Protocol for the Use of Topical Negative Pressure Wound Management Approved by: CHS clinical Policy Group and Clinical Quality and Governance Committee On: 1 April 2010 12 April 2010 Review Date: March 2012 Directorate responsible for Review Governance and Corporate Development Policy Number: SNP 015 Signature:... Helen Thompson Acting Managing Director Community Health Services
Equality Impact Assessment Policy/ Service Screening Checklist Policy Title: Protocol for the use of Topical Negative Pressure Wound Management Directorate: Nursing and Quality Name of person/s auditing / authoring policy: Locality Tissue Viability Leads Policy/ Service Content: For each of the following checks is this policy sensitive to people of different age, ethnicity, gender, disability, religion or belief, sexual orientation & transgender? The checklists below will help you to see any strength and / or highlight improvements required to ensure that the policy / procedure is compliant with equality legislation. A. Check for DIRECT or INDIRECT discrimination against any minority group of SERVICE USERS: Question: Does your policy/service contain any issues Response which may adversely impact people from using the services who otherwise meet the criteria under the grounds of: 1.0 Age X 1.1 Gender (Male, Female and Transsexual) X 1.2 Learning Difficulties / Disability or Cognitive X Impairment 1.3 Mental Health Need X 1.4 Sensory Impairment X 1.5 Physical Disability X 1.6 Race or Ethnicity X 1.7 Religion or Belief (including other belief) X 1.8 Sexual Orientation X Action required Resource implication Yes No Yes No Yes No If yes is answered to any of the above items the policy may be considered discriminatory and requires review and further work to ensure compliance with legislation. B. Check for DIRECT or INDIRECT discrimination against any minority group relating to EMPLOYEES: Question: Does your policy/ service contain any issues which may adversely impact employees from operating Response Action required Resource implication the under the grounds of: Yes No Yes No Yes No 1.9 Age X 2.0 Gender (Male, Female and Transsexual) X 2.1 Learning Difficulties / Disability or Cognitive X Impairment 2.2 Mental Health Need X 2.3 Sensory Impairment X 2.4 Physical Disability X 2.5 Race or Ethnicity X 2.6 Religion or Belief (including other belief) X
2.7 Sexual Orientation x If yes is answered to any of the above items the policy may be considered discriminatory and requires review and further work to ensure compliance with legislation. TOTAL NUMBER OF ITEMS ANSWERED YES INDICATING DIRECT or INDIRECT DISCRIMINATION = 0 Number of Yes answers for Service users Number of Yes answers for Employees. Is there any evidence that some groups are affected differently? Is there a need for external or user consultation? If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? Is the impact of the policy/guidance likely to be negative? If so can the impact be avoided? What alternatives are there to achieving the policy/guidance without the impact? Yes/ No Comments / X X X X X X Can we reduce the impact by taking X different action? IMPACT (Please Tick) High Medium Low X To be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval. If you have answered Yes to any of the above questions, it is likely the policy/ service will need a full EIA, please complete a full impact assessment. If you have identified a potential discriminatory impact of this procedural document, please refer it to policy/service administrator; together with any suggestions as to the action required to avoid/reduce adverse impact. Signatures of authors / auditors: Date of signing: Diane Blockley 21/01/10
Protocol for the Use of Topical Negative Pressure Wound Management VERSION CONTROL First Date Version 1.0 Sept 2007 Amendment 2.0 April 2010
CONTENTS TITLE PAGE 1. Introduction 1 2. Purpose 1 3. Clinical Benefits 1 4. Indications for use 1 5. New Referrals 2 6. Topical Negative Pressure Checklist 3 7. Types of Treatment 4 8. References 7 9. Appendices: 8
1. INTRODUCTION The purpose of this protocol is to ensure the safe and appropriate use of Topical Negative Pressure for wound management. SCOPE This protocol is applicable to all qualified nursing staff employed by Leicestershire County & Rutland Community Health Services. The qualified nurse should ensure that they work in line with their professional standards. o NMC The Code (2008) o NMC Record Keeping (2004) This protocol should be applied in conjunction with the following: o The Leicestershire County & Rutland Community Health Services Wound Care Formulary NP062. o Infection Control Guidelines for Cleaning & Decontamination Community Health Services & Primary Care CH/PC101 2. PURPOSE 2.1 Topical Negative Pressure wound therapy (TNP) is a mechanical wound care treatment that uses controlled negative pressure to assist and accelerate wound healing (Bryant 2000). 2.2 TNP is a non invasive technique entailing exposure, either continuously or intermittently, of a wound to sub-atmospheric pressure (Morykwas & Argenta 1997). 2.3 Studies have shown that micro vascular blood flow increased above baseline values with negative pressures of -125mmHg (Morykwas 1997). 3. CLINICAL BENEFITS o o o o o o o o o o Increased local blood flow to the wound by dilation of the arterioles Reduced tissue oedema through removal of excess fluid Stimulation of granulation tissue, resulting in progressive wound closure Stimulation of cell proliferation Removal of free radicals from wound Removal of slough Reduction in wound volume Protection from outside contaminants Decrease in wound bio burden Maintenance of a moist wound healing environment 4. INDICATIONS FOR USE 4.1 TNP may be used for the management of : Title of Policy: Protocol for the Use of Topical Negative Pressure Wound Management Page 1 of 26
o Partial / full thickness pressure ulcers o Dehisced surgical wounds o Diabetic / neuropathic ulcers o Venous leg ulcers o Post surgical wounds o Sinus drainage and management o Traumatic wounds o Pre-op flap / grafts o Post-op flaps / grafts o Necrotising fascitis o Burns 4.2 Contraindications As with all treatments, TNP should only be used on wounds which have been thoroughly and accurately assessed. Its use is contra indicated if: o Necrotic tissue / eschar is present o Dressings are placed directly over exposed vital structures (i.e. tendons, ligaments, blood vessels, anastomotic sites, organs and / or nerves) o Untreated osteomyelitis is noted o Non-enterocutaneous or unexplored fistulae are present o There is malignancy in the wound o The patient is being treated with systemic steroids o The patients is unable to understand what the treatment entails or comply with the treatment o Sensitivity to silver (when using silver impregnated dressings) 4.3 Warnings Precautions should be taken for patients: o With active bleeding o With difficult wound haemostasis o Who are taking anti-coagulant therapy 5 NEW REFERRALS All new referrals should be sent to the TNP Co-ordinator (see Appendix 1) who will co-ordinate with the Tissue Viability Leads to assess and authorise the type of treatment to be continued in the Community. The TNP Co-ordinator will then liaise with the referee and District / Ward Nurses to inform them of which treatment will be used. The TNP Co-ordinator will then send out a pump which is owned by the Community Health Services to the District Nurse Base/Community Hospital Ward or arrange for hire of a pump from either KCI (VAC ) or Talley Medical (Venturi ) Title of Policy: Protocol for the Use of Topical Negative Pressure Wound Management Page 2 of 22
6. TOPICAL NEGATIVE PRESSURE CHECKLIST PROCEDURE KCI VAC KCI ACTIVAC TALLEY VENTURI TALLEY COMPACT Preparation for skin graft Reconstruction work Complex surgical wound Preparation for wound closures Edudate Management Infection Risk Contamination risk from other wounds Patient with limited mobility x Odour Control Sternal splinting/support x x Progressing complex wounds still needing TNP Title of Policy: Protocol for the Use of Topical Negative Pressure Wound Management Page 3 of 22
7. TYPES OF TREATMENT 7.1 Venturi Standard / Compact The Talley Venturi system follows the therapy application technique first described by Chariker and Jeter et al (1989) using saline-moistened gauze, a silicone drain and clear, semi-permeable adhesive film. Flat and channel drains are available which can be cut to length for a custom fit to each wound. The flat drain is suitable for shallow or deep wounds with minimal to heavy exudate production and is used for the majority of wounds. The channel drain is used for managing sinuses and wounds with tunnelling or undermining and can be placed directly into the sinus tract or coiled to fit into undermined wounds. The standard Venturi pump canister will hold 600ml of exudate and should be used for heavily exuding wounds. The Compact pump canister will hold 300ml is lighter and more portable and should be used for moderately exuding wounds. 7.2 Application of TNP via Venturi Standard / Compact A standard flat drain core care plan is available on SystmOne. This care plan can be adjusted to meet the individual needs for each patient. See Appendix 5 7.3 Specific points to remember Protect surrounding skin with Cavilon Film (not cream). With the Venturi it is not necessary to line the wound with Urgotul / Mepitel as the moistened gauze will not stick however, if a high level of colonisation is suspected, the wound can be lined with Urgotul SSD to reduce bacterial load, until bacterial colonisation reduced. Before fitting canister, remove the polystyrene protection from the sensor pins on the back. The Venturi will commence at 80mmHG. However it can be increased in stages to 90 or 100mmHG for greater exudate control. The pump must be kept in the upright position or exudate will flow onto sensors activating the alarm and canister full alert. Correcting it will not stop the alarm until the canister is changed. There is a bung on the top of the canister covering a blind port remove this and apply over drainage port (opposite side of canister) when canister is full for disposal. Therapy should be continued until healthy granulation tissue is almost to skin level and exudate levels can be managed with conventional high absorbency dressing products e.g Aquacel Packing / Allevyn Adhesive (necessitating no more than alternate day change). Title of Policy: Protocol for the Use of Topical Negative Pressure Wound Management Page 4 of 22
7.4 Wound Sealing Kits and Canisters All wound sealing kits and canisters for the Venturi system can be ordered from Logistics or are available on FP10. 7.5 PIP/FP10 Order Codes VENTURI wound sealing kit- STANDARD flat drain: 340-5909 VENTURI wound sealing kit- LARGE flat drain: 340-5883 VENTURI wound sealing kit- CHANNEL drain: 340-5974 VENTURI 600ml canister (complete with solidifier): 340-5875 VENTURI 300ml canister (complete with solidifier) 349-5991 7.6 KCI VAC / ACTI-VAC The VAC / ActiVAC uses an integrated system incorporating either a polyurethane or polyvinyl foam dressing that acts as an interface between the wound surface and the vacuum source. The foam dressing is covered with a transparent semi-occlusive adhesive drape; a Sensa T.R.A.C. Pad is then applied and connected to the VAC therapy unit. Canisters for the VAC/ActiVAC are only available in one size which holds 300mls of exudate. The VAC / ActiVAC pressures will usually be pre-set at 125 mm/hg although this may not be the case in certain patients, especially those receiving care from the Burns and Plastics Dept. Advice will be given regarding therapy levels when the patient is discharged. Any adjustments made to the therapy levels must be referred to the Tissue Viability Lead for advice. The VAC / ActiVAC system should continue until granulation tissue is clean, healthy and well established (almost to skin level) and exudate levels controllable with conventional high absorbency dressing products e.g. Aquacel / Allevyn Adhesive (requiring no more than alternate day changes). 7.7 Specific points to remember Protect surrounding skin when required with Cavilon Film (not cream). The occlusive drape must be removed carefully by lifting one edge then stretching the drape horizontally. If this instruction is not adhered to, epidermal stripping may occur. Granufoam can adhere strongly to wound-bed and a contact layer may be required to line wound-bed eg. Urgotul, NA Ultra, Atrauman. Title of Policy: Protocol for the Use of Topical Negative Pressure Wound Management Page 5 of 22
7.8 Dressing Kits and Canisters Black Granufoam VAC Dressing Kits are available on FP10, this is for small medium and large only. White Foam is available in small and large and Silver Granufoam is available in small and medium. All other sizes and variations of dressings will need to be ordered via the Tissue Viability Leads. Both Freedom and ActiVAC canisters are available on FP10. 7.9 PIP/FP10 Order Codes VAC Granufoam SMALL dressing kit: VAC Granufoam MEDIUM dressing kit: VAC Granufoam LARGE dressing kit: VAC White Foam SMALL dressing kit: VAC White Foam LARGE dressing kit: VAC Granufoam Silver SMALL dressing kit: VAC Granufoam Silver MEDIUM dressing kit: VAC Freedom canister with gel 300ml: Acti VAC Canister with gel 300ml: M8275051 M8275052 M8275053 M8275068 M8275067 M8275098 M8275096 M320058 M8275058 7.10 Decontamination of the Pump Any spillage of bodily fluids onto any part the pump should be cleaned as outlined in the Infection Control Guideline CH/PC101 7.11 Discontinuing Therapy 7.12 Pumps owned by Community Health Services. When therapy has been discontinued, the pump should be returned to the TNP co-ordinator via the internal mail ensuring that all parts including the charger and carry bag are included. N.B Canisters containing exudate must be removed and disposed of as per Local Policy before the pump is returned. 7.13 Hired pumps The TNP co-ordinator must be notified as soon as therapy has been discontinued. It is then the responsibility of the nurse providing the care to contact either Talley or KCI to discontinue funding and arrange for the collection of the pump, charger and case from the patients address or another appropriate location. N.B Canisters containing exudate must be removed and disposed of as per Local Policy before the pump is returned. Title of Policy: Protocol for the Use of Topical Negative Pressure Wound Management Page 6 of 22
8. REFERENCES Bryant R. (2000) Acute and chronic Wounds. Mosby, St Louis, USA (p. 436) Chariker. M.E., Jeter.K.F.,Tintle.T.E.,Bottsford. J.E. (1989) Effective management of incisional and cutaneous fistulae with closed suction drainage. Contemporary Surgery. Vol 34, 59-63 Morykwas M. J., Argenta L.C (1997) Nonsurgical modalities to enhance healing and care of soft tissue wounds.journal of the Southern Orthopaedic Association 6(4):279-88. Nursing and Midwifery Council (2004) Guidelines for records and record keeping. NMC. London. Nursing and Midwifery Council (2008) The Code: Standards of conduct, performance and ethics for nurses and midwives. NMC. London. Title of Policy: Protocol for the Use of Topical Negative Pressure Wound Management Page 7 of 22
Appendix 1 How to apply for TNP Therapy Request Details should be completed on a copy of the form below and sent by fax to the TNP Co-ordinator on 01509 568886. NHS No: Name: Address: Postcode: Date of Birth: Patient Telephone No: Hospital Topical Negative Pressure/ TNP THERAPY REQUEST Bradgate Ward, Loughborough Hospital Tel: 01509 568881 Fax: 01509 568886 DATE: Referrer: Contact Number: Hospital/Ward: Patient to have.. dressing changes to come home with: Foam size: PATIENT DETAILS DIAGNOSIS GP NAME & ADDRESS GP details DATE OF DISCHARGE: / /200 DRESSING CHANGE DUE. /./200 Next OPD /. /200 When did TNP/VAC commence? DETAILS OF WOUND How long has wound been present? Approx TNP/VAC duration Wound Site/Cause of wound Indications for commencing VAC /TNP Size of wound District Nurse team / Ward involved DISTRICT NURSE DETAILS Contact Number/Fax No: Base: Date of contact: / /200 PLEASE NOTE Patients being discharged on a KCI VAC will be transferred onto a Talley Venturi to continue their treatment. Please provide a clear rationale below if you wish to continue treatment with the KCI VAC. Any other information: Signature of referrer Designation. Title of Policy: Protocol for the Use of Topical Negative Pressure Wound Management Page 8 of 22
NHS No: Name: Address: Postcode: Date of Birth: Patient Telephone No: COMMUNITY Topical Negative Pressure/ TNP THERAPY REQUEST Bradgate Ward, Loughborough Hospital Tel: 01509 568881 Fax: 01509 568886 DATE: Referrer: Contact Number: Locality: PATIENT DETAILS DIAGNOSIS GP details GP NAME & ADDRESS DETAILS OF WOUND Wound Site/Cause of wound/level of exudate How long has wound been present? Previous treatment used Indications for commencing VAC /TNP Size of wound DISTRICT NURSE DETAILS District Nurse team involved Contact Number/Fax No: Base: Date of contact: / /200 ANY OTHER INFORMATION Signature of referrer Designation. Please ensure that all boxes on the form are fully completed in order that the required equipment can be dispatched as quickly as possible Title of Policy: Protocol for the Use of Topical Negative Pressure Wound Management Page 9 of 22
Appendix 2. Your Patient is receiving Topical Negative Pressure (TNP) with a KCI VAC / ACTI-VAC Useful points to remember The trust owns just one VAC Freedom pump and one Acti-Vac pump and when these are in use units will be rented from KCI at the cost of 39.00 per day. The TNP co-ordinator must be notified as soon as therapy has been discontinued. It is then the responsibility of the nurse providing the care to contact KCI (0800 980 8880) to discontinue funding and arrange for the collection of the pump, charger and case from the patients address or another appropriate location. The VAC Freedom / Acti-Vac system should continue until granulation tissue is clean, healthy and well established (almost to skin level) and exudate levels controllable with conventional high absorbency dressing products e.g. Aquacel / Allevyn Adhesive (requiring no more than alternate day changes). Dressing kits and canisters Black Granufoam VAC Dressing Kits are available on FP10, this is for small medium and large only. White Foam is available in small and large and Silver Granufoam is available in small and medium. All other sizes and variations of dressings will need to be ordered via the Tissue Viability Leads. Both Freedom and ActiVAC canisters are available on FP10. Outpatients appointments Due to the time constraints in OPD it is not always possible for the VAC dressing to be re-applied during their appointment time. Therefore the VAC must be removed and a conventional dressing applied prior to their appointment. Plans will then need to be made to visit the next day to reapply the VAC. Re-admission If the patient is being re-admitted the VAC pump should be removed, if possible, and a temporary dressing applied. Please advise the TNP Co-ordinator if a patient is admitted with the VAC insitu as soon as possible. This is essential so that the Tissue Viability Team at UHL can arrange for the VAC to be returned to the TNP Coordinator. Discontinuation of treatment Upon discontinuation please inform the TNP Co-ordinator who can advise you if the unit is owned by the PCT or rented from KCI. You will need to provide the pump number and a full address and postcode of where the unit is to be collected from to enable prompt cancellation/company collection. If the unit belongs to the PCT, Title of Policy: Protocol for the Use of Topical Negative Pressure Wound Management Page 10 of 22
please return the unit in the plastic box provided via the internal mail to the TNP Coordinator. Features of the vac / acti-vac to remember The VAC / ACTIVAC pressures will usually be pre-set at 125 mm/hg although this may not be the case in certain patients, especially those receiving care from the Burns and Plastics Dept. Advice will be given regarding therapy levels when the patient is discharged. Any adjustments made to the therapy levels must be referred to the Tissue Viability Lead for advice. The occlusive drape must be removed carefully by lifting one edge then stretching the drape horizontally. If this instruction is not adhered to, epidermal stripping may occur. Protect surrounding skin when required with Cavilon Film (not cream). Granufoam can adhere strongly to wound-bed and a contact layer may be required to line wound-bed eg. Urgotul, NA Ultra, Atrauman. If you have any problems, require a tissue viability opinion or need additional training, please contact your local Topical Negative Pressure Resource Nurse or Locality Tissue Viability Lead. Or alternatively you can contact KCI s 24 hour Advice Line. Useful contacts TNP Co-ordinator Melanie Percival Bradgate Ward Loughborough Hospital Epinal Way Loughborough Tel: 01509 568881 Fax: 01509 568886 KCI Medical Terry McCann (VAC Clinical Specialist) Tel: 07827 278 540 Office Number/24 hr advice line Tel: 0800 980 8880 Title of Policy: Protocol for the Use of Topical Negative Pressure Wound Management Page 11 of 22
Appendix 3. Your Patient is receiving topical negative pressure (TNP) with a Talley Venturi Standard/Compact System Useful points to remember The PCT currently own 3 Venturi units and 6 Compact units. When they are all in use, Venturi units are rented from Talley at a cost of 12.50 per day. The TNP co-ordinator must be notified as soon as therapy has been discontinued. It is then the responsibility of the nurse providing the care to contact Talley (01794 503 500 option 1) to discontinue funding and arrange for the collection of the pump, charger and case from the patients address or another appropriate location. The Talley system should be continued until healthy granulation tissue is almost to skin level and exudates levels can be controlled with conventional high absorbency dressing products e.g Aquacel Packing / Allevyn Adhesive (necessitating no more than alternate day change). Wound sealing kits and canisters All wound sealing kits and canisters can be ordered from Logistics or are available on FP10 for the Venturi units. Outpatients appointments Remove the Ventutri unit before all OPD appointments. UHL do not use Venturi and will not be aware of the functions of the machine. Apply a conventional dressing prior to attendance and re-apply the Venturi unit upon return or the next morning. Re-admission If the Patient is re-admitted the pump should be removed and a temporary dressing applied. Please advise the TNP Co-ordinator if a Patient is admitted as soon as possible. If it is not possible to remove the pump and the Patient is admitted with the Venturi/Compact unit in situ then please, again, advise the TNP Co-ordinator asap. Discontinuation of treatment Upon discontinuation please inform the TNP Co-ordinator who can advise you if the unit is owned by the PCT or rented from Talley. You will need to provide the pump number and a full address and postcode of where the unit is to be collected from to enable prompt cancellation/company collection. If the unit belongs to the PCT, please return the unit in the plastic box provided via the internal mail to the TNP Coordinator. Title of Policy: Protocol for the Use of Topical Negative Pressure Wound Management Page 12 of 22
Features of the venturi/compact to remember The unit must be kept in the upright position or exudates will flow onto sensors activating the alarm and canister full alert. Correcting it will not stop the alarm until the canister is changed. Before fitting the canister, remove the polystyrene protection from the sensor pins on the back. There is a bung on the top of the canister covering a blind port remove this and apply over drainage port (opposite side of canister) when canister is full for disposal. The Venturi will commence at 80mmHG. However it can be increased in stages to 90 or 100mmHG for greater exudate control. Protect surrounding skin with Cavilon Film (not cream). It is not necessary to line the wound with Urgotul / Mepitel as the dampened gauze will not stick however, if a high level of colonisation is suspected, the wound can be lined with Urgotul SSD to reduce bacterial load, until bacterial colonisation reduced. For further information and advice on the Venturi unit, consult the instruction booklet, Link Nurse or Locality Tissue Viability Lead. Useful contacts TNP Co-ordinator Melanie Percival Bradgate Ward Loughborough Hospital Epinal Way Loughborough Tel: 01509 568881 Fax: 01509 568886 LE11 5JY Talley Medical Laura Wood (Clinical Nurse Adviser) Tel: 07791 135 325 Rory Telfer Tel: 07769 142 918 Office Number Tel: 01794 503500 and then choose option 1 Title of Policy: Protocol for the Use of Topical Negative Pressure Wound Management Page 13 of 22
Appendix 4 Equipment needed for setting up a patient for Talley Venturi, Topical Negative Pressure (TNP) Sterile dressing packs Sterile scissors Probes Steripods Film dressings 12 x 12 cm or 6 x 6 cm Sterile gloves A small supply of conventional dressings (in case pt goes into hospital or has problems with TNP) A supply of Wound Sealing Kits with either flat drain or channel drain depending on size and location of wound. These can be ordered via Logistics or on FP10. Venturi canisters complete with solidifier N.B. Venturi units on loan from Talley Medical will come with 3 x Wound Sealing Kits (usually standard flat drain) and 1 x canister. Further supplies need to be obtained via Logistics or FP10 (see separate sheet) Title of Policy: Protocol for the Use of Topical Negative Pressure Wound Management Page 14 of 22
Appendix 5 Equipment needed for setting up a patient for KCI VAC/ActiVAC, Topical Negative Pressure (TNP) Sterile dressing packs Sterile scissors Probes Steripods Film dressings 12 x 12 cm or 6 x 6 cm Sterile gloves A small supply of conventional dressings (in case pt goes into hospital or has problems with TNP) Atrauman/NA dressings to line the wound Granufoam dressings in either small, medium or large VAC Freedom/Acti-VAC canisters Supplies need to be obtained via Logistics or FP10 (see separate sheet) Title of Policy: Protocol for the Use of Topical Negative Pressure Wound Management Page 15 of 22
Appendix 6 COMMUNITY CORE CARE PLAN No FOR: Topical Negative Pressure Talley Venturi Standard/Compact Flat Drain NAME DOB Date Identified Need Signature Has a wound which requires the application of Topical Negative Pressure therapy via a FLAT DRAIN Date Patient Goal (including stages) Signature To promote a healing environment To manage wound exudate To minimise infection risk Title of Policy: Protocol for the Use of Topical Negative Pressure Wound Management Page 16 of 22
Date Negotiated Plan of Care Signature Negotiate planned care intervention with patient and obtain consent for treatment Provide routine analgesia prior to dressing procedure Wash hands and prepare equipment Remove soiled dressings and dispose as per local policy Assess wound Apply barrier film (Cavilon) if required, to peri-wound area Place a layer of the moistened gauze onto the wound bed ensuring that it is in contact with all undermining areas Cut the flat drain so that it can lay within the wound margins, ensuring that the tip of the drain is 1cm from wound edge to allow for contraction, and that all of the holes inside the drain are within the wound margin Cut a strip of adhesive gel and place beneath the neck of the drain to anchor the drain to the patient Apply further adhesive gel strips to any peri-wound area which may need filling out to achieve a flatter surface and facilitate an effective seal Place further moistened gauze onto the drain ensuring that it is contact with the wound edges and higher than skin level Apply the large transparent film dressing over the entire wound ensuring contact with at least 2.5cm of intact skin beyond the wound edge Crimp or gently pinch the edges of the transparent film around the drain tubing to ensure a proper seal Connect flat drain to extension tube, open clamp and connect to the Venturi unit Turn on Venturi unit to initiate suction. Ensure unit it set to 80mm Hg on continuous mode Observe the wound site, the dressing should contract noticeably and become firm to touch (like a raisin) Title of Policy: Protocol for the Use of Topical Negative Pressure Wound Management Page 17 of 22
If the dressing does not contract, a seal has not been achieved. Reinforce dressing with extra semi-permeable film to achieve a seal Educate patient and/or carers on how to manage the Venturi unit and action to take if any problems arise Dispose of waste as per local policy Change canister every week or as indicated by amount of drainage Evaluate every 2 weeks or as indicated by wounds progress Title of Policy: Protocol for the Use of Topical Negative Pressure Wound Management Page 18 of 22
Appendix 7 COMMUNITY CORE CARE PLAN No FOR: Topical Negative Pressure VAC/Acti VAC NAME DOB Date Identified Need Signature Patient has a wound which requires the application of Topical Negative Pressure via VAC / ActiVAC. Date Patient Goal (including stages) Signature To promote a healing environment. To manage wound exudate. To minimise infection risk. Date Negotiated Plan of Care Signature Negotiate planned care intervention with patient and obtain consent for treatment. Explain and discuss the procedure with the patient. Provide routine analgesia prior to dressing procedure. Title of Policy: Protocol for the Use of Topical Negative Pressure Wound Management Page 19 of 22
Ensure there is adequate lighting and the patient is comfortable and in a position where the wound can be accessed and viewed easily. Clamp the T.R.A.C. /SensaT.R.A.C tubing and disconnect it from the canister tubing. Allow any fluid in the canister tubing to be sucked into the canister. Switch off the therapy unit and clamp the canister tubing. Remove and discard the canister (if full or at least weekly). Carefully remove the occlusive drape by gently lifting one edge and then stretching the drape horizontally and slowly pulling up from the skin. Carefully remove the foam dressing from the wound bed. Assess wound. Clean the wound if required. Clean, dry and prepare the peri wound skin. Cut the V.A.C foam to fit the size and shape of the wound, including tunnelling and undermined areas. Avoid cutting the foam over the wound bed. Place the foam into the wound cavity (Note: If the wound is bigger than the largest foam dressing, more than one piece of foam may be used as long as the edges of the foam are in contact with each other). Avoid foam contact with intact skin. Cut the occlusive drape to size and apply over the top of the foam, ensuring a 3 5cm border onto intact skin or protective barrier (Note: do not compress the foam into the wound). Choose a location on the sealed occlusive drape to apply the T.R.A.C /SensaT.R.A.C. Pad tubing where the tubing will not rub or cause pressure. Cut a hole through the drape, approximately the size of a 2 coin, leaving the foam intact. Place the T.R.A.C /SensaT.R.A.C pad directly over the hole in the drape. Gently press around the T.R.A.C /SensaT.R.A.C pad. Title of Policy: Protocol for the Use of Topical Negative Pressure Wound Management Page 20 of 22
Date Signature Insert the canister into the therapy until it clicks into place. Connect the T.R.A.C /SensaT.R.A.C tubing to the canister tubing and open clamps. Press POWER button to follow the on-screen instructions to set the level and type of pressure required according to instructions. Start the therapy unit by pressing THERAPY ON/OFF the foam should collapse into the wound. If it does not, assess the drape for air leaks and seal with leftover drape or a semi-permeable film dressing. Educate patient and/or carers on how to manage the VAC unit and action to take if any problems arise. Dispose of waste as per local policy. Change canister every week or as indicated by amount of drainage Evaluate every 2 weeks or as indicated by wounds progress. Title of Policy: Protocol for the Use of Topical Negative Pressure Wound Management Page 21 of 22