Policies & Procedures. Title: I.D. Number: 1160

Transcription

1 Policies & Procedures Title: NEGATIVE PRESSURE WOUND THERAPY (NPWT) I.D. Number: 1160 Authorization: [X] SHR Nursing Practice Committee Source: Nursing Date Revised: March, 2010 Date Effective: November, 2006 Scope: Saskatoon City Hospital Royal University Hospital St. Paul s Hospital Any PRINTED version of this document is only accurate up to the date of printing 4-Apr-12. Saskatoon Health Region (SHR) cannot guarantee the currency or accuracy of any printed policy. Always refer to the Policies and Procedures site for the most current versions of documents in effect. SHR accepts no responsibility for use of this material by any person or organization not associated with SHR. No part of this document may be reproduced in any form for publication without permission of SHR. 1. PURPOSE 1.1 To optimize wound healing. 1.2 To evacuate and contain wound drainage. 2. POLICY 2.1 Negative Pressure Wound Therapy (NPWT) will be initiated on inpatient units in Acute Care or Long Term Care, and in Home Care. 2.2 The physician is responsible for writing orders to initiate and maintain NPWT, utilizing NPWT preprinted orders (#102840). 2.3 The manager of nursing or designate will be notified of the request for NPWT prior to initiation. 2.4 NPWT will not be initiated on inpatient units on a weekend, statutory holiday, or bank day. The exception is NPWT initiated in the Operating Room. 2.5 Registered Nurses and Licensed Practical Nurses will initiate and maintain NPWT as ordered by the physician. 2.6 A complete wound assessment, including wound measurements will be performed prior to initiation of NPWT, at first dressing change, and weekly during therapy. Include photographs of wound if possible. 2.7 Sterile technique will be used. 2.8 The NPWT dressing will be changed as per physician s order, but no less than twice per week.

2 2.9 The NPWT dressing should be removed if negative pressure is off for a period exceeding two hours. Replace with a traditional dressing and re-evaluate use of NPWT Discontinuation of NPWT will be considered when: 3. PROCEDURE The goal of therapy has been met The wound shows no progress for one to two weeks Relative or absolute contraindications (see Appendix A) have developed The patient is unable or unwilling to follow plan of care 3.1 To access KCI V.A.C. rental machine and order supplies, refer to Procedure to Acquire a V.A.C. Unit binder or the Skin and Wound Care webpage on the SHR Infonet. 3.2 NPWT consumable supplies are accessed through SPD at SPH and Stores at RUH. 3.3 Supplies: NPWT unit NPWT dressing and drape, appropriate size based on wound NPWT canister Clean gloves Sterile gloves Dressing tray Sterile scissors (2) Skin Prep/skin barrier Thin hydrocolloid dressing or transparent dressing, optional Normal saline Dual Top 3.4 Removal: Administer analgesia as ordered Thirty minutes prior to NPWT dressing change, turn off negative pressure and close tubing clamps Cut several small openings in drape and squeeze a small amount of sterile saline through each opening Count and document number and type of pieces removed. 3.5 Application: refer to most current manufacturer s clinical guidelines. 3.6 Documentation Number of foam pieces used on exterior of drape Dimensions and characteristics of wound, type and number of foam pieces and any non-adherent material used, patient tolerance, and application of NPWT on Wound Care Record (#101649). 3.7 Up to four days notice is required for referral to Home Care or transfer to Long Term Care or rural areas and must include: copy of completed NPWT physician s orders wound dimensions list of supplies required Page 2 of 5

3 arrangements for physician follow up consider sending supplies for two dressing changes for patients going to LTC and rural areas 3.8 Provide discharge teaching for patients referred to Saskatoon Home Care or rural home care utilizing Discharge Instructions for VAC (form #102847). 3.9 Cleaning and transportation of KCI V.A.C. units: refer to Procedure to Acquire a V.A.C. Unit binder or the Skin and Wound Care webpage on the SHR Infonet. 4. REFERENCES Nursing Interventions and Clinical Skills, Mosby, Inc., 2004 V.A.C. Therapy Clinical Guidelines, KCI Medical Canada Inc., July 2007 VAC Working Group, Regina Qu Appelle Health Region, November 26, 2003 Page 3 of 5

4 Is Wound Appropriate for Negative Pressure Wound Therapy (NPWT)? Appendix A Optimize best-practice wound care: wound assessment & documentation moist wound healing pain management control BP/blood glucose appropriate turning/positioning regimen educate patient and caregivers Braden scale-pressure relief surface maximize nutritional status (albumin or pre-albumin) management/treatment of infection Consider Consult eg. Nutrition Wound Resource Nurse Plastics Vascular Is wound appropriate for NPWT? traumatic dehisced surgically debrided chronic wounds post graft/flap highly exudating surgical NPWT not appropriate Absolute Contra-Indications Difficult wound hemostasis Untreated osteomylitis/infection Malignancy in wound Non-enteric and unexplored fistulae Localized Ischemia Exposed vital organs, vessels or anastomotic sites Relative Contra-Indications Inadequate debridement Inflammatory wound Palliative/Maintenance wounds Patient Non-Compliance Immunodeficient disease (Leukemia, HIV) Exposed ligaments, tendons or nerves (see manufacturers recommendations for application) Obtain physician s order Page 4 of 5 Review policy & procedure and manufacturer s guidelines

5 Appendix B Page 5 of 5