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UNIT 4 Supporting Physiological Functioning
Procedure 32-6 ■ Applying a Negative Pressure WoundTherapy (NPWT) Device (continued)
Procedure Steps 1.Consider administering pain medication before initiating negative pressure wound therapy. Allow sufficient time for the medication to take effect. 2. Select the appropriate dressing (per NPWT system used) to fill the entire wound cavity. Dressings should be placed directly against the wound surface to allow for equal suction/ pressure throughout the wound bed. 3.Obtain suction pump unit as prescribed. Negative pressure wound therapy is pro- vided by several manufacturers. Use the unit and dressing method that is approved by your facility. a. Place the suction unit upright on a level surface. b.Remove the canister from the sterile package and insert it into the pump. c. Connect the tubing to the canister. d.Ensure the opposite end of the tubing remains clean before con- necting with the tubing from the dressing. e. You may place the suction unit at the end of the bed or hang it on an IV pole. f. Do not place the unit on the floor. Ensure the unit is not knocked over, as drainage from the canister can back up and contaminate the pump’s filter, blocking suction.
4.Place the waterproof bag or trash receptacle so you can reach it easily during the procedure. Convenient placement facilitates access to safe disposal of the dressing into a trash receptacle for biohazardous waste. 5. Assist the patient to a comfort- able position that allows for easy access to the wound. Facilitates access to the wound site with less contamination and promotes good body mechanics for the nurse. 6. Drape the patient (use a bath blanket if needed) to expose only the wound area. Draping provides privacy and emotional comfort. 7. Place a waterproof pad as needed. An underpad protects the linens from moisture and drainage. 8. Prepare a sterile or clean field and add all supplies: gloves, scis- sors, irrigation supplies, gauze pad, selected wound dressings, tubing, and/or connectors. 9. Don sterile or clean procedure gloves. Use a gown and protective eyewear. Using sterile/aseptic versus clean tech- nique is based on the wound type, physi- cian preference, or facility protocol. A safe rule to follow is to use sterile gloves for a fresh noninfected wound and clean gloves for other wounds.
10.Irrigate the wound with 10 to 30 mL of sterile saline or other pre- scribed solution before all dressing changes. Use a 35-mL syringe and a 19-gauge angiocatheter (needle removed) to direct the flow of the irrigation fluid from the clean end toward the dirty end of the wound. Irrigation facilitates loosening of adher- ent tissue and removes debris and exu- date while adhering to infection control principles of clean to dirty. 11.Remove the excess solution from the wound. Clean and dry the periwound skin with sterile gauze sponges, as needed. Consider a skin protectant around the wound edges. Excess moisture predisposes skin to maceration and possible damage. Apply- ing a skin protectant can assist the drape in sticking to the skin and protecting the skin when the drape is removed (i.e., from stripping of skin by the adhesive). 12.Remove soiled gloves and don new, sterile ones for the procedure. Change gloves during patient care if the hands will move from a contaminated body site (e.g., perineal area or wound) to a clean body site. 13. To apply appropriate dressing per preferred negative pressure wound therapy unit, follow Proce- dure 32A or 32-6B.
Procedure 32-6A ■ Open-Pore Reticulated Polyurethane FoamTherapy (i.e.,Vacuum-Assisted Closure [VAC]) ➤ 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.
Begin with steps 1 through 13 at the beginning of Procedure 32-6. Then proceed as follows: 1.Select the appropriate foam dressing: black, white, or silver. Black foam is sufficient for most wounds unless individual patient circumstances
require white or silver. White foam is denser and will limit granulation formation. It may be used for painful or superficial wounds, tunneling/sinus tracts/undermin- ing, or where granulation tissue growth needs to be limited. Silver dressings may act as a barrier to bacterial penetration in
the wound bed. Silver may eradicate bio- films of colonized bacteria. 2.Cut the foam dressing to the appropriate size to fill the wound cavity. Do not cut the foam dressing over the wound. Rub the cut edges to remove any loose pieces.
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