Nursing Paper on Negative Pressure Wound Therapy

Negative Pressure Wound Therapy

Introduction

Chronic wounds are types of wounds that fail to advance with the normal healing process (Rhee et al., 2015). Different kinds of chronic wounds affect several people across the globe, which create a burden upon the nurses and other players in the healthcare system. For instance, in the United States, public spending on the chronic wounds in healthcare alone has been approximated to be $25 billion dollars per annum (Armstrong et al., 2012). Chronic wounds affect different people in diverse degrees of severity and different therapies have been established to enhance the healing of these kinds of wounds affecting people. This paper focuses on Negative Pressure Wound Therapy and the role of Wound Ostomy Continence Nurse.

Different types of treatment options have been developed to enhance the healing of acute and chronic wounds. These alternatives include moist wound healing (MWH) dressings among others. Negative pressure wound therapy (NPWT) entails a treatment modality that is medically recognized as one of the successful approaches used in managing chronic wounds among patients. NPWT involves a process in which negative pressure is applied across a wound. This technology is traced back in the 1980s, which encompasses a dressing application that is in foam on the wound (Bollero et al., 2010). This is then connected to a vacuum pump through a tubing. Therefore, the area around the wound is sealed off with a paste film to allow the pump to deliver a controlled negative pressure on the wound. The main aim of NPWT is to enhance wound healing, stimulate wound bed granulation, and offer a bridge to surgical closure. Different names have been associated with negative pressure, for instance, vacuum assisted closure, vacuum sealing technique, and sealed service wound suction among others. Currently, NWPT has three main components. These are a suitable wound filler, an evacuation tube, and a semipermeable film dressing, which covers the wound and forms an airtight seal.

Negative pressure has currently turned out to be one of the recognized approaches to wound care therapy. This is largely attributed to the work of Morykwas and Argenta back in the year 1997. Many healthcare facilities today apply the therapy on treating wounded patients. According to literature, Morykwas and Argenta initially performed different research works associated with NPWT. Between the year 1986 and 1998, the Russian Medical Journal published different articles about the use and application of PPWT (Bollero et al., 2010). Different other studies were also put forth regarding an active wound care therapy different from the initial wound dressing.

Negative Pressure Wound Therapy Process

Generally, wound healing is a process that requires moisture balance (Bollero et al., 2010). The uncovered cells of a wound surface require part of the surface humidity, which is important for viability. In as much as few amounts of moisture on a wound can cause the death of the cell, a lot of moisture, on the other hand, can enhance drenching and harm the edges of the wound. Therefore, this requires that a balance of moisture need to be maintained in order to avoid any of the two extremes that can cause a delay in the normal healing process of the wound. Moreover, the volume and composition of a wound discharges have a strong effect on the moisture level around the wound bed and consequently on the healing process of the wound. In the process of irritation or inflammation, the wound exudation is likely to increase as a result of the changes in the vessel perviousness and movement of the irritated cells. Nevertheless, moderate wound exudation enhances the healing process of the wound by providing the moisture, nutrients, and other growth components that are significant for healing. When the wounds turn out to be slowly responding to the healing process, they become chronic. This makes the composition of the wound exudate to be characterized by high levels of oxidative enzymes, cytokines, and proteases, which obstruct the healing process.

Normally, in a healthy and immunocompetent person, a normal wound naturally heals with time in an orderly manner. Nevertheless, if complications are present, for instance, if the patients have other medical conditions, the healing ability of the wound is likely to stall. There are several reasons under this state that may cause the wound to deviate from the normal healing process. These include the following:

  • Insufficient blood supply
  • Deprived tissue perfusion
  • Untreated deep infection
  • Existence of a foreign element in the wound, for example, retained stitch

All these factors are responsible for inhibiting the normal healing process of the wound through constraining the granulation growth of tissue in the wound (Bollero et al., 2010). Chronic wound fluid also encompasses high levels of Pro-seditious cytokines that obstruct the healing process by prompting sustained inflammation.

Optimization of the Wound Healing Process and the Role of Wound Ostomy Continence Nurse

A wound ostomy continence nurse (WOCN) is a professional nurse that supports healthcare practice through professional nursing to individuals with wounds, ostomies, and incontinence. The nurse possesses specialized knowledge, skills, and expertise required in this field. In the process of wound healing, one of the roles played by the WOCN is the optimization of the patient’s health status. This is a significant process in the wound healing therapy, as it helps in achieving the desired goals. The process involves the preparation of the patient through identifying all factors that can hinder the healing process of the wound, for instance, diseases, tissue perfusion, and the general metabolism.

Secondly, the WOCN assists in handling the causes of the wound. Wound management cannot be undertaken successfully without identifying and treating the causes of the wound. For instance, moderate wounds are normally a consequent of trauma, infections, or surgical procedures. Nevertheless, chronic wounds result from factors, such as pressure ulcers, diabetic foot ulcers (DFUs) or venous and arterial leg ulcers, which are more complex, especially in healing. All these causes and other factors should be addressed by WOCN in order to maximize the healing process and prevent further reoccurrence of the wound. Generally, chronic pressures and friction can result in tissue injury to patients with a wound, which can lead to the development of diabetic foot ulcers and pressure ulcers. This process is most prevalent to diabetic patients and immobile persons. Therefore, for the wound healing therapy process to be successful, WOCN need to ensure that these mechanical processes are controlled through repositioning of the patients to minimize frictions and shears.

The function of a wound ostomy continence nurse in negative pressure wound therapy also involves optimization of the wound bed and the confined wound surroundings. These facets provide the nurses and other healthcare practitioners an opportunity to prevent any barriers that may hinder the healing process. An effective environment plays a significant role in the healing of the wound by triggering the growth of the new tissue and wound closure.

Addressing the concerns of the wounded patients is another role played by WOCN in wound therapy. Normally, chronic wounds are painful, an aspect that affects the patient’s quality of life. Wounds can also inhibit the life of an individual by restricting mobility and disrupting the normal life, work, and ability to learn and perform other activities. Consequently, this process can lead to development of depression and anxiousness (Bollero et al., 2010). Furthermore, persistent enervating pain among patients can also impact their medical processes, especially compliance with the treatment plan, which affects the wound healing process. In recognizing these factors, the nurses play a significant role in wound therapy by offering effective pain management remedies, such as oral analgesics. The nurses perform an important task in minimizing the distress encountered by the patients as a result of the wounds, which fosters the healing process. They also engage in encouraging and empowering patients to be actively involved in the treatment decisions that have a positive impact on them.

Understanding the Role of Negative Pressure Wound Therapy

Negative pressure wound therapy augments the capacity of the endogenous reparation mechanisms that heal all kinds of wounds. Nevertheless, NPWT is commonly advisable for deep rooted, cavity and fully thick wounds among patients.  NPWT helps in the healing process of deep wounds by triggering an enhanced rate of formation of new tissues that fill up the wound bed. This process ensures that healing takes place whereby a wound is surgically closed and reconstructed. Currently, there are different dressings, which serve as the border between the sub atmospheric pressure and the wound bed. The dressings include the foam, gauze, and micro domed polyester.

The healing process involved in NPWT is constructed on the fact that even a negative pressure applies three-dimensional motorized stress on the wound bed. This stress is thereafter transferred down to the cellular and the cytoskeletal levels that activate cell recruitment and multiplication. Consequently, the growth of the granulation tissue is also stirred to enhance the process of wound healing in a swifter pace as compared to other moist wound healing dressing processes (Amamath et al., 2014).

NPWT also triggers angiogenesis and increased flow of blood near the edges of the wound. This enhances the availability of oxygen and other nutrients that are significant in tissue regeneration. The use of negative pressure in wound therapy is also important in eliminating wound exudate and other infectious components that result in the reduction of bioburden and subsequently control the chances of narrowing the microvasculature. The negative pressure also eliminates pro-inflammatory cytokines thereby transforming the composition of wound exudate, which ensures a conducive environment for the healing of the wound. NPWT enhances the rate of granulation tissue formation and reduces the period for the closure of the wound (Amamath et al., 2014). This therapy has, therefore, been effective in ensuring a closure of deep wounds and wound bed healing before the real skin reconstruction.

Use of Negative Pressure Wound Therapy

Initially, negative pressure wound therapy was applied to wounds that did not respond to traditional or advanced wound care management. NPWT is also currently applied to deep cavity wounds that have high levels of exudates. It is an effective approach in managing several acute wounds, for instance, skin grafts, transferring injuries, and stomach wounds (Green, 2012).

NPWT is also applied to traumatic wounds because the therapy is effective in a sealed environment thereby controlling any further contamination and enhancing adequate perfusion around the wound. Furthermore, NPWT is commonly applied in traumatic wounds, particularly for devolving lesions as a way of preparing the wound bed for prolonged primary closure. In grade 3 and grade 4 pressure ulcers management, NPWT has been effectively applied, particularly in those that have been debrided (Green, 2012). This is because the therapy enhances the period for closure to promote quick formation of granulation tissue in wounds. For diabetic and neuropathic ulcers, NWPT allows for eradication of excess exudates, which reduces the grafting of the skin. This also minimizes the risk of contamination, providing conditions that support healing.

Therefore, NPWT mechanisms have been able to assist in wound healing in different ways. These contrivances of action involve eliminating excess fluid and enhancing the flow to the wound bed (Perry et al., 2015). The NPWT also decreases infective load on the wound surface, offers a motorized upshot that promotes healing of the wound, and stimulates cell propagation and amalgamation (Rhee et al., 2015). Finally, the therapy also upsurges the degree of angiogenic and triggers cytokines as well as endothelial cell mobilization.

Nevertheless, with these probable benefits, there are also negative side effects that are associated with NPWT. The common side effects of NPWT include soreness, retaining foreign bodies as a result of the dressing in the body, bleeding, contaminations, demise as a consequent of the infection or bleeding, and impediments emanating from power failures, which has an effect on unrecognized disruption of therapy. In the United States, for instance, the U.S. Food and Drug Administration (FDA) was concerned about NPWT systems safety in 2001 and went ahead to provide a safety announcement concerning stern complications of the process (Rhee et al., 2015). According to the FDA, several injuries and casualties were reported as a result of NPWT, especially the happenings within home settings. The most prevalent side effects of the process were infections. Conversely, bleeding represented the most austere adverse effect since it led to a substantive amount of injury and death. Consequently, the FDA offered guidelines concerning patient assortment, nursing, and the risk elements that should be put in place by medical practitioners before beginning the therapy process. Additionally, the body organ recommended edification of the patients and caregivers to enhance secure nursing care, especially for home setting therapies.

Conclusion

Wound care health practitioners have several ways and approaches of providing treatment to manage and assist in healing acute and chronic wounds among patients. The biggest challenge among these practitioners is establishing the most suitable management approach at the same time considering different components of the wound, the specific patient, and other factors like the cost of care. The benefits of handling wounds through applying NPWT and their side effects have been clearly analyzed and established. Generally, many people with both acute and chronic wounds prefer negative pressure wound therapy treatment. This is because the NPWT therapy has been acknowledged as the most suitable for the different types of acute and chronic wounds.

 

References

Amarnath, S., Reddy, M. R., Rao, C. H., & Surath, H. V. (2014). Timer switch to convert suction apparatus for negative pressure wound therapy application. Indian Journal of Plastic Surgery47(3), 412.

Armstrong, D. G., Marston, W. A., Reyzelman, A. M., & Kirsner, R. S. (2012). Comparative effectiveness of mechanically and electrically powered negative pressure wound therapy devices: a multicenter randomized controlled trial. Wound Repair and Regeneration20(3), 332-341.

Bollero, D., Driver, V., Glat, P., Gupta, S., Lazaro-Martinez, J. L., Lyder, C., … & Woo, K. (2010). The role of negative pressure wound therapy in the spectrum of wound healing. Ostomy Wound Manage56(5 Suppl), 1-18.

Green, B. (2012). Taking a closer look at what we understand about negative pressure wound therapy. Wound Healing Southern Africa7(1), 13-16.

Perry, K. L., Rutherford, L., Sajik, D. M., & Bruce, M. (2015). A preliminary study of the effect of closed incision management with negative pressure wound therapy over high-risk incisions. BMC veterinary research11(1), 1.

Rhee, S. M., Valle, M. F., Wilson, L. M., Lazarus, G., Zenilman, J. M., & Robinson, K. A. (2015). Negative pressure wound therapy technologies for chronic wound care in the home setting: A systematic review. Wound Repair and Regeneration23(4), 506-517.