NPWT – Removing the Pressure in Wound Management
Negative-pressure wound therapy (NPWT) is rapidly becoming a mainstay in chronic wound management.[1] This technique is a topical intervention widely used to treat problematic acute and chronic wounds that do not respond to conventional moist wound healing techniques. A negative pressure, typically -125 mmHg, is applied to the wound bed, removing excess exudate and helping to establish fluid balance. In addition, NPWT is thought to stimulate granulation tissue formation, reduce interstitial edema and improve microvascular blood flow.[2-3]
How NWPT Works
The negative pressure in NPWT is applied via a tube from a vacuum device, threaded through a gauze or foam dressing that has been sealed with a transparent film. The negative pressure may be applied continuously or intermittently, depending on the wound type and the treatment objectives
NWPT Indications
NWPT is indicated for a wide range of wounds, including chronic, acute, and traumatic wounds, partial-thickness burns, dehisced wounds, pressure ulcers, neuropathic ulcers, muscle flaps, and skin grafts. It is also useful in wounds due to arterial or venous insufficiency, wounds with exposed bone or tendons, orthopedic and degloving injuries, and wounds with exposed hardware.
NWPT Therapy Effects
NWPT therapy exerts many effects on both the gross and microscopic levels, initially reducing edema by removing the interstitial fluid and improving blood flow by allowing vessels, compressed by the excess pressure, to fully expand. NPWT is also able to reduce bacterial contamination within the wound, and offers the further advantage that dressings need to be changed only every 48-72 hours. This allows for improved patient comfort, less time spent changing dressings and a cleaner, more hygienic dressing.
Disadvantages of NWPT
Possible disadvantages of NPWT include some pain sensation on treatment, a risk of developing pressure ulcers in the areas treated, and the relative expense of the treatment, particularly over a short time frame.
Adjunctive Modalities
Wound care is changing. Adjunctive modalities are playing an increasingly important role in many aspects of wound management, and it is becoming more and more important to understand how these emerging techniques can be used for the benefit of patients. To learn more about adjunctive modalities, consider training for a wound certification exam, then enjoy the benefits of increased knowledge, improved qualifications, and enhanced job prospects.
Learn More With Our Wound Care Education Options
Interested in learning more about wound care and certification? Browse through our wound care certification courses for information on our comprehensive range of education options to suit healthcare professionals across the full spectrum of qualifications and experience.
References
- Hess CL, Howard MA, Attinger CE. A review of mechanical adjuncts in wound healing: hydrotherapy, ultrasound, negative pressure therapy, hyperbaric oxygen, and electrostimulation. Ann Plast Surg. 2003 Aug;51(2):210-8.
- Ahearn C. (2009). Intermittent NPWT and Lower Negative Pressures — Exploring the Disparity between Science and Current Practice: A Review; Ostomy Wound Management; 55(6), p.2
- Sibbald RG, Mahoney J, VAC Therapy Canadian Consensus Group. (2003). A Consensus Report on the Use of Vacuum-Assisted Closure in Chronic, Difficult-to-Heal Wounds; Ostomy Wound Management; 49(11), p.52
Yes,I think this article is extremely Accurate! I sufferred a great deal of pain when I (myself,being the patient,not the nurse in this case, My MD ordered a wet to dry dressing change 8Hours after an I&D surgery for a MRSA abcess in my leg. They should have, I believe pre-medicated me with Versed or Fentanyl prior to that first dsg change….because it was extremely painful(worse than being in Labor!). I subsequently sufferred with so much anxierty and fear prior to each scheduled dsg change. I had a wound vac for about 8 weeks following discaharge and had to have these dsg changes 3x per week as an outpatient. Then, when I contacted the physicain to request ani-anxiety meds prior to the dressing changes he refused to gove it to me and said:Vicodin should be just fine.
This was by far, the worst couple of months of my life. So’ I completely validate that experiencing pain, and anticipating pain can be very depressing and detrimental to the patients emotional well being and quality of life.
I filed a formal complaint with the hospital, regarding the neglect to relieve pain, both by the surgeon,the wound care Nurse, and staff Nurses. We has healthcare providers need to be patient advocate for our patients and demand that they are treated adequately for their pain. I had a discussion with the wound care Nurse about my “fear of pain before dsg changes causing so much panic and stress. She said “Yes, many of my patients start crying even when I just walk in their room before the dsg change”. I told her “well, that should not be happenning! You nedd to be ensuring that they are properly medicated with the appropriate medications prior to their procedure”.
Anyway, thanks for validating my feelings in regard to pain in wound care management.
Because of my experience, I am planning to become wound care certified, so I can serve as an advocate for my patients with these issues.
Thank you for posting this article!
Keri M Bartolomei RN, BSN