(NPWT) including Vacuum Assisted Closure (Vac) - Royal United ...

9. Wounds which may be treated with NPWT with
precautions
For the following wounds, NPWT may only be used in consultation with the TVN
and/or the patient’s consultant:
• Wounds with unstable fractures, open joints or sharp / loose fragments of bone.
• Enteric fistulae of known origin for closure (Alvarez et al. 2001).
• Wounds with exposed tendon (Heugel et al. 2002).
• Infected wounds – daily dressings may be required in conjunction with
antimicrobial wound liners and treatment with systemic antibiotics if appropriate.
• Patients who are taking anti-coagulants, have haemostasis problems or a friable
wound – seek specialist TVN advice and line the wound with a non-adherent
dressing prior to application of the foam. Paraffin tulle should never be used. The
patient’s clotting times must be monitored closely during NPWT and lower
pressures may be required.
• Wound near organs or irradiated, sutured or weakened blood vessels – seek
specialist TVN advice and protect these with at least 3 layers of a non-adherent
dressing and consider using lower pressures.
• Chronic wounds – NPWT should only be considered after an appropriate wound
management plan including modern wound dressings has failed (Azad &
Nishikawa, 2002; Joseph et al. 2000).
Discuss any queries with the TVN or the appropriate company prior to application of
NPWT.
Document name: Negative Pressure Wound Therapy (NPWT) Ref.: 745
Issue date: 10 June 2013
Status: Approved
Author: Kate Purser and Nicola Heywood Page 9 of 20