Skill 45

Negative-Pressure Wound Therapy

Negative-pressure wound therapy (NPWT) is the application of a vacuum (negative pressure) to a wound through suction to draw edges of a wound together while providing a moist environment to promote healing and collect wound fluid (Figs. 45-1 and 45-2) (AHRQ, 2009; Campbell, Smith, and Smith, 2008; Netsch, 2011). The therapy is commonly used for dehisced wounds, diabetic foot ulcers, pressure ulcers, vascular ulcers (includes venous and arterial ulcers), burn wounds, surgical wounds (especially infected sternal wounds), and trauma-induced wounds (AHRQ, 2009; NPUAP-EPUAP, 2009; Petkar et al., 2011). The WOCN (2010) reports increased rates of healing associated with stage III and IV pressure ulcers when using NPWT.

Fig. 45-1 Dehisced wound before V.A.C. therapy. (Courtesy KCI USA, Inc., San Antonio, TX.)

Fig. 45-2 Dehisced wound after V.A.C. therapy. (Courtesy KCI USA, Inc., San Antonio, TX.)

Added benefits of NPWT include improved patient comfort and a reduction in the frequency of dressing changes. Contraindications to NPWT for chronic wounds are exposed vital organs, inadequately debrided wounds, untreated osteomyelitis or sepsis near a wound, untreated coagulopathy, necrotic tissue with eschar, and malignancy within a wound (AHRQ, 2009; Netsch, 2011).

A health care provider or wound care specialist orders the cycle and amount of negative pressure to a wound. There are different recommendations for the level of negative pressure to use for wound healing. Check your agency policy. The target negative pressures for wound healing tend to range from −50 to −175 mm Hg, but a setting of −125 mm Hg is most common (Netsch, 2011). The schedule for changing NPWT dressings varies based on the type and condition of wound.