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VACUUM ASSISTED CLOSURE (V.A.C.) THERAPY: An Advanced System for Wound Healing in the Home Setting Susan E. Duffield, BSN, RN, CWOCN.

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Presentation on theme: "VACUUM ASSISTED CLOSURE (V.A.C.) THERAPY: An Advanced System for Wound Healing in the Home Setting Susan E. Duffield, BSN, RN, CWOCN."— Presentation transcript:

1 VACUUM ASSISTED CLOSURE (V.A.C.) THERAPY: An Advanced System for Wound Healing in the Home Setting Susan E. Duffield, BSN, RN, CWOCN

2 Learning Objectives Define Negative Pressure Wound Therapy (NPWT) Define Negative Pressure Wound Therapy (NPWT) Discuss guidelines for the appropriate use of NPWT Discuss guidelines for the appropriate use of NPWT Identify patients with wounds who would benefit from NPWT and patients for who this modality would be contraindicated. Identify patients with wounds who would benefit from NPWT and patients for who this modality would be contraindicated. Discuss guidelines for the application of NPWT. Discuss guidelines for the application of NPWT. Explain the basic steps in obtaining insurance reimbursement for NPWT in the home care setting. Explain the basic steps in obtaining insurance reimbursement for NPWT in the home care setting.

3 V.A.C. Therapy a.k.a. NPWT NPWT applies continuous or intermittent sub-atmospheric pressure, or suction, to the wound bed via a computerized vacuum pump attached to an open-cell foam sponge that is placed in the wound and secured with an adhesive semi-occlusive dressing. Wound fluids are evacuated via a tubing system placed on the foam at one end and connected to a disposable canister housed in the therapy unit on the opposite end. NPWT applies continuous or intermittent sub-atmospheric pressure, or suction, to the wound bed via a computerized vacuum pump attached to an open-cell foam sponge that is placed in the wound and secured with an adhesive semi-occlusive dressing. Wound fluids are evacuated via a tubing system placed on the foam at one end and connected to a disposable canister housed in the therapy unit on the opposite end.

4 The V.A.C. System Manufactured by Kinetic Concepts, Inc., San Antonio, TX. Manufactured by Kinetic Concepts, Inc., San Antonio, TX.

5 Clinical Benefits of V.A.C. Therapy Maintenance of moist, protected environment Maintenance of moist, protected environment Removal of excess interstitial fluid from the wound periphery Removal of excess interstitial fluid from the wound periphery Increased local vascularity Increased local vascularity Decreased bacterial colonization Decreased bacterial colonization Quantification/qualification of wound drainage Quantification/qualification of wound drainage Increased rate of granulation tissue formation Increased rate of granulation tissue formation Increased rate of contraction Increased rate of contraction Increased rate of epithelialization Increased rate of epithelialization

6 V.A.C. Therapy Indications Acute wounds Acute wounds Full-thickness surgical wounds Full-thickness surgical wounds Chronic wounds Chronic wounds –Stage 3 pressure ulcers –Stage 4 pressure ulcers –Diabetic ulcers –Venous stasis ulcers Traumatic wounds Traumatic wounds Dehisced wounds Dehisced wounds

7 Stage 3 Pressure Ulcer Full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to (but not through) the underlying fascia. The ulcer presents clinically as a deep crater with or without undermining adjacent tissue. Full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to (but not through) the underlying fascia. The ulcer presents clinically as a deep crater with or without undermining adjacent tissue. Kinetic Concepts, Inc.

8 Stage 4 Pressure Ulcer Full thickness skin loss with extensive destruction; tissue necrosis; or damage to muscle, bone or supporting structures (e.g. tendon, joint capsule). Note: Undermining and sinus tracts may also be associated with Stage IV pressure ulcers. Full thickness skin loss with extensive destruction; tissue necrosis; or damage to muscle, bone or supporting structures (e.g. tendon, joint capsule). Note: Undermining and sinus tracts may also be associated with Stage IV pressure ulcers. Kinetic Concepts, Inc.

9 Venous Stasis Ulcer Ulceration associated with venous hypertension Ulceration associated with venous hypertension Johns Hopkins Medical Images Johns Hopkins Medical Images

10 Diabetic Foot Ulcer Diabetics are prone to foot ulcerations due to both neurologic and vascular complications Diabetics are prone to foot ulcerations due to both neurologic and vascular complications Wound Care Information Network

11 V.A.C. Therapy Precautions Acute bleeding, patients on anticoagulants, or difficult wound homeostasis. Acute bleeding, patients on anticoagulants, or difficult wound homeostasis. Ensure all vessels are adequately protected with overlying fascia, tissue, or other protective barrier. Ensure all vessels are adequately protected with overlying fascia, tissue, or other protective barrier. Greater care should be taken with respect to weakened, irradiated, or sutured blood vessels. Greater care should be taken with respect to weakened, irradiated, or sutured blood vessels.

12 V.A.C. Therapy Contraindications Malignancy in wound Malignancy in wound Necrotic tissue with eschar Necrotic tissue with eschar Untreated osteomyelitis Untreated osteomyelitis Fistulas to organs or body cavities Fistulas to organs or body cavities Do not place V.A.C. dressing over exposed arteries or veins Do not place V.A.C. dressing over exposed arteries or veins

13 Clinical Efficacy 300 wounds treated (acute, subacute, and chronic) 300 wounds treated (acute, subacute, and chronic) 296 wounds improved with an  rate of granulation tissue formation 296 wounds improved with an  rate of granulation tissue formation Wounds were treated until completely closed, split-thickness skin graft applied, or flap rotated Wounds were treated until completely closed, split-thickness skin graft applied, or flap rotated Annals of Plastic Surgery, 1997

14 Cost Effectiveness of V.A.C. Therapy Retrospective chart review of 1032 Medicare home care patients Retrospective chart review of 1032 Medicare home care patients 61% faster healing rate 61% faster healing rate 38% less cost 38% less cost Ostomy/Wound Management, 1999

15 APN Orders for V.A.C. Therapy Location of wound Location of wound Size of foam dressing (S, M, L, XL) Size of foam dressing (S, M, L, XL) V.A.C. Therapy setting (usually 125 mm Hg continuously or intermittently 5 min on/2 min off) V.A.C. Therapy setting (usually 125 mm Hg continuously or intermittently 5 min on/2 min off) Frequency of dressing changes – usually every 48 hours Frequency of dressing changes – usually every 48 hours

16 Application of the V.A.C. Visiting Nurse Visiting Nurse Home caregivers and patients able to apply and remove V.A.C. Home caregivers and patients able to apply and remove V.A.C.

17 Dressing Application Overview Place foam in wound Place foam in wound Cover with semi- occlusive dressing Cover with semi- occlusive dressing Secure tubing Secure tubing Connect tubing to the V.A.C. therapy unit Connect tubing to the V.A.C. therapy unit

18 Operating the V.A.C. Unit Insert canister securely in unit Insert canister securely in unit Connect dressing tubing to canister tubing Connect dressing tubing to canister tubing Press power button ON Press power button ON Follow prompts Follow prompts Start therapy Start therapy Therapy should be on 24 hours each day Therapy should be on 24 hours each day

19 Alarms Therapy OFF Therapy OFF Canister is full Canister is full Air leak Air leak

20 Monitoring and Progression of Wound Healing Weekly wound measurements Weekly wound measurements Signs of healing Signs of healing –Oozing of blood as granulation occurs –Wound bed becomes redder –Gradual  in wound drainage –  in dimensions of wound Average length of treatment is 4-6 weeks Average length of treatment is 4-6 weeks

21 Ambulatory Options For the patient who is goes to work or school, a battery powered model is available. For the patient who is goes to work or school, a battery powered model is available. Wound must be minimally draining. Wound must be minimally draining.

22 Termination of V.A.C. Therapy Adequate granulation base achieved allowing for: Adequate granulation base achieved allowing for: –Changing to conventional dressing changes –Split-thickness skin graft –Flap closure

23 Reimbursement Guidelines for Home V.A.C. Therapy Medicare B Medicare B –Complete Initial Statement of Ordering Physician (ISOP) (available at www.woundvac.com) www.woundvac.com –Fax ISOP to KCI –Mail completed original ISOP to KCI Private Insurance Private Insurance –Complete above steps –Some insurers may require additional information, such as clinical notes, before issuing authorization for coverage Medicaid Medicaid –Not currently covered in NJ

24 Additional Information 1-877-WOUNDVAC 1-877-WOUNDVAC www.woundvac.com www.woundvac.com www.woundvac.com V.A.C. Recommended Guidelines for Use: Physician and Caregiver Reference Manual (Kinetic Concepts, Inc.) V.A.C. Recommended Guidelines for Use: Physician and Caregiver Reference Manual (Kinetic Concepts, Inc.)

25 Key Points Non-invasive active therapy for wound healing Non-invasive active therapy for wound healing Indicated to treat a variety of acute & chronic wounds Indicated to treat a variety of acute & chronic wounds Dressing changes every 48 hours Dressing changes every 48 hours Reimbursable under Medicare B & most private insurers Reimbursable under Medicare B & most private insurers


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