Ask the treatment expert ... about timing negative pressure wound therapy
Rosalyn Jordan, RN, BSN, MSc, CWOCN, WCC
Can you give me some guidelines regarding when I should start negative pressure wound therapy and when it should be discontinued?
Negative pressure wound therapy (NPWT) is an advanced wound dressing that applies subatmospheric pressure to the wound bed. It promotes and accelerates wound healing.
First, assess the wound bed and determine the status of the tissue in it. Does it appear healthy with moist, red granulation tissue? What percentage of it is covered with granulation tissue?
Of course, wound healing may occur more rapidly if the wound bed is covered with 100% healthy granulation tissue.
Note the amount of necrotic tissue, such as slough or eschar, covering the wound bed. NPWT is not a debridement measure. Depending on the amount of necrotic tissue, other debridement methods may be the best treatment option prior to application of NPWT.
The maximum amount of eschar in the wound bed upon application of NPWT should be determined based on recommendation from the manufacturer, clinical guidelines and the facility or agency protocols.
When should NPWT be discontinued? After the wound bed is filled with healthy granulation tissue and the drainage is diminished. Epithelization is the next phase of wound healing. Many clinicians discontinue NPWT at this time.
Based on wound healing assessment, if no healing has been noted or if the wound remains the same after two to three weeks, the wound care regime should be re-evaluated. This could include a change in the topical wound treatment, including discontinuation of negative pressure wound therapy.
Timely addition or discontinuation of NPWT based on the status of wound healing is essential for the provision of quality, cost-effective wound care.