Introduction: James is a healthy 32 year old gentleman, who is active and cognitively intact the latter contributes to his ability to manage this therapy at home. James along with professional support will monitor his wound care to achieve a healed wound.
The immediate benefits of this choice in wound care are the facilitation of his early discharge from hospital and the VIC therapy will assist in the promotion of blood supply to the wound bed allowing for formation of granulation tissue . Using this system will allow him to continue working due to the portability of the system.James will be able to maintain his socially active lifestyle with some limitations. “There is a substantial body of clinical and economic evidence supporting INPUT in wound management, including early discharge and faster healing, fewer readmission and better patients’ Quality of life” (Ottoman, 2012) With pre discharge education regarding this system and ongoing support from trained staff the VIC system will ensure optimum benefits are achieved. The final outcome and goal to be achieved is a healed wound in a reduced timeshare.
The VIC dressing would remain in place or 3- 7 days depending on the exudates present and the adherence of the dressing. This allows for longer times between dressing changes. James will play an active part in his care by monitoring the site regularly in partnership with the community nursing services. The wound care and his wellbeing will be assessed regularly. A holistic assessment on commencement of the therapy and regular ongoing assessments during its use will ensure James receives and optimum level of care based on evidence based practice. INPUT is Negative pressure wound therapy it sees a vacuum dressing to boost and promote wound healing in acute and chronic wounds. “Negative pressure (suction) is applied to the wound bed through a foam or gauze contact medium using an electrically, battery or mechanically powered pump; this involves achieving an airtight, vacuum, seal.
” (Guy & Groggier, 2012) Subsequently, James was referred to a plastic surgeon for reconstructive surgery. The surgeon performed a instantaneous rotation flap using muscle and tissue from nearby areas.Postoperatively, the surgeon opted to used negative pressure wound therapy (TINT) using a VIC system. Indications for use for James, As Sesame’s wound site is unable to be closed surgically the negative wound pressure therapy will promote and expedite his healing, it allows for increases in local blood flow, reduction in edema, stimulates the formation of granulation tissue, stimulates cell proliferation and removes soluble healing inhibitors from the wound, “provide elective local infection control”. (Richer , Avowed , Warner & Jёregimens B. 2012) as this is a closed system. It also allows for wound edges to be drawn closer together.
Discuss advantages particularly for postoperative incision management . In Sesame’s case the non closure f his wound. * negative pressure wound therapy has economic benefits in acute wound care these benefits include the economic impact of delayed wound healing on the national health budget. * this system will allow James to continue to work and remain socially active enabling him to achieve a positive influence on is quality of life.Sesame’s age makes this system suitable for at home use and with support of the visiting home care service this should prove successful in treating his current wound.
Disadvantages for its use * “Possible disadvantages of INPUT include some pain sensation on treatment, a sis of developing pressure ulcers in the areas treated, and the relative expense of the treatment, particularly over a short time frame” (Seizes, 2011) * “This survey confirms that pain is a major problem in wound management, irrespective of the etiology of the wound, or whether it is acute or chronic.All patients should be considered for appropriate analgesia during wound treatment. ” (Umea, S et al, 2004) * “The rational selection of adequate dressings should be vigorously promoted through active educational programmer for healthcare professionals and, perhaps, for patients themselves. ” (Umea, S et al, 2004) Are there any precautions or contraindications to its use with James?Precautions: * for negative pressure wound therapy to be successful, constant monitoring of the equipment must occur noting that the seal is not broken or leaking, the tubing is free from kinks, the drainage is checked and present and the container is changed when required. Observation of the wound and the dressing site must occur regularly.
* an important factor also to consider is that there is a sufficient pain regime in place. Contraindications * if slough develops, debarring of the area would be required before continuing INPUT. He presence of exposed frail structures: exposed blood vessels, delicate fascia, exposed tendons or ligaments (direct negative pressure may cause trauma and bleeding) Use of intermittent pressure therapy : * intermittent pressure therapy has been noted to lead to the rapid formation of granulation tissue leading to improved healing but pain can be an issue which has been noted to compromise the effect of treatment the pain occurs resultant from the sudden changes in pressure, “when going from sub atmospheric to atmospheric pressure. (Mammals , Gustafson, Landslide, Selling, ; Imaginations, 2012) * hen the negative pressure is repeatedly switched on and off it can cause pain this occurs when the foam used with this therapy expands and contracts over the granulation tissue.
” We propose that the INPUT mode be tailored to the individual wound for optimal effects. This increases tissue perfusion, by inactivating capillary auto regulation (whereby capillaries are shut down if high blood flow is not needed.Allows the proliferating cells time to rest between cycles of cell division, which is negative pressure may switch off the mitotic (nuclear division) process. ” (European Wound Management Association 2007). Use of continuous negative pressure therapy.
* a strong and growing number of studies have found that intermittent negative therapy increases blood flow to the wound site more effectively than continuous negative pressure and that proliferation of new granulation tissue is significantly higher (63. 4%) over continuous negative pressure. Low levels of Continuous Pressure recommended in recent research indicates that lower pressure may be beneficial especially in soft tissue to minimize chimera in the hypo perfuse zone surrounding the wound edge. Research done at the Lund University Medical Center commends levels of -might for soft tissue and slightly higher for muscle tissue.
Skin preparation, * it is essential to ensure that foam and or gauze does not come into contact with intact skin and that surrounding skin is lined with film dressing.If foam needs to extend onto it, “for example with small wounds or when bridging more than one between the pieces. ” (Guy ; Groggier, 2012) An airtight seal is created using film dressing “The whole system is reliant on there being an effective seal around the dressing and this is achieved using the VIC semi-permeable film drape. ( Baxter, 2001) Preventing pressure injury, * drains must be secured at the exit point s of the dressing to help obtain a seal and to prevent skin damage due to pressure at these point of exit.Discontinuing therapy: * INPUT should be discontinued when the goal of treatment has been achieved. (Bonham) * other reasons to discontinue treatment include when exudates is reduced, “less than 15% wound volume production over a two week period and when uniform granulation tissue and little depth to the wound is present ” (Henderson, Tensions, Hurt, Odder, Maloney & Saba , 2010) * the therapy is to being tolerated when the patient is experiencing continuous intense pain and in the presence of extreme bleeding. Other possible ongoing issues.
* Infection. Deterioration of the wound base, surrounding skin and maceration of wound margin leading to wound breakdown. * localized skin irritation. * non-concordance related to excessive ongoing pain with use of INPUT .
“It is also important to recognize that emotional components, including anxiety and previous experience, can compound a person’s perception of pain and may negatively affect the patient/practitioner relationship” (Hollingsworth, 2005) Conclusion In Sesame’s case negative pressure wound therapy will allow him freedom to be at home and to maintain his social and work life balance.