Journal of Community Nursing

NPWT IN THE COMMUNITY

rovision of wound care makes up

a large proportion of community

nursing time (around 70%)

(Drew, 2007), as well as accounting

for 4% of total healthcare expenditure

(Posnett et al, 2009). The Government

strategy to move more care into the

community (Department of Health

[DH], 2009), has also led to increasingly

complex wound management being

provided in patients’homes.

The use of advanced therapies

to promote wound healing is

increasing (Falanga, 2005). Indeed, the

development of such products was one

of the drivers behind the DH’s proposal

that more complex wound care should

be undertaken in the community

setting (DH, 2009). However, it is

essential that nurses who treat wounds

choose the most appropriate product —

balancing the need to provide optimal

care with increasing demands for cost-

effective treatment.

Negative pressure wound therapy

(NPWT) has the potential to promote

wound healing, alleviate exudate

and odour, and improve quality of

life (Wounds UK, 2008).While it was

seen as being an expensive treatment

modality, used in secondary care by

specialists (Ousey and Milne, 2009),

Jeanette Milne, tissue viability nurse specialist,

South Tyneside Foundation Trust

the introduction of more portable and

affordable systems has made it more

accessible to patients in the community

(Dowsett et al, 2012) .

NPWT is commonly used to treat

chronic wounds — category 3 and 4

pressure ulcers, surgical wounds healing

by secondary intention, diabetic foot

ulcers (DFUs) (Chadwick et al, 2009), or

venous leg ulcers in conjunction with

compression — especially those that

have been non-respondent to alternative

therapies. It can be used with different

clinical goals in mind; either as a bridge

to surgical closure or to achieve wound

closure by reducing wound dimensions

and improving the quality and speed of

deposition of granulation tissue.

This article provides practical

guidance on when and how to

successfully use disposable NPWT in the

community setting.

TREATMENT PATHWAYS

The benefits of a formalised care

pathway approach are that it:

Introduces a standard of care that

facilitates staff training

Improves communication between

organisations and staff

Facilitates audit/outcomes tracking

Reduces variation in practice

Can lead to improvements in

patient experience.

Using disposable negative pressure

wound therapy in the community

IN BRIEF

Wound care represents a large part of the community nurse’s role.

Recently, negative pressure wound therapy (NPWT) devices have

become more portable, facilitating earlier hospital discharge and

increased home use.

Wound measurement is a method of giving patients feedback

RQ FOLQLFDO SURJUHVV DV ZHOO DV GHWHUPLQLQJ WKH HIÀFDF\ RI WKH

treatment chosen.

Patients should be fully involved and informed about their therapy.

KEY WORDS:

Treatment pathway

Portable NPWT

Wound measurement

Outcomes

Jeanette Milne

Care pathways can also be used to

support the rationale for use, duration

of use and patient selection criteria

when justifying a therapy to the funding

authorities in a business case.

To ensure the greatest chance of

success, it is essential that nurses using

NPWT adhere to the manufacturer’s

indications, contraindications and

precautions (

Table 1

). A typical treatment

pathway is shown in

Figure 1

, but it

is also important to bear in mind the

following when considering NPWT.

Choosing the right filler

Both foam and gauze fillers/dressings

are available for use with NPWT.

Table 2

shows their positive and

negative properties.

Level of negative pressure

It has been found that -80mmHg is the

appropriate level of negative pressure

in most wound types and has optimum

effects on (Malmsjö et al, 2009):

Microvascular blood flow

Wound contraction

JCN supplement

2015,Vol 29, No 5

Remember

NPWT should not be considered as a

substitute for thorough debridement

and is contraindicated in wounds

containing necrotic tissue.