehensive approach to address the complexity of wound care and to optimize patient outcomes. The treatment of wounds represents a major cost to society. Therefore, most of the clinical researchers and medical practitioners have an increasing focus on quality of care, patient outcomes, and lowering costs. Wound care clinicians are not immune to these pressures. Wound care clinicians must ensure that their assessments, treatment pathways, and product selections are both clinically and economically sound.
Negative pressure wound therapy (NPWT) has been demonstrated to be an efficacious option to promote healing in a variety of acute and chronic complex wounds. Previous guidelines on the use of NPWT have focused on application but have not provided recommendations on when it is most appropriate to use NPWT. Actually, there are few criteria for the wound management such as (1) when to initiate NPWT based on various wound types, (2) pre-application management to optimize treatment outcomes, (3) identification of appropriate candidates for NPWT, (4) benchmark indicators for treatment response, and (5) recommendations for the future issues in NPWT for such events like the transition between NPWT and moist wound healing (MWH) or another treatment modality. In general, there are guidelines that focus on the multiple disciplines convened to develop a document to guide clinicians in making decisions about the appropriate use of NPWT within the spectrum of wound healing. Where empirical research was lacking, clinical experiences and patient factors were considered to ensure the clinical utility of the document. The goal of these guidelines is to encourage responsible wound management across the healthcare continuum and spectrum of wound pathologies to achieve positive, cost-effective patient outcomes (Bollero, et al., 2010). In addition, there are available equipments that can be used to assist the nurses in their practice (Genadyne Biotechnologies Inc, 2008).
In the process, the Negative Pressure Wound Therapy (NPWT) applies subatmospheric pressure, or suction, to the wound bed via a computerized therapy unit attached to an open-cell foam sponge that is placed in the wound and secured with an adhesive drape. The adhesive drape helps to provide a semiocclusive environment that supports moist wound healing, which has been the standard for wound care since the mid-1980s.5 The drape is vapor permeable to facilitate gas exchange, an important consideration when treating wounds infected with anaerobic organisms that would thrive in an occlusive, oxygen-depleted environment. The foam and drape also protect the wound base from environmental contaminants and reduce the risk of friction or shear, enhancing the body's ability to heal.
Risk Management Issues with NPWT
The system used for negative pressure wound therapy (NPWT) is meant to be just that a system whose components are designed to work together. The NPWT system has been approved by the Food and Drug Administration (FDA) to treat a variety of chronic, acute, traumatic, sub-acute, and dehisced wounds. In general, the system is relatively easy to use and tolerated by patients. Some institutions, however, are using alternative means of supplying negative pressure. These variations on the FDA-approved system have the potential to injure patients, thus putting the institution and individual clinicians at risk for liability. The following discussion focuses on the variations that have been reported anecdotally and why these variations could jeopardize patient safety.
Control of pressure levels
Instead of the computerized therapy unit that is part of the NPWT system (and which must be rented), wall suction and portable suction devices are being used to provide negative pressure. Wall suction in which negative pressure is delivered through a stationary unit mounted to a wall is appropriate in many clinical situations; however, it lacks the control mechanisms needed to provide safe negative pressure for wound care. Many wall suction devices have control panels that are notched to dial in low, medium, or high levels of suction. Others have a control panel with numeric values that indicate pressure averages. In general, neither style can be adequately regulated to deliver a precise amount of sub atmospheric pressure, which is important in providing the maximum benefits of NPWT and maintaining vascular decompression. Standard wall suction devices are unable to provide the controlled intermittent suction that stimulates replication of cells via mechanical stretch. Intermittent negative pressure is also an essential component for accelerated cell proliferation (Mendez-Eastman, 2001).
References:
Bollero, D., Driver, V., Glat, P., Gupta, S., Lázaro-MartÃnez, J.L., Lyder, C., Ottonello, M., Pelham, F., Vig, S., & Woo, K., (2010) The Role of Negative Pressure Wound Therapy in the Spectrum of Wound Healing: A Guidelines Document, Ostomy Wound Management, 56 (5) [Online] Available at: http://www.woundsresearch.com/files/00_ConvaTecCVR2A_lr-3.pdf [Accessed 06 Jan 2011]
Genadyne Biotechnologies Inc., (2008) Genadyne A4 Negative Pressure Wound Therapy (User Manual / Technical Manual) [Online] Available at: http://genadyne.com/Manuals/A4_Manual_071609_V1.pdf [Accessed 06 Jan 2011].
Mendez-Eastman, S., (2001) Guidelines for Using Negative Pressure Wound Therapy, Advances in Skin & Wound Care: The Journal for Prevention and Healing, 14 (6) [Online] Available at: http://endoflifecare.tripod.com/imbeddedlinks/id2.html [Accessed 06 Jan 2011].
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