Negative-Pressure Wound Therapy
Negative-pressure wound therapy enhances wound healing and helps with delayed or impaired wound healing. Treatment involves a special dressing placed in the wound or over a graft or flap and a pump that creates negative pressure within the wound bed. The negative-pressure device removes excess wound fluids that may cause maceration or delayed healing and stimulates the growth of healthy granulation tissue. Negative pressure also increases local blood flow, reduces edema, and draws the wound edges together. (See Understanding negative-pressure wound therapy.)
Negative-pressure wound therapy is indicated for acute and traumatic wounds, pressure ulcers, and chronic open wounds, such as diabetic ulcers, meshed grafts, and skin flaps.1 It’s contraindicated for fistulas that involve organs or body cavities, necrotic tissue with eschar, untreated osteomyelitis, malignant wounds, and wounds with exposed arteries and veins. This therapy should be used cautiously in patients with active bleeding, in those taking anticoagulants, and in those in whom achieving wound hemostasis has been difficult.
Waterproof trash bag ▪ goggles and gown, if indicated ▪ emesis basin ▪ sterile irrigating solution ▪ gloves ▪ sterile gloves ▪ sterile scissors ▪ linen-saver pad ▪ irrigation kit with syringe ▪ suction tubing ▪ evacuation canister tubing ▪ skin protectant wipe ▪ evacuation canister ▪ negative-pressure wound therapy unit ▪ measuring tool and guide.
For Foam Packing
Foam packing ▪ transparent dressing therapy drape.
For Gauze Packing
Nonadherent gauze ▪ antimicrobial gauze packing moistened with sterile normal saline solution ▪ drain ▪ ostomy strip paste ▪ transparent dressing(s).
Preparation of Equipment
Assemble the negative-pressure wound therapy unit at the bedside according to the manufacturer’s instructions. Set negative pressure according to the doctor’s order (25 to 200 mm Hg) and the manufacturer’s instructions. Prepare a place for the supplies within reach.
Warm the sterile irrigating solution to 90° to 95°F (32° to 35°C) to reduce discomfort. Pour irrigating solution into the container of the irrigation kit.
Verify the doctor’s order for frequency of dressing changes, type of negative-pressure unit, type of wound packing, and settings for the negative-pressure unit and assess the patient’s condition.
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.2
Explain the procedure to the patient. Answer all questions to decrease anxiety and increase cooperation.
Perform hand hygiene and put on gloves.3,4,5 If necessary, put on a gown and goggles to protect yourself from wound drainage and contamination.
Assess the patient’s condition. Medicate the patient for pain, if needed and as ordered, before beginning the procedure.
Place a linen-saver pad under the patient to catch any spills and avoid linen changes. Position the patient to allow maximum wound exposure. Place the emesis basin under the wound to collect any drainage.
Using sterile technique, prepare a sterile field and place all the supplies on the sterile field.
Remove the soiled dressing and discard it in the waterproof trash bag. Remove your gloves.
Irrigate the wound thoroughly using the normal saline solution and the irrigation syringe. (See “Wound irrigation,” page 795.)
Clean the area around the wound with normal saline solution; wipe intact skin with a skin protectant wipe and allow it to dry well. Remove and discard your gloves.
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