Use of negative pressure wound therapy with instillation and a reticulated open cell foam dressing with through holes in the acute care setting

Abstract

Negative pressure wound therapy with instillation and dwell time (NPWTi-d) is an automated system used to deliver, dwell, and remove topical solutions from the wound bed. Recently, a reticulated open cell foam dressing with through holes (ROCF-CC) was developed, which assists with wound cleansing by removing thick exudate and infectious materials. We present our experience using NPWTi-d with ROCF-CC on complex wounds when complete surgical debridement was inappropriate because of medical instability, recurrent non-viable tissue, or palliative treatment plan. For all wounds, NPWTi-d with ROCF-CC was initiated by instilling normal saline, acetic acid, or hypochlorous acid with 2 to 10 minutes of dwell time, followed by 0.5 to 4 hours of negative pressure. Dressings were changed every 2 to 3 days. Fourteen patients with multiple comorbidities were treated for wound types including diabetic foot ulcers, necrotising fasciitis, dehisced wounds, and pressure injuries. Duration of NPWTi-d with ROCF-CC ranged from 1 to 15 days, and at dressing changes, wounds showed improved granulation tissue formation, less malodour, less surrounding erythema, and demarcation of healthy skin from devitalised tissue. Based on these patients, adjunctive use of NPWTi-d with ROCF-CC provided a practical option for improving tissue quality in wounds for patients in whom surgical debridement was not possible or desired.

Keywords: advanced practice nursing; negative pressure wound therapy; wound healing.

Figure 1

Placement of reticulated open cell foam dressing with through holes (ROCF‐CC) dressings for negative pressure wound therapy with instillation and dwell time (NPWTi‐d). A, Abdominal wound at presentation; B, application of the ROCF‐CC contact layer; C, application of cover layer; D, initiation of NPWTi‐d

Figure 2

Wound‐healing progression in three different complex wounds. Wound bed preparation outcomes following 5–7 days of negative pressure wound therapy with instillation and dwell time (NPWTi‐d) with reticulated open cell foam dressing with through holes (ROCF‐CC) dressing. A, Abdominal surgical dehiscence wound on Day 0 and Day 7; B, wound with necrotising fasciitis on Day 0 and Day 5; C, upper thigh wound with devitalised tissue on Day 0 and Day 6

Figure 3

Management of a midline sternal wound. A, Sternal wound after incision and drainage; B, wound after 4 days of negative pressure wound therapy with instillation and dwell time (NPWTi‐d) with reticulated open cell foam dressing with through holes (ROCF‐CC); C, wound after 6 days of continued treatment before debridement; D, wound after 6 days of NPWTi‐d with ROCF‐CC after debridement; E, wound after 11 days of NPWTi‐d with ROCF‐CC; F, wound after 15 days of NPWTi‐d with ROCF‐CC, prior to discharge to long‐term acute care hospital

Figure 4

Using a foam bridge to offset placement of instillation tube. A, Initial placement of instillation tube directly over a sacral pressure injury; B, application of a foam bridge to place tubing on an area less prone to device‐associated pressure injury; and C, placement of the two‐pad tubing set. The vacuum tube (white arrow) is placed away from bony prominences, and the instillation tube (black arrow) is placed at the wound site