17.15 Complex adjunct therapies, dressings and appliances

Negative Pressure Wound Therapy (NPWT)

Negative Pressure Wound Therapy (NPWT) is increasingly being used as a treatment option for acute, chronic, and surgical wounds, and is also being used within the Community environment. It is a Specialist wound therapy initiated in Secondary care by the Consultant Surgeons, Tissue Viability, and Plastic Surgery Departments, and on occasions in Primary Care by the Community Nursing Teams supported by the Tissue Viability Team.

The product is supplied by Secondary care in the North and East and funded through an agreed mechanism with the NEW Devon CCG.

In the Community authorisation for the use and provision of NPWT is through the Tissue Viability Team, who will give the relevant training and monitor treatment on an ongoing basis. NPWT should only be undertaken by Practitioners who have completed the relevant training and competencies as per their employing organisation guidelines, policies and procedure.

Please note that all NPWT products should be requested via the Tissue Viability Service and not via prescription.

There are a number of different products available from a number of manufacturers, currently the products of choice are either Venturi or Renasys for large, heavily exuding wounds, and PICO for smaller, lighter exuding wounds.

The Venturi Compact product has been designed for use with both gauze and foam wound care sets and has a capacity of 300ml (Lightweight). There is also a channel drain system available.

The Renasys system has two devices, the Renasys go, a portable device for mobile patients, and Renasys EZ plus for additional power and capacity.

The PICO system is a canister free, single use therapy, provided as a seven day kit. The pump is designed to stop working after seven days of continuous use. The pump is attached to a dressing, and the dressing collects the wound exudate, with some moisture able to evaporate through the film of the dressing. The negative pressure generated is a continuous 80mmHg, and the wound must be producing less than 300ml of exudate and be small enough to be covered by one of the PICO dressing sizes suitable for this system.

Wounds suitable for NPWT following individual assessment include:

  • Dehisced surgical wounds
  • Diabetic foot ulceration
  • Pressure ulceration
  • Trauma wounds
  • Excised pilonidal sinus wounds

Wounds not suitable for NPWT include:

  • Fistulae of unknown origin
  • Malignant wounds
  • Body cavity wounds near to internal organs
  • Untreated osteomyelitis
  • Wounds near exposed or damaged blood vessels

It has been proposed that NPWT may aid wound healing by:

  • Maintaining a moist wound environment
  • Improving blood flow to ensure oxygen and nutrient delivery
  • Removing exudate
  • Promoting granulation
  • Increasing the rate of epithelial growth
  • Reducing infection
  • Pulling the wound edges together
Discontinuation of Therapy

A treatment goal should be defined and NPWT should be discontinued when it is reached. Other reasons to discontinue NPWT may include:

  • When uniform granulation tissue and little depth of the wound is present
  • The patient is not tolerating the NPWT, or withdraws consent to treatment
  • When the wound volume reduction is less than 15% over a two week period
  • The patient complains of extreme pain
  • There is excessive bleeding
  • An alternative treatment option is more suitable if there are signs of local or spreading infection
Key Recommendation
  • Robust systems should be in place to assess patient's suitability for starting NPWT, reviewing treatment and discontinuing treatment at an appropriate point
  • As well as clinical assessment a risk assessment which considers the patient's environment should also be undertaken when considering the use of NPWT in a homecare setting
  • Minimise wastage by agreeing suitable quantity that can be ordered at any one time. The quantity should be sufficient to ensure availability when needed but minimise wastage if therapy is changed. NPWT should not be included on repeat prescribing as it is requested via the Tissue Viability Team not on prescription.
Additional Information

NICE Interventional Procedure Guidance: https://www.nice.org.uk/guidance/ipg467

Physical debridement pads

Debrisoft®
  • Pad 10cm x 10cm (£6.45)
  • Lolly 23.5cm x 10cm (£5.79)

Notes

  1. See debridement guidance
  2. Always fully moisten with water or saline
  3. Always use the soft fibre side and not the knitted reverse side
  4. Not a wound dressing
  5. Can be used to remove crustations and fibrin deposits at wound edges and scale or skin flakes on surrounding skin

Desloughing dressings

UrgoClean®
  1. UrgoClean Pad 6cm x 6cm (£0.97), 10cm x 10cm (£2.16), 15cm x 20cm (£4.06) per dressing
  2. UrgoClean Rope (with probe) 2.5cm x 40cm (£2.43), 5cm x 40cm (£3.21)

 

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