NPWT Standards of Care: 9 Questions to Ask
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by Diane Krasner PhD, RN, CWCN, CWS, MAPWCA, FAAN
Wound care clinicians who use Negative Pressure Wound Therapy and legal professionals who review NPWT cases should all be focusing on the same standard of wound care issues when it comes to NPWT:
- Is the use of NPWT appropriate for the patient and the patient’s wound at this point in time?
- Have device indications, contraindications, precautions and warnings been taken into consideration? Have treatment options other than NPWT been considered and offered?
- Are the members of the interprofessional wound care team properly trained in the use of NPWT?
- Has the physician ordered the device with appropriate settings and specifications (e.g. pressure in mmHg; continuous vs. intermittent; frequency of dressing change)?
- Is appropriate and functioning equipment being utilized (e.g. pump, canisters, tubing)?
- Have the correct dressing materials been ordered and utilized (e.g. foam, silver foam, contact layers, gauze, drapes)?
- Have appropriate arrangements been made for use of NPWT across the continuum of care (acute care, long term care, home care, outpatient)?
- Have arrangements been made for wound reevaluation to determine when NPWT can be discontinued?
- Has the patient and his/her caregivers been trained in how to monitor the device, device alarms and what to do and who to contact in case of problems or emergencies?
About The Author
Diane Krasner PhD, RN, CWCN, CWS, MAPWCA, FAAN is a certified wound specialist, a Fellow of the American Academy of Nursing, a Master of the American Professional Wound Care Association, a Wound & Skin Care Consultant, and serves on a variety of editorial and managerial boards for prestigious wound care organizations.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.
Comments
VAC versus other forms of NPWT
I am researching the products in this field for my mother who is likely to have a portable unit for home use. I keep reading that VAC as practiced by KCI is superior to other forms of NPWT as practiced by equipment from suppliers like Smith & Nephew, Convatec, etc. I've read all the websites and some technical papers but no obvious differences stand out to an educated lay person that might explain the difference is such contrast. Is there really a statistically valid difference in clinical use or is this promotional hyperbole? Many thanks!
I am not aware of any RCT
I am not aware of any RCT studies that compare NWPT devices head-to-head.
There are differences between devices, obviously, but whether there is a statiscally significant or clinically signifiant differece in outcomes remains to be investigated.
At this juncture, other considerations will probably have a greater impact on NPWT product selection, such as access, availability, reimbursement, etc.
Diane Krasner, PhD, RN, CWCN, CWS, MAPWCA, FAAN
NPWT product differences
As a CWOCN in an acute care hospital I have experienced the opportunity to apply many, many KCI Wound VAC's. I also was required to trial two other NPWT products in the interest of cost saving. My findings: there is not a product that can compare to the efficacy of the KCI product. NOT ALL NPWT IS ALIKE! I witnessed healing progress with each three weekly dressing change using the KCI product that I did not with the other two products. I don't completely dispel the other products. It depends on what the goals are. The KCI product is more expensive. But as they say, "You get what you pay for".
Why is the KCi better?
I would be interested to know from the CWOCN poster exactly and specifically why you feel the KCI product works so much better? Is it the pump, the foam, the film, exactly what is it that in your experience makes it work better?
NPWT
I agree with Dr. Krasner, the research on comparitive efficacy of one NPWT device over another is just not out there. AHRQ posted a comprehensive technology assessment of NPWT devices on their website at:http://www.ahrq.gov/clinic/ta/negpresswtd/
but clearly state therein that no definitive research existed comparing products. Gupta et al (2007) compared KCI VAC and Blue Sky Versitile 1, with Blue sky failing to receive their recommendation. (Suppl to Wounds Vol 19, No. 1, Jan 2007. Thorny issue, this.
All NPWT is not equal with
All NPWT is not equal with different pressures, materials etc. However the RCT evidence for clear superiority of one device over another is just not there. In fact, we often found that 'home made' NPWT with basic sponge, suction tubing, occlusive dressings and wall suction did no worse if not better than commercial products - though they have their advantages including better control of pressures, leak alarms and control of exudate etc. A quick google will show that often authors who publish favouring one product have been invited many times to present their findings to international conferences.
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