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CHAPTER 32 Skin Integrity & Wound Healing
Procedure 32-6 ■ Applying a Negative Pressure WoundTherapy (NPWT) Device ➤ For steps to follow in all procedures, refer to the Universal Steps for All Procedures on the inside back cover.
and grafts. NPWT will prepare the wound bed for closure, reduce edema, promote granulation formation, and remove exudate and infective material. ■ Determine whether there is any contraindication to use of a NPWT: nonenteric or unexplored fistulas; necrotic tissue with eschar; untreated osteomyelitis; malignancy in the wound or in exposed blood vessels, anastamosis sites, organs, or nerves. ■ Assess patients for active or prolonged bleeding; patients who are on anticoagulant therapy or platelet aggregation inhibitors; or patients with infected, damaged, irradiated, or sutured blood vessels. Patients who are at increased risk for bleeding should be closely monitored. These conditions could be fatal if negative pressure is applied and bleeding is uncontrolled (exsanguination could occur). Notify the healthcare provider of these conditions. ■ Assess the wound for bone fragments or sharp edges. When NPWT is activated, mechanical stress is placed on the wound. Sharp edges or bone may puncture protective barriers, vessels, or organs, causing injury; bleeding, if uncontrolled, could be fatal. ■ Assess the wound for infection. Monitor infected wounds closely because they may require more frequent dressing changes than noninfected wounds. ■ Assess the wound for size (length, width, and depth in cen- timeters); location and depth of undermining or tunneling; amount, character, and odor of drainage; type and percent- age of tissue present in wound bed (granulation, slough, fibrin, necrotic); and periwound condition (i.e., intact, denuded, erythema, induration, or maceration). If no response or improvement in the wound condition occurs within 2 weeks, use of NPWT should be reevaluated. ■ Assess the patient’s nutrition status. Adequate protein stores are needed for wounds to heal. Evaluate the patient’s albumin or prealbumin level before initiating therapy, as NPWT may deplete these levels and prevent healing. ■ Assess for pain. Wound care is painful. Wound pain that is inadequately treated can lead to wound bed hypoxia that impairs wound healing and increases infection rates. Wound pain also negatively affects the patient’s quality of life.
Equipment ■ Suction unit (pump) ■ Collection canister with connecting tubing ■ Open-pore reticulated polyurethane foam dressing ■ Semipermeable transparent adhesive dressing ■ Skin preparation product or sealant (skin prep) ■ Sterile 4 in. × 4 in. gauze ■ Clean nonsterile gloves ■ Two pairs of sterile gloves (if using sterile technique) ■ Sterile scissors (if using sterile technique) ■ Waterproof pad ■ Bath blanket ■ Goggles or safety glasses, mask, and protective gown ■ 10- to 20-mL irrigation syringe ■ Normal saline for irrigation ■ Emesis basis ■ Biohazard bag for contaminated materials Procedure 32-6A Open-Pore Reticulated Polyurethane Form Therapy ■ GranuFoam (black), white, or silver foam dressing ■ Therapeutic regulated accurate care (TRAC) pad Procedure 32-6B Gauze Dressing Application (i.e., Chariker-Jeter Dressing Method) ■ Fenestrated drain ■ Ostomy paste Delegation As a nurse, you are responsible for assessing the wound and evaluating interventions. You should not delegate application of a negative pressure wound therapy device to a UAP. How- ever, you may ask the UAP to report to you any changes in the wound dressing, pressure in the unit, or alarms. Preprocedure Assessments ■ Assess the type of wound to be treated with negative pressure. Negative pressure wound therapy (NPWT) is used to promote wound healing by secondary or tertiary intention in acute, chronic, traumatic, and dehisced wounds; partial-thickness burns; or flaps
➤ When performing the procedure, always identify your patient according to agency policy, using two identifiers, and be attentive to standard precautions, hand hygiene, patient safety and privacy, body mechanics, and documentation. ➤ Note: The success of NPWT partially depends on the training and expertise of the clinician.Allow adequate time for this procedure. Experienced nurses need at least 15 minutes.You will need more time if problems arise, and even more if you are a novice. ➤ Note: This procedure assumes you are performing the initial application of vacuum-assisted closure (VAC) therapy. If you are changing the dressing, first read the "What If..." section near the end of this procedure. (continued on next page)
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