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Treatment Barriers Eliminated: Innovative Negative Pressure Wound Therapy System Increases Staff Confidence and Reduces Wound Volume
Introduction: Negative pressure wound therapy (NPWT) has become the go-to standard of care for complex wounds. Fournier’s gangrene (FG) affects 1.6 out of 100,000 people1. Treatment of FG includes aggressive surgical debridement and antibiotics; followed by NPWT2. Long-term Acute Care Hospitals (LTACH) play a significant role in treating complex wounds, including FG. According to Arnold et al, the goal in LTACH’s is not always complete healing. Alternate goals include decreased wound volume and increased granulation tissue to facilitate discharge to rehab or home health3. Published benefits of NPWT include: decreased valuable staff time, length of stay, pain medication as well as improved patient comfort, quality of life and mobility4.
NPWT requires a solid dressing technique skill set, especially for complex wounds5.NPWT was often abandoned at our LTACH when treating complex wounds due to barriers such as seal maintenance, copious exudate, difficult anatomical locations and staff ease of use. Furthermore, patient’s had difficulty ambulating with a bulky NPWT system.
Method:To address these barriers, our LTACH adopted an innovative NPWT system that dynamically adjusts to wound exudate volume and viscosity and an ostomy barrier ring was applied around all wounds.
Results: Case series of 10 complex wounds including FG, stage 4 pressure injuries and a fistula. This innovative NPWT system and dressing technique eliminated previous treatment barriers experienced at our LTACH. Patient mobility and ambulation improved due to the light weight of the system. NPWT was uninterrupted allowing mechanisms of action to be realized. Average wound volume reduction = 88%; average length of treatment 4.9 weeks.
Discussion: Goals of complex wound treatment in LTACH’s include decreased wound volume and granulation tissue3. We were able to achieve these healing goals on extremely complex wounds, plus remove barriers to NPWT treatment with implementation of key dressing techniques and an innovative NPWT system.
Nursing staff reported easier NPWT management, dressing seal maintenance, reduction in alarms and easier patient ambulation. Adopting an innovative NPWT systems that adjusts to changing wound conditions along with use of ostomy barrier rings to maintain a seal has reduced early abandonment of NPWT in our facility.
References
1. Broner, M. (2020). Overview of Fournier’s gangrene. Urologic Nursing, 40(6), 291-293, 298. doi:10.7257/1053-816X.2020.40.6.291
2. Doughty, D. B. & McNichol, L. L. (Eds.). (2016). Wound ostomy and continence nurses society core curriculum: Wound management. Wolters Kluwer.
3. Arnold, M., Yanez, C. & Yanez, B. (2020). Wound healing in the Long-term acute care setting using an air fluidized therapy/continuous low pressure therapeutic bed. Journal of Wound Ostomy and Incontinence Nursing, 47(3), 284-290. doi:10.1097/WON. 0000000000000646
4. Bali, Z.U., Akdeniz, C. B., Muezzinoglu, T., Ulcer, O. & Kara, E. (2020). Comparison of standard open wound care and Vacuum-assisted closure therapy on Fournier’s gangrene. Journal of Urological Surgery, 7(1), 1. https://cms.galenos.com.tr/Uploads/Article_36096/JUS-7-42-En.pdf
5. Verbelen, J., Hoeksema, H., Heyneman, A., Pirayesh, A. & Monstrey, S. (2011). Treatment of Fournier's gangrene with a novel negative pressure wound therapy system. Wounds: A compendium of clinical research and practice, 23(11), 342–349. https://www.researchgate.net/publication/235343799_Treatment_of_Fournier's_Gangrene With_a_Novel_Negative_PressureWound_Therapy_System
