vac training final
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Negative Pressure
Wound Therapy
(NPWT)In the management of
Woundsby
Randika PereraSynergy Life Solutions9/29/2014
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Basic woundmanagement
debride
Surgical Chemical Enzymat ic
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Basic woundmanagement
dress
Healing
promoting
substance
Absorption
of
discharge
Dirty wound sketch Clean wound sketch
Maitain a
mois t and
cleanenvi ronment
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A Dirty Wound
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Debridement
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A traditional dressing
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the way it works
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A change of dressing
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With the VAC on
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Principle
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History of NPWT. Therapy
Research started in 1989 byDr. Louis Argenta& Prof. Michael Morykwasof Wake ForestUniversity School of Medicine in North Carolina, USA
NPWT. originally designed to treat chronic wounds
NPWT. system released in Europe in 1994
Annals of Plastic Surgery June 1997- 175 cases
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Removes interstitial fluid
allowing Tissue decompression
Reduces local ized edema
Helps remove infectious
materials Reduces bacterial colonization
Enhances dermal perfusion
Provides a closed, moist wound
healing environment
How
VACWOUNDTherapy Works
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Encourages mechanical
stretching and approximation
of the wound edges
Applies negative pressure to
uniformly draw wound closed
(wound contraction)
Promotes wound healing via
stimulation of granulation
tissue Promotes flap survival and
graft uptake
Enhances epithelial migration
Impact of
VACWOUNDTherapy on
wound bed
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Vacuum Assisted Closure.
NPWT. is a non invasive, act ive wound -closuresystem that uses contro l led, local ized negat ive
pressure to prom ote heal ing in acute and ch ronicwounds.
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Granulation Tissue Formation
Ilizarov Method- use of tissue expanders to apply mechanical
stress to soft tissues to increase mitotic rates, (Ilizarov G A, 1989)
Thoma,1911 - first postulation of the effects of mechanical stress to
encourage angiogenesis & tissue growth
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Tension Stress Effect
Morykwas hypothesis: mechanicalstress (contraction of wound) helpscause granulation tissue formation(tissue growth)
Tissue stress effect similar to usingIlizarov techniqueand soft-tissueexpanders to increase mitotic rates
Intermittent applicationresults inrepetive release of second messengers,
further enhancing gran tissueformation
The tension-stress effect on the genesis and growth of tissues. Part 1 Ilizarov GA Clin
Orthop Rel Res 1989;238:249-281
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Granulation Tissue Formation
Reverse Tissue Expansionas dressing collapses in
wound cavity, it exerts a centripetal force on wound
edges
Swan Marc, Banwel l Paul, Advanced Management of the Open Abd omen: Oxford Wo und Heal ing Society, 2003
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Increased Perfusion
Peak blood flow recorded at 125 mmHg
Study helped establish original pressure protocol with Foam Dressing
(400-600 micron pore-size)
Hypothesized that reduction in oedema decompresses small
blood vessels and increases flow
Frank Ischaemia and Wound Hypoxia
Morykwas Michael J, Argenta Louis C, Shelton-Brown Erica I, McGuirt Wyman:Vacuum-
Assisted Closure: A New Method for Wound Control and Treatment: Animal Studies and
Basic Foundation. Annals of Plastic Surgery, 1997; 38 (6)
Positive effect on
perfusion with 125
mmHg
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Effects of Varying Levels of Pressure
Wounds treated at 125 mmHg exhibited a
significant increase (p
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Reduction of Bacteria
All pigs (control and NPWT) were infected with 108organisms /g tissue
VACWOUNDs exhibited significant decrease in number of micro-organisms
(
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Granulation Tissue Formation
At 125 mmHg, VACWOUND
Therapy significantly increased
granulation tissue formation
over wet-to-moist gauze
63.3% with continuous pressure
103.4% with intermittent pressure
0
20
40
60
80
100
120
Continuous Intermittent
Fig 2. Percent increase (mean + standard deviation) in the
rate of granulation tissue formation of acute wounds in
pigs compared to conventional wet-to-moist saline gauze
dressing changes (control).
Morykwas Michael J, Argenta Louis C, Shelton-Brown Erica I, McGuirt Wyman:Vacuum-
Assisted Closure: A New Method for Wound Control and Treatment: Animal Studies andBasic Foundation. Annals of Plastic Surgery, 1997; 38 (6)
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Reduction of Inhibitory Factors
Reduction of oedema has positive effect
in wound healing
Reduction of inhibitory factors contained
in interstitial fluid (chemical)
Decompression of small blood vessels,
which restores flow (mechanical)
Inhibition of Cell Proliferation by Chronic Wound Fluid
Brian Bucalo MD, William H Eaglestein, MD, Vincent Falanga, MD 1993 WoundRepair and Regeneration
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VACWOUND Therapyis indicated for
Acute Wounds(caused by trauma or surgery)Sub-acute Wounds
Flaps & GraftsFull-thickness surgical wounds
Chronic wounds -Venous stasis ulcersDehisced wounds
Acute Surgical Wounds
Pressure Ulcers
Ortho Trauma Wounds
Diabetic WoundsOpen Abdominal Wounds
Partial Thickness Burns
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INDICATED for
TRAUMA WOUNDS
an application of 13 days
application of 9 days
Follow up after 20 days
Ideal wounds for Negative Pressure Wound Therapy
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INDICATED for
DIABETIC FOOTULCERS
Result in 3 days
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VENUS/ARTERIAL
LEG ULCERS
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Acute Surgical Wounds
Pressure Ulcers
Diabetic Wounds
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Open Abdominal Wounds
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Skin Grafts
Partial Thickness
Burns
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Pump
Dressing Installation
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M.A.P.C.MicroprocessorAss is tedPressure Con trol
ubing
Continuous feedback system that constantly
monitors the negative pressure at the wound site,
compares it with the target pressure, and adjusts
accordingly, so that the wound site pressure is equal
to the target pressure.
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dvantages
Provides more effective therapybecause target sub atmospheric pressureis monitored and maintainedat Maximizes accuracy and effectiveness of
NPWT.Therapy
Ensures controlled, consistent and safeNPWT.the wound site, even
during patient movement
Enables the User to adjust the rate of negative pressureonce the foam is
compressed in the wound to meet individual patients needsand increase
patient comfort
MAPC. System alerts the User of tubing blockagesand pressure leakages
to maximize patient safety
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How to put on a V C
Aggressivelyclean wound
Debride necrotic tissueor eschar if possible
Achieve hemostasis
Shave hair around borderif needed
Irrigate wound with normal saline
Dry and prep skinas appropriate
Cut foamto size of wound
Gently lay foamin wound, including tunnels,undermining, and all surfaces
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How to put on a V C
Materials needed:
Scissors (sterile or clean)
Gloves (sterile or clean)
Dressing kitCanister
NPWT. Unit
Optional:
Skin prep Tincture Benzoin
Non-adherent dressing,
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Clean Wound Thoroughly
Aggressive cleaning of the wound at each dressing change is imperative to
decrease bacterial load and minimize odor
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Cut Foam
Cut the foam to fit the size and shape of the wound, including tunnels and undermined areas
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Lay Foam in Wound
Gently place the foam into the wound cavity, covering the entire wound base and
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Cut the Drape
Cut the drape large enough to cover the foam and 3-5 cm of surrounding healthy tissue with drape.Synergy Life Solutions9/29/2014
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Applying the Drape
Apply the drape beginning on one side of the foam, toward the tubing. Do not stretch the
drape and do not compress the foam into the wound with drape. This helps minimize
tension or shearing forces on periwound tissue.
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Foam and Drape
Important: Foam should not overlap on to intact skin.
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Applying the suction tubing
Cut hole in drape about 1.5 cm and apply tubingSynergy Life Solutions9/29/2014
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Applying the suction tubing
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Connect to Canister
Connect dressing tubing to canister tubing, making sure clamps are open
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Y Connecting
A Y-connector is available to connect 2 or more wounds to one NPWT. pump
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NPWT. Canister
Canister has graduated marks to measure exudate. Change at least once per week or
when full.Synergy Life Solutions9/29/2014
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Canister with Isolyser
Canister comes with Isolyser gel that gels fluid on contact and helps eliminate odor
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Dressing in Place with Therapy OFF
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Dressing with Therapy
ON
Therapy is turned on and foam is pulled down into wound
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Adjusting NPWT. Pressure
Standard is 125 mmHg
May turn down (minimum 75 mmHg) when:
Unrelieved pain
Bruising in wound bed
Elderly and nutritionally compromised patient
Excessive bleeding
Compromised circulation (PVD)
Excessive granulation tissue growth
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Adjusting NPWT Pressure
May turn pressure up when:
Excessive drainage
Large wound volume
Using NPWT. Soft-Foam (White Form)
Difficulties maintaining a seal
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Continuous vs. Intermittent
Continuous therapy:
Always for at least first 48 hours
Maintain for length of treatment when:
Significant discomfort in intermittent mode
High amounts of exudate
Wound requires constant contraction (sternal
wounds, tunnels)
Intermittent therapy
Use to stimulate granulation tissuefaster
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NPWT. Alarms
Low pressure (leak) alarm(delayed)-Excessive Leakage
Therapy NOT ON alarm (delayed 15 minutes)
Canister full alarm
Canister out alarm
Consumable Block
Alarm delay button will temporarily delay audible alarm
If cause of alarm is not resolved within 5 minutes, unitautomatically shuts off
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Battery Back Up
NPWT. can run off an internal battery. Clips to the end of bed or IV pole.
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Infected Wounds
NPWT. can be used on infected wounds
Change dressings more often until clinical
signs of infection go away (usually 3-5 days)
Be sure to keep therapy ON
Be sure to clean wound aggressively at
dressing change
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Wound Healing : Progression
Decrease in overall wound volumeshould be noted from
week to week
Wound should become beefy red initially
Wound may look largerat beginning because of removal of
edema
May be oozing of bloodfrom disruption of capillary buds as
granulation tissue develops
Wound should become redder as granulation tissueincreases
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Wound Healing : Progression
Color of wound may then becomepaleras amount
of collagen in wound increases
Likely gradual decrease in exudatelevels
New epithelial growthshould be evident at viablewound edges
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Bridging
Practical Tips:
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Wound Wont eal
Leaks generally make whistling sounds; listen
closely for them
Check around connector and tubing first
Gentlypat around perimeterof wound to seal
off air leaks
May need to seal over drain holes
If you cant hear it, sometimes listening with
stethoscopecan pinpoint leak
Practical Tips:
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bdomen
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Exposed metal
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In Burns
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Orthopedic Trauma
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P Fl
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Post Flap
Result of
2 VAC
dressingapplication
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Case of
Trauma
Amputationwith complication
of diabetesSynergy Life Solutions9/29/2014
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Crushed Injury
Amputation
VACWOUNDTherapy applied
for 4 daysSynergy Life Solutions9/29/2014
Case of ROAD ACCIDENT
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Case of ROAD ACCIDENTHBsAg Positive
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Result of VAC application for 12 days
Initiation of VAC Post Graft
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d A id i h
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Road Accident case : with no
vessels for primary closure(results of 13days VAC application)
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A Result of 4-5
days VACapplication
StumpAmputation
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Stit h li I f ti
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Stitch line Infection
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Wound ready for secondary closure
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after 4 days VAC application
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Result of 3 days VAC application
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y pp
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Helps to stimulate granulation tissue
formationHigh drainage capacity, therefore
particularly suitable for heavy
exudating and infectious wounds
VACWOUND Black PU Foamis made of open cell, polyurethane(PU) material
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Physical characteristics prevent tissue in-growth
High tensile strength makes it easier to handle
when placing and removing from tunnels
and smaller spaces
Non-adherent
VACWOUND VersaFoamis made of a micro-porous, polyvinyl alcohol(PVA) material
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How VAC helps in Flaps & Graft
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How VAC helps in Flaps & Graft
Fixation of skin grafts (mesh-grafts)untilthe graft has taken (4-6 days). In thesespecial cases, VACWOUND Therapy is
used for the secure fixation of a split skingraft to the wound.The soft foam helpsgently press the graft onto the wound
bed and thus ensures full contactbetween the graft and the underlyingwound bed, irrespective of the woundcontours and the formation of pockets
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CONTRAINDICATIONS
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CONTRAINDICATIONS
Necrotic tissue with eschar present
Wound should be debrided to remove
majority of necrotic tissue and escharUntreated Osteomyelitis
Exposed blood vessels or organs
Ensure all vessels or underlying organs areprotected with overlying fascia, tissue or otherprotective barrier
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PRECAUTIONS
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PRECAUTIONS
Active bleeding
Difficult wound haemostasis
Patients who are on anticoagulants
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Questions?