Contra Indications / Precautions to NPWT Therapy Contraindications Malignancy in wound (known or suspected): When mechanical stretch is applied to normal cells, it results in increased proliferation. However, biologically, cancerous cells are often not anchored and do not respond to the same stimuli as healthy cells, thereby rendering negative pressure ineffective. Fistula of unknown origin: To avoid sealing unexplored cavity. The base of the wound must be established to avoid damage to any unknown organs or vessels. Exposed arteries or veins: Potential to cause damage to vessels. Necrotic tissue with eschar: Negative pressure effects cannot be achieved at wound bed if covered with slough or necrotic tissue. Wound would require debriding prior to assessment for NPWT therapy Untreated Osteomyelitis: Necrotic bone requires removing prior to NPWT therapy to reduce incidence of future occurrence. Osteomyelitis must be treated 2 weeks prior to NPWT therapy commencement. Active bleeding: Cause of bleeding must be established and treated prior to TNP therapy Precautions To avoid active bleeding caution should be taken for patients with: Difficult wound haemostasis Patients on anticoagulation therapy NPWT dressing in close proximity to blood vessels or organs. Weakened, irradiated or sutured blood vessels or organs In the presence of bone fragments or sharp edges. Patients who do not have adequate tissue coverage over vascular structures (Gupta et al 2004, KCI Medical 2007) Training Training in the use of NPWT will be delivered in practice to clinicians who are managing this group of patients. Training will be delivered by the Skin Care Service in conjunction with other competent clinicians and the system manufacturer. Equality Analysis This has been undertaken and the evidence has been retained by the authors and the Equality and Diversity Lead of LCH
Contra Indications / Precautions to NPWT Therapy Contraindications Malignancy in wound (known or suspected): When mechanical stretch is applied to normal cells, it results in increased proliferation. However, biologically, cancerous cells are often not anchored and do not respond to the same stimuli as healthy cells, thereby rendering negative pressure ineffective. Fistula of unknown origin: To avoid sealing unexplored cavity. The base of the wound must be established to avoid damage to any unknown organs or vessels. Exposed arteries or veins: Potential to cause damage to vessels. Necrotic tissue with eschar: Negative pressure effects cannot be achieved at wound bed if covered with slough or necrotic tissue. Wound would require debriding prior to assessment for NPWT therapy Untreated Osteomyelitis: Necrotic bone requires removing prior to NPWT therapy to reduce incidence of future occurrence. Osteomyelitis must be treated 2 weeks prior to NPWT therapy commencement. Active bleeding: Cause of bleeding must be established and treated prior to TNP therapy Precautions To avoid active bleeding caution should be taken for patients with: Difficult wound haemostasis Patients on anticoagulation therapy NPWT dressing in close proximity to blood vessels or organs. Weakened, irradiated or sutured blood vessels or organs In the presence of bone fragments or sharp edges. Patients who do not have adequate tissue coverage over vascular structures (Gupta et al 2004, KCI Medical 2007) Training Training in the use of NPWT will be delivered in practice to clinicians who are managing this group of patients. Training will be delivered by the Skin Care Service in conjunction with other competent clinicians and the system manufacturer. Equality Analysis This has been undertaken and the evidence has been retained by the authors and the Equality and Diversity Lead of LCH