Negative Pressure Wound Therapy

Elizabeth Day Dechant, BSN, RN, CWOCN, CFCN

The benefit of Negative Pressure Wound Therapy (NPWT) as an “active,” adjunctive treatment is well-established. Evidence has shown that wounds treated with negative pressure granulate faster than wounds managed with traditional dressings. There is ever-increasing literature to support the use of NPWT to treat wounds effectively and safely in even the youngest patients.¹ Some specific benefits of NPWT for pediatric and adolescent patients include decreased frequency of dressing changes, as well as a dressing that is occlusive and unlikely to be removed by the patient.

Jeffrey M. Levine, MD, AGSF

I was asked to perform a wound consult on a newly admitted resident to a post-acute unit of a nursing home. She rested quietly with a barely touched breakfast on her bedside table. Her aide had tried to feed her, but she accepted only small spoonfuls of oatmeal and a sip of orange juice. She came to our facility after a long hospitalization for COVID-19–related complications, including pneumonia, kidney failure, and septic shock that required pressor agents. While in the ICU on a ventilator, she developed a pressure injury. At 86 years old, her transfer papers revealed feeding tube refusal and a do-not-resuscitate (DNR) order.

By Dr. Lenz and Dr. Hussain

Negative pressure wound therapy (NPWT) is a known adjunctive modality for healing wounds. The use of NPWT is well documented for the treatment of both acute and chronic wounds. NPWT is designed to remove fluid, decreasing the afterload to blood flow and resulting in increased localized tissue perfusion. Use of negative pressure may also enhance the formation of granulation tissue by secondary intention.

Advanced therapeutic devices in wound care can be among your greatest tools for encouraging wound closure. However, it can be disappointing when you may have an advanced modality in mind, but it is denied by the patient’s insurance plan. Or it is simply too expensive to have the patient pay out of pocket. One type of healing device that has a tremendous positive impact on wound healing is negative pressure wound therapy (NPWT). If it is not reimbursed properly, however, the patient may be looking at a shocking expense of thousands of dollars. What’s a wound care clinician to do? Having a few knowledge tools in your pocket may help you to navigate some of the complexities of ordering an NPWT system.

Managing chronic wounds can be difficult and often includes multiple treatment strategies. Management techniques can vary depending on the size of the wound, comorbidities of the patient, and the underlying etiology. However, many chronic wounds benefit from the application of negative pressure wound therapy (NPWT). This treatment is known for improving healing conditions across a wide range of acute and chronic wounds.

A fistula is a connection between two organs that are not normally connected, such as the stomach and the skin. Fistulas develop in various conditions and for a multitude of reasons, such as malignancy, Crohn’s disease, colitis, and others. Many times, fistulas occur after a surgical procedure. Goals of a care plan around a fistula focus on protection of the adjacent skin, containment of the effluent, nutrition, conditioning, and quality of life.

By: Dianne Rudolph, DNP, GNP-BC, CWOCN

What are some ways to achieve insurance coverage for fistula pouches or to use ostomy supplies for a fistula? We often run into the issue of supplies not being covered for Medicare or Medicaid patients.

Unfortunately, coverage is inadequate. CMS (Centers for Medicare & Medicaid Services) coverage for fistulas is limited for fistulas caused by or resulting from a surgical procedure, and even then, it may be difficult to get reimbursed. Spontaneous fistulas (15% to 25%) are generally not covered. The Wound, Ostomy and Continence Society is working on trying to effect a change in coverage. Some insurance companies may be more amenable to reimbursement, and it may require a case-by-case application or appeal. For patients being discharged home, it may be possible to secure a short-term supply of 10 to 14 days. The cost for the pouches may run $255 and up for a box of 10.

By Thomas E. Serena, MD, and Khristina Harrell, RN

With apologies to Nietzsche: "What kills you makes you dead." The slow painful death of large and expensive in-person conferences has begun. Technological evolution has selected against these lumbering dinosaurs, but, rather than a massive asteroid, the parlous event came as a microscopic virus. Lockdowns and social distancing enacted in response to COVID-19 pushed us all deeper into a virtual world, a world that will persist long after COVID resolves.

Holly M. Hovan MSN, RN-BC, APRN, CWOCN-AP

Negative pressure wound therapy (NPWT) is an advanced wound care modality using a sponge with an occlusive dressing connected to a pump that creates a negative pressure environment to promote wound healing. NPWT has many indications and contraindications, and they should be discussed with the provider and interdisciplinary team before initiating or recommending treatment. Initially, a thorough history and physical examination should be completed, along with a review of prior treatments used for wound care, goals of wound care, underlying medical conditions, and allergies.

By KCI, an Acelity Company

San Antonio, TX, – May 21, 2019 – KCI, an Acelity Company, announces that the Company has received 510(k) clearance from the U.S. Food and Drug Administration (FDA) for DERMATAC™ Drape, a proprietary silicone-acrylic hybrid drape that provides both clinical and operational benefits, as an accessory to certain of KCI’s Negative Pressure Wound Therapy (NPWT) Systems. Constructed with a precise combination of silicone and acrylic, DERMATAC™ Drape conforms to different anatomical locations, adapting to the body and providing a tight, highly effective seal for 48 to 72 hours, including uneven areas, for wound protection, creating the ideal balance for wound healing support.