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....
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.
Because NPWT is an advanced wound therapy, it sometimes requires a bit more of a creative approach and some arts and crafts when applying it to achieve a seal, especially depending on the location of the wound. NPWT is typically used when more common treatment options have been exhausted or with larger, more complex wounds.
Helpful Negative Pressure Wound Therapy Strategies
Here are some tips and tricks to achieve a seal on the first try and to best manage NPWT in general:
- Prep your periwound skin appropriately first. Using creams, lotions, or some powders near the clear film dressing can compromise the seal.
- Cleanse the skin so that it is free from exudate or topical products.
- Skin sealants or skin barrier films are helpful to protect the skin and prep the periwound environment for application of the dressing. Be sure to allow the skin sealant or barrier film to dry before applying the NPWT dressing.
- Be sure that foam is not overlapping wound edges onto healthy tissue—this will cause a suction or sponge injury to the periwound.
- The sponge can simply be cut precisely to fit the wound, or the wound can be "picture-framed." Picture-framing is when clear film dressing is used around the wound edges to protect it from the foam (in case it is too large or shifts).
- Be sure that skin around and beneath the NPWT tubing is protected to avoid medical device–related pressure injuries (MDRPIs) (see my previous blog on additional tips and tricks to prevent MDRPIs). A foam dressing or gauze padding is helpful to provide a barrier between high-risk areas where tubing would come in contact with the skin.
- Be sure that direct caregivers who are applying the NPWT dressing have been trained and are re-educated at intervals to ensure they are comfortable with the skill. NPWT requires more knowledge and skill than standard topical treatments. Creative ways for education and routine competency days are helpful to be sure that staff are engaged, feel supported, and understand the skill hands on and not just by reading about it.
- Be sure that the amount and characteristics of drainage are recorded regularly and that the provider or service is notified of changes in wound appearance, drainage, or periwound skin.
- NPWT is an adjunctive therapy that requires many layers to align for appropriate and effective therapy. There should be staff education, collaboration of the interdisciplinary team, clear orders, frequent monitoring of the wound, and regular follow-up.
NPWT is an advanced wound therapy with many benefits when used appropriately. The clinician applying NPWT should possess the knowledge and skills to apply the dressing correctly and should provide follow-up and notify the care team of any issues.
An interprofessional approach is best when managing complex wounds with advanced wound treatment modalities and often yields the most positive patient outcomes. A certified wound care nurse or specialist is a significant asset to the interprofessional team when managing patients with complex wound care needs and/or barriers to healing. The foregoing tips and tricks will hopefully make managing and applying NPWT a bit easier and more efficient.
Stay tuned for future topics related to NPWT, including connecting two wounds to one pump (using a connecter approach vs. bridging) and wound and fistula management with NPWT.
About the Author
Holly is a board-certified gerontological nurse and advanced practice wound, ostomy, and continence nurse coordinator at The Department of Veterans Affairs Medical Center in Cleveland, Ohio. She has a passion for education, teaching, and our veterans. Holly has been practicing in WOC nursing for approximately six years. She has much experience with the long-term care population and chronic wounds as well as pressure injuries, diabetic ulcers, venous and arterial wounds, surgical wounds, radiation dermatitis, and wounds requiring advanced wound therapy for healing. Holly enjoys teaching new nurses about wound care and, most importantly, pressure injury prevention. She enjoys working with each patient to come up with an individualized plan of care based on their needs and overall medical situation. She values the importance of taking an interprofessional approach with wound care and prevention overall, and involves each member of the health care team as much as possible. She also values the significance of the support of leadership within her facility and the overall impact of great teamwork for positive outcomes.
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.