Skill 8-8

Applying Negative-Pressure Wound Therapy

Skill Variation: Applying a Single-Use Negative-Pressure Wound Therapy System

Negative-pressure wound therapy (NPWT), also known as topical negative pressure, vacuum therapy, and vacuum-assisted closure (VAC), promotes wound healing and wound closure through the application of controlled, uniform suction (vacuum) to the wound surface (Apelqvist et al., 2017; Baranoski & Ayello, 2020; Hurd et al., 2017; Taylor et al., 2023). NPWT results in reduction in bacteria in the wound and the removal of excess wound fluid, while providing a moist wound healing environment (Taylor et al., 2023). The negative pressure results in mechanical tension on the wound tissues, stimulating cell proliferation, blood flow to wounds, and the growth of new blood vessels (Lalezari et al., 2017). NPWT also acts to pull the wound edges together. Refer to Figure 1 for an illustration of the principles of NPWT.

A wound contact material is applied to fit the contours of the wound. There are various wound contact materials, including open-cell foam dressings or fillers and open-weave gauze dressing fillers (Milne, 2015). An airtight adhesive polyurethane drape that is permeable to water vapor, transparent, and bacteria proof or thin hydrocolloid is used to seal the wound and dressing (Apelqvist et al., 2017; Baranoski & Ayello, 2020). A small hole is made in the drape and a connection pad is applied over the hole, sealing the opening, and is connected to tubing and a vacuum source (Apelqvist et al., 2017). This system prevents air from entering the system from the external environment and provides for the application of the negative pressure. Excess wound fluid, small tissue debris, and infectious materials are removed through tubing into a collection container (Apelqvist et al., 2017; Benbow, 2016). A cycle of continuous, intermittent, or variable pressure (75 to 125 mm Hg) is used, depending on the particular device, the patient's condition, the location and type of wound, type of filler material, and the amount of drainage (Apelqvist et al., 2017; EPUAP, NPIAP, & PPPIA, 2019a; Schreiber, 2016). Refer to Figure 2 for examples of components of an NPWT system.

NPWT is used in the management of complex and nonhealing wounds, including stage 3 and 4 pressure injuries as well as to prevent surgical-site infections in patients who are high risk for surgical-site infections (Baranoski & Ayello, 2020; EPUAP, NPIAP, & PPPIA, 2019a; Gantz et al., 2020; Lindsay, 2019).

There are several modifications of conventional NPWT in use as well. Instillation and dwell-time therapy (NPWTi-d) is a modification of NPWT that involves retrograde instillation of a topical solution into the sealed wound using a computer-controlled programmable therapy unit with a period of dwell, followed by removal of the solution via the negative pressure cycles (Apelqvist et al., 2017; Kanapathy et al., 2020; Ludolph et al., 2018). Solutions used include normal saline, hypochlorous acid, and antimicrobials to enhance wound irrigation and cleansing and decrease bacterial colonization on the surface of the wound, potentially contributing to decreased time taken to complete wound healing (Baranoski & Ayello, 2020; Ludolph et al., 2018). Single-use NPWTs (sNPWTs) are cannister-free, battery-powered, disposable, and portable systems. The sNPWT dressing may integrate multiple layers within the dressing, including a silicone adhesive wound contact layer, foam layer, absorbent layer, and outer film layer as well as integrated tubing and tubing port/connector pad (Lindsay, 2019; Smith & Nephew, 2018). sNPWT systems handle fluid mainly through evaporation from the outer layer of the dressing and are therefore appropriate for smaller wounds and wounds with low-to-moderate exudate levels (Banasiewicz et al., 2019) (Figure 3). sNPWTs may be used for treatment of a wide variety of wounds, such as postoperatively on closed surgical incisions to reduce surgical-site complications, chronic wounds, chronic ulcers on the lower extremities, plastic surgery wounds, and skin grafts (Banasiewicz et al., 2019; Edwards et al., 2018; Kirsner et al., 2019; Lindsay, 2019). Refer to the Skill Variation Applying a Single-Use Negative-Pressure Wound Therapy System at the end of this skill.

NPWT dressings are ideally changed based on the characteristics of the individual patient and the wound (EPUAP, NPIAP, & PPPIA, 2019a). Initial dressing changes may be necessary every 12 hours (wounds with heavy exudate) to 48 hours, then two to three times a week as indicated by the wound's response to the therapy, the manufacturer's specifications, and prescribed intervention (Baranoski & Ayello, 2020; EPUAP, NPIAP, & PPPIA, 2019a).

The following skill outlines one procedure for one example of NPWT. The Skill Variation at the end of this skill outlines the procedure for one example of sNPWT. There are many manufacturers of NPWT systems.

The nurse must be familiar with the components of and procedures related to the particular system in use for an individual patient.

Delegation Considerations

The application of NPWT is not delegated to assistive personnel (AP). Depending on the state's nurse practice act and the organization's policies and procedures, the application of NPWT may be delegated to licensed practical/vocational nurses (LPN/LVNs). The decision to delegate must be based on careful analysis of the patient's needs and circumstances as well as the qualifications of the person to whom the task is being delegated. Refer to the Delegation Guidelines in Appendix A.

Equipment

Negative pressure unit
Evacuation/collection canister (depending on specific system in use)
Wound contact material, as indicated by wound care plan and device/materials in use
Transparent adhesive drape
Connection pad/tubing port
Drainage tubing
Skin protectant/barrier wipes
Sterile gauze sponge
An 18- to 19-gauge needle/angiocath and 30- to 35-mL syringe or a commercial cleanser packaged in a pressurized container (Baranoski & Ayello, 2020, p. 152; McLain et al., 2021; WOCN, 2016)
Sterile irrigation solution as prescribed, warmed to body temperature, commonly 0.9% normal saline solution or other solution as prescribed
Waste receptacle to dispose of contaminated materials
Sterile gloves (two pairs)
Sterile scissors
Clean, disposable gloves
Gown, mask, eye protection
Additional PPE, as indicated
Sterile scissors
Waterproof pad and bath blanket

Assessment

Confirm the prescribed intervention for the application of NPWT. Check the patient's chart and question the patient about current treatments and medications that may make the application contraindicated. Assess the situation to determine the need for a dressing change. Confirm any prescribed interventions relevant to wound care and any wound care included in the plan of care. Assess the patient's level of comfort and the need for analgesics before wound care. Assess if the patient experienced any pain related to prior dressing changes and the effectiveness of interventions employed to minimize the patient's pain. Assess the current dressing to determine if it is intact. Inspect the wound and the surrounding tissue. Assess the location, appearance of the wound, stage (if appropriate), drainage, and types of tissue present in the wound. Measure the wound. Note the stage of the healing process and characteristics of any drainage. Also assess the surrounding skin for color, temperature, and edema, ecchymosis, or maceration.

Actual or Potential Health Problems and Needs

Many actual or potential health problems or issues may require the use of this skill as part of related interventions. An appropriate health problem or issue may include:

Altered skin integrity
Altered body image perception
Knowledge deficiency

Outcome Identification and Planning

The expected outcomes to achieve when applying NPWT are that the application is accomplished without contaminating the wound area, without causing trauma to the wound, and without causing the patient to experience pain or discomfort, and the device functions correctly. Other outcomes that may be appropriate include the following: the appropriate and prescribed pressure is maintained throughout therapy, and the wound exhibits progression in healing.

Implementation

Action	Rationale
1. Review the patient's health record for prescribed application of NPWT therapy, including the prescribed pressure setting for the device. Gather necessary supplies.	Reviewing the health record validates the correct patient and correct procedure. Preparation promotes efficient time management and an organized approach to the task.
2. Perform hand hygiene and put on PPE, if indicated.	Hand hygiene and PPE prevent the spread of microorganisms. PPE is required based on transmission precautions.
3. Identify the patient.	Identifying the patient ensures the right patient receives the intervention and helps prevent errors.
4. Assemble equipment on the overbed table or other surface within reach.	Organization facilitates performance of task.
5. Close the curtains around the bed and close the door to the room, if possible. Explain what you are going to do and why you are going to do it to the patient.	This ensures the patient's privacy. Explanation relieves anxiety and facilitates engagement.
6. Assess the patient for possible need for nonpharmacologic pain-reducing interventions or analgesic medication before wound care dressing change. Administer appropriate prescribed analgesic. Allow enough time for the analgesic to achieve its effectiveness before beginning the procedure.	Pain is a subjective experience influenced by past experience. Wound care and dressing changes may cause pain for some patients.
7. Adjust the bed to a comfortable working height (VHACEOSH, 2016).	Having the bed at the proper height prevents back and muscle strain.
8. Assist the patient to a comfortable position that provides easy access to the wound area. Position the patient so the cleaning/irrigation solution will flow from the clean end of the wound toward the dirty end. Expose the area and drape the patient with a bath blanket, if needed. Put a waterproof pad under the wound area.	Patient positioning and draping provide for comfort and warmth. Gravity directs the flow of liquid from the least contaminated to the most contaminated area. Waterproof pad protects the patient and the bed linens.
9. Have the disposal bag or waste receptacle within easy reach for use during the procedure.	Having a waste container handy allows for easy disposal of the soiled dressings and supplies, without the spread of microorganisms.
10. Using sterile technique, prepare a sterile field and add all the sterile supplies needed for the procedure to the field. Pour warmed, sterile irrigating solution into the sterile container, as indicated.	Proper preparation ensures that supplies are within easy reach and sterility is maintained. Warmed solution may result in less discomfort.
11. Put on a gown, mask, and eye protection.	The use of PPE is part of Standard Precautions. A gown protects your clothes from contamination if splashing should occur. Goggles protect mucous membranes of your eyes from contact with irrigant fluid.
12. If NPWT is currently in use, turn off the negative pressure unit. Consider turning off suction 5 to 10 minutes before dressing change to reduce pressure (Banasiewicz et al., 2019) Put on gloves. Loosen the tape on the old dressings by removing in the direction of hair growth and the use of a push-pull method (Fumarola et al., 2020). Push-pull method: lift a corner of the dressing away from the skin, and then gently push the skin down and away from the dressing/adhesive (Fumarola et al., 2020). Continue moving fingers of the opposite hand to support the skin as the product is removed (Fumarola et al., 2020). Once all adhesive is loosened from the skin, carefully lift dressing from the surrounding skin to prevent medical adhesive-related skin injury (MARSI). Remove the sides/edges first, then the center. If the patient is at increased risk for MARSI (see Box 8-2 in Skill 8-2), requires repeated application or removal of adhesive devices, or there is resistance, use an adhesive remover (Banasiewicz et al., 2019; Barton, 2020; Fumarola et al., 2020; Kelly-O'Flynn et al., 2020).	Reduction in pressure reduces risk of pain associated with dressing removal (Banasiewicz et al., 2019). Gloves protect the nurse from contaminated dressings and prevent the spread of microorganisms. Removal of the tape in the direction of hair growth minimizes trauma to the skin (Fumarola et al., 2020). Pushing the skin down and away from the adhesive reduces the risk for MARSI (Fumarola et al., 2020). The use of adhesive remover allows for the easy, rapid, and painless removal without the associated problems of skin stripping and helps reduce patient discomfort (Banasiewicz et al., 2019; Barton, 2020; Fumarola et al., 2020; Kelly-O'Flynn et al., 2020).
13. Carefully remove the soiled dressings. If any part of the dressing sticks to the underlying skin, use small amounts of sterile saline to help loosen and remove it.	Cautious removal of the dressing is more comfortable for the patient and ensures that any drain present is not removed. Sterile saline moistens the dressing for easier removal and minimizes damage and pain.
14. Note the presence, amount, type, color, and odor of any drainage on the dressings. Note the number of pieces of wound contact material removed from the wound. Compare with the documented number from the previous dressing change.	The presence and characteristics of drainage should be documented. All dressing materials must be removed from the wound bed during NPWT dressing changes (Baranoski & Ayello, 2020). Counting the number of pieces of wound contact material assures the removal of all foam that was placed during the previous dressing change (Schreiber, 2016).
15. Discard the dressings in the receptacle. Remove your gloves and put them in the receptacle. Perform hand hygiene.	Proper disposal of dressings and used gloves prevents the spread of microorganisms. Hand hygiene prevents the transmission of microorganisms.
16. Put on sterile gloves. Using sterile technique, clean or irrigate the wound, based on wound care plan and prescribed wound care (see Skill 8-3). Alternatively, clean gloves (clean technique) may be used when cleaning a chronic wound or pressure injury.	Aseptic technique maintains sterility of items to come in contact with wound. Cleaning and/or irrigation remove exudate and debris. Clean technique is appropriate for cleaning chronic wounds, wounds in the home, or pressure injuries (Baranoski & Ayello, 2020; EPUAP, NPIAP, & PPPIA, 2019a; Taylor et al., 2023).
17. Clean the area around the wound with normal saline or prescribed skin cleanser. Dry the surrounding skin with a sterile gauze sponge.	Cleaning of skin removes debris and aids in adherence of dressing materials. Moisture provides a medium for the growth of microorganisms.
18. Assess the wound for appearance, stage, presence of eschar, granulation tissue, epithelialization, undermining, tunneling, necrosis, sinus tract, and drainage. Assess the appearance of the surrounding tissue. Measure the wound. Refer to Fundamentals Review 8-2 and 8-3.	This information provides evidence about the wound healing process and/or the presence of infection.
19. Remove gloves and perform hand hygiene.	Hand hygiene prevents the transmission of microorganisms.
20. Put on sterile gloves. Wipe intact skin around the wound with a skin protectant/barrier wipe and allow it to dry. Alternatively, clean gloves (clean technique) may be used when cleaning a chronic wound or pressure injury.	Aseptic technique maintains sterility of items to come in contact with wound. Skin barrier/protectant prevents skin irritation and excoriation from tape, adhesives, and wound drainage (Fumarola et al., 2020; Kelly-O'Flynn et al., 2020). Clean technique is appropriate for cleaning chronic wounds, wounds in the home, or pressure injuries (Baranoski & Ayello, 2020; EPUAP, NPIAP, & PPPIA, 2019a; Taylor et al., 2023).
21. If the use of a wound contact layer (impregnated porous gauze or silicone adhesive contact layer) is indicated, use sterile scissors to cut the wound contact layer to fit the wound bed. Apply wound contact layer to the wound bed.	Impregnated porous gauze or silicone adhesive contact layer may be indicated, depending on wound filler material in use, to prevent adherence of wound filler to wound be to protect the wound bed (McNichol et al., 2022).
22. Fit the wound contact material to the shape of the wound. If using foam wound contact material, use sterile scissors to cut the foam to the shape and measurement of the wound.Do not cut foam over the wound.More than one piece of foam may be necessary if the first piece is cut too small. Carefully place the foam in the wound (Figure 4).Ensure foam-to-foam contact if more than one piece is required. Note the number of pieces of wound filler placed in the wound. Do not under- or overfill.	Wound contact material should fill the wound, but not cover intact surrounding skin. Foam fragments may fall into the wound if cutting is performed over the wound. Foam-to foam contact allows for even distribution of negative pressure. Recording the number of pieces of wound contact material aids in assuring the removal of all dressing material with next dressing change (Schreiber, 2016). Appropriate filling of wound is necessary to ensure safe and effective application of NPWT (Apelqvist et al., 2017; Schreiber, 2016).
23. Trim and place the transparent adhesive drape or hydrocolloid to cover the wound contact material and an additional 3- to 5-cm border of intact periwound tissue (Figure 5). Avoid stretching the transparent adhesive drape tight over the wound.	The occlusive air-permeable adhesive drape or hydrocolloid provides a seal, allowing the application of the negative pressure. Tight stretching of transparent adhesive drape during application may cause periwound damage (Schreiber, 2016).
24. Apply the connector pad/tubing port, if necessary, depending on the device and dressing materials in use. Choose an appropriate site to apply the connector pad/tubing port. Pinch the transparent adhesive drape and cut a hole through it (Figure 6). Apply the connector pad/tubing port and connective tubing over the hole (Figure 7). Position tubing away from the periwound area and anchor (Schreiber, 2016). Some devices, such as sNPWT, have integrated tubing, tubing port/connector pad and dressing, which do not require separate connection to the dressing. Refer to the Skill Variation: Applying a Single-Use Negative-Pressure Wound Therapy System at the end of this skill.	Position the connector pad/tubing port and tubing to avoid placement over pressure areas, bony prominences, or skin creases to avoid excess pressure on the underlying skin and tissues (Schreiber, 2016). A hole in the drape and application of connector pad/tubing port and connective tubing are necessary for the application of negative pressure and removal of fluid and/or exudate. Securing the tubing prevents accidental excessive tension on the dressing (Schreiber, 2016).
25. Attach the drainage cannister, depending on the device in use. Remove the drainage collection canister from the package and insert into the negative pressure unit until it locks into place. Attach the connective tubing to the canister and check that the clamps on the tubing are open, if present.	The tubing and canister provide means for the collection of drainage. Clamps must be open for the device to work properly.
26. Remove gloves and discard. Perform hand hygiene. Turn on the power to the negative pressure unit. Select the prescribed therapy settings (suction and cycle type) and start the device.	Removal of gloves, proper disposal, and hand hygiene prevent transmission of microorganisms.
27. Assess the dressing to ensure seal integrity. The dressing should be collapsed, shrinking to the wound contact material and skin (Figure 8). Observe drainage in tubing.	Shrinkage confirms a good seal, allowing for accurate application of pressure and treatment. Observation of drainage in device tubing ensures proper flow (Schreiber, 2016).
28. Label dressing with date and time. Remove all remaining equipment; place the patient in a comfortable position, with side rails up as indicated and bed in the lowest position.	Recording the date and time provides communication and demonstrates adherence to the care plan. Proper patient and bed positioning promotes safety and comfort.
29. Remove PPE, if used. Perform hand hygiene.	Proper removal of PPE reduces the risk for infection transmission and contamination of other items. Hand hygiene prevents the spread of microorganisms.
30. Check all wound dressings at least every shift. More frequent checks may be needed if the wound is more. Check negative pressure settings at least every shift. Assess the patient's tolerance of and response to the therapy at least every shift.	Checking dressings, the device, and patient response ensures the assessment of changes in patient condition and timely intervention to prevent complications.

Evaluation

The expected outcomes have been met when the application of NPWT was accomplished without contaminating the wound area, causing trauma to the wound, or causing the patient to experience pain or discomfort; the device functions correctly; the appropriate and prescribed pressure was maintained throughout therapy; and the wound has exhibited progression in healing.

Documentation

Guidelines

Record your assessment of the wound, including evidence of granulation tissue, stage (if appropriate), and characteristics of drainage. Include the appearance of the surrounding skin. Document the cleansing or irrigation of the wound and solution used. Document the application of the NPWT, noting the pressure setting, patency, and seal of the dressing. Describe the color and characteristics of the drainage in the collection chamber. Record pertinent patient and family/caregiver education and any patient reaction to this procedure, including the presence of pain and effectiveness or ineffectiveness of pain interventions.

Sample Documentation

Developing Clinical Reasoning and Clinical Judgment

Unexpected Situations and Associated Interventions

While assessing the patient, the nurse notes that the seal between the transparent adhesive drape and the wound contact material and skin is not tight: Check the dressing seals, tubing connections, and canister insertion, and ensure the clamps are open. If a leak in the transparent drape is identified, the appropriate pressure is not being applied to the wound. Apply additional transparent dressing to reseal. If this application does not correct the break, change the dressing.
Patient reports acute pain while NPWT is operating: Assess the patient for other symptoms, obtain vital signs, assess the wound, and assess the vacuum device for proper functioning. Report your findings to the health care team and document the event in the patient's health record. Administer analgesics, as prescribed. Continue or change the wound therapy, as prescribed. Some patients may be unable to tolerate NPWT and may require a change in the type of wound contact material used, addition of a wound contact layer, intermittent therapy cycling, a reduction in suction pressure, or discontinuation of the therapy (Apelqvist et al., 2017; Milne, 2015; Schreiber, 2016).

Special Considerations

The wound should be debrided of as much necrotic tissue as possible before using NPWT; it is best to have the wound bed free of necrotic tissue (Baranoski & Ayello, 2020).
Time dressing changes to allow for wound assessment by other members of the health care team.
Dressings may need to be changed more often than 48 to 72 hours for wounds with heavy exudate (Baranoski & Ayello, 2020; EPUAP, NPIAP, & PPPIA, 2019a).
Measure and record the amount of drainage each shift as part of the intake and output record.
Check the fluid level in the canister periodically. Depending on the particular device in use, replace the canister whenever full or nearly full.
The battery pack for sNPWT devices may contain a magnet; these devices should be kept at least 4 inches away from other medical devices to avoid disruption of nearby medical devices (Smith & Nephew, Inc., 2018; Watret et al., 2020).
Be alert for audible and visual alarms on the vacuum device to alert you to problems, such as tipping of the device greater than 45 degrees, a full collection canister, an air leak in the dressing, or dislodgment of the canister.
NPWT should operate for 24 hours a day. It should not be shut off for more than 2 hours in a 24-hour period. Remove the dressing any time therapy cannot be reestablished within the 2-hour time period (McNichol et al., 2022). When suction is lost, there is no mechanism for exudate control and allowing the dressing to remain in place without suction significantly increases the risk of wound infection (McNichol et al., 2022, p. 226). When NPWT is restarted, clean/irrigate the wound as prescribed or per facility policy and apply a new NPWT dressing.
When maceration of the surrounding skin beneath the occlusive dressing occurs, this may be treated by placing a barrier/wafer dressing beneath the transparent dressing to protect the skin. Verify with facility policy, as needed.
Approaches to NPWT continue to change, including the size of the vacuum pumps, types of wound contact materials, and length of time recommended for the use of NPWT (Benbow, 2016).
Appropriate nutritional support is critical in achieving successful wound healing and may be overlooked (Quain & Khardori, 2015). Collaborate with the registered dietician and dietary staff to develop an individualized nutrition intervention plan for the patient (Baranoski & Ayello, 2020).

Community-Based Care Considerations

NPWT can be used in outpatient and home and other community settings (Edwards et al., 2018; EPUAP, NPIAP, & PPPIA, 2019a).
Patients and caregivers must be educated about NPWT: how NPWT works, the risks and benefits of NPWT, device operation, signs of and actions for possible complications, response to alarms and emergencies, and when to seek and whom to contact for assistance (Benbow, 2016; Schreiber, 2016).

Applying a Single-Use Negative-Pressure Wound Therapy System

Single-use negative-pressure wound therapy (sNPWT) systems have a multi-layered wound dressing with integrated tubing and tubing port/connector pad (Figure 3 on p. 505). sNPWT systems are cannister-free, battery-powered, disposable, and portable. sNPWT systems manage fluid through evaporation from the outer layer of the dressing and are therefore appropriate for smaller wounds and wounds with low-to-moderate exudate levels (Banasiewicz et al., 2019). This Skill Variation outlines the general procedure for one example of sNPWT. There are many manufacturers of NPWT systems.

The nurse must be familiar with the components of and procedures related to the particular system in use for an individual patient.

Review the patient's health record for prescribed application of sNPWT. Gather the necessary supplies.
Perform hand hygiene and put on PPE, if indicated.
Identify the patient.
Assemble equipment on the overbed table or other surface within reach.
Close the curtains around the bed and close the door to the room, if possible. Explain to the patient what you are going to do and why you are going to do it.
Assess the patient for the possible need of nonpharmacologic pain-reducing interventions or analgesic medication before wound care dressing change. Administer the appropriate prescribed analgesic. Allow enough time for the analgesic to achieve its effectiveness before beginning the procedure.
Adjust the bed to a comfortable working height (VHACEOSH, 2016).
Remove the current sNPWT dressing (if present), clean the wound, and apply skin protectant as outlined in Steps 8-20 in Skill 8-8.
Remove the paper backing from the adhesive on one side of the outer film layer of the dressing. Orient and place the dressing centrally over the wound with the tubing port located uppermost from the wound (Smith & Nephew, 2018).
Remove the paper backing from the remaining edges of the outer film layer of the dressing. Smooth the dressing around the wound to prevent creasing (Smith & Nephew, 2018).
Attach the device to the dressing by twisting together the tubing connector from the device and the dressing.
Remove gloves and perform hand hygiene.
If not already in place, insert the batteries into the device.
Turn the device on to start the application of negative pressure.
Apply the fixation strips to each of the sides of the dressing to reduce the risk of the dressing edges curling.
Assess the dressing to ensure seal integrity. The dressing should be collapsed, shrinking to the wound contact material and skin.
Label the dressing with date and time. Remove all remaining equipment; place the patient in a comfortable position, with side rails up as indicated and the bed in the lowest position.
Remove PPE, if used. Perform hand hygiene.
Check all wound dressings at least every shift. Check the device display status to monitor system functioning at least every shift. Assess the patient's tolerance of and response to the therapy at least every shift.

EVIDENCE FOR PRACTICE

Negative Pressure Wound Therapy and Quality of Life

Because the skin is a sensory organ and plays a major role in communication with others and self-image, wounds and pressure injuries require emotional as well as physical adaptation. Although stress and adaptation vary greatly among people, actual and potential emotional stressors are common in all patients with wounds. Therapies related to wound care may also be a source of stress and could impact the quality of life (QoL) of the patient and caregivers.

Related Research

Janssen, A. H., Wegdam, J. A., de Vries Rellingh, T. S., Eskes, A. M., & Vermeulen, H. (2020). Negative pressure wound therapy for patients with hard-to-heal wounds: A systematic review. Journal of Wound Care, 29(4), 206-212. https://doi.org/10.12968/jowc.2020.29.4.206

This systematic review examined the effect of negative pressure wound therapy (NPWT) on QoL. Eight databases were searched from 2000 to 2019 for qualitative studies that addressed patients' experiences with NPWT in relation to QoL. The primary reason for study exclusion was that it did not focus on QoL or had a nonqualitative research design. Studies were selected by two independent reviewers and evaluated for methodologic quality using the Critical Appraisal Skills Programme (CASP) for Qualitative Research. Of the 43 studies identified, 5 matched the eligibility criteria in which 51 individual patients shared their personal experiences with NPWT. Content analysis was used to extract and define central themes in patients' personal experiences. Four major themes emerged: reduced freedom of movement caused by an electric device, decreased self-esteem, increased social and professional dependency, and gaining self-control. The authors concluded that NPWT is associated with major effects on the physical, psychological, and social domains of QoL. The researchers suggested health care professionals should be aware of the strong effects of NPWT on patient QoL and assess the ability of a patient to cope with the device and potential associated limitations as well as the possible gains in self-control. Decisions to use NPWT must be tailored to the patient and involve shared decision making with regard to use of NPWT or standard wound care.

Relevance for Nursing Practice

Using the best treatment for a wound or pressure injury is important. However, the best treatment may not produce the best patient experience, if the patient's physical, psychological, and emotional needs are not met. Nurses need to be holistic in their approach to patients receiving wound care and be aware of patient experiences related to any prescribed treatments for wounds and pressure injuries. Interventions, including patient education; support; collaboration; and a thoughtful, person-centered approach, can foster use of the best treatment choice for patients.

EVIDENCE FOR PRACTICE

Prevention of Medical Adhesive-Related Skin Injuries

Fumarola, S., Allaway, R., Callaghan, R., Collier, M., Downie, F., Geraghty, J., Kiernan, S., & Spratt, F. (2020). Overlooked and underestimated: Medical adhesive-related skin injuries. Best practice consensus document on prevention. Journal of Wound Care, 29(Suppl 3c), S1-S24. https://doi.org/10.12968/jowc.2020.29.Sup3c.S1

This consensus document is the result of a review of the literature on medical adhesive-related skin injury (MARSI) by a panel of wound care experts, educators, and researchers. This best practice guideline provides recommendations for the assessment and prevention of MARSI, with the goal of standardizing care across all health care settings.

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Skill 8-8

EVIDENCE FOR PRACTICE

EVIDENCE FOR PRACTICE