Presentation on theme: "Susan E. Duffield, BSN, RN, CWOCN"— Presentation transcript:
1Susan E. Duffield, BSN, RN, CWOCN VACUUM ASSISTED CLOSURE (V.A.C.) THERAPY: An Advanced System for Wound Healing in the Home SettingSusan E. Duffield, BSN, RN, CWOCN
2Learning Objectives Define Negative Pressure Wound Therapy (NPWT) Discuss guidelines for the appropriate use of NPWTIdentify patients with wounds who would benefit from NPWT and patients for who this modality would be contraindicated.Discuss guidelines for the application of NPWT.Explain the basic steps in obtaining insurance reimbursement for NPWT in the home care setting.
3V.A.C. Therapy a.k.a. NPWTNPWT 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.
4The V.A.C. SystemManufactured by Kinetic Concepts, Inc., San Antonio, TX.
5Clinical Benefits of V.A.C. Therapy Maintenance of moist, protected environmentRemoval of excess interstitial fluid from the wound peripheryIncreased local vascularityDecreased bacterial colonizationQuantification/qualification of wound drainageIncreased rate of granulation tissue formationIncreased rate of contractionIncreased rate of epithelialization
7Stage 3 Pressure UlcerFull 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.
8Stage 4 Pressure UlcerFull 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.
9Venous Stasis Ulcer Ulceration associated with venous hypertension Johns Hopkins Medical Images
10Diabetic Foot UlcerDiabetics are prone to foot ulcerations due to both neurologic and vascular complicationsWound Care Information Network
11V.A.C. Therapy Precautions Acute bleeding, patients on anticoagulants, or difficult wound homeostasis.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.
12V.A.C. Therapy Contraindications Malignancy in woundNecrotic tissue with escharUntreated osteomyelitisFistulas to organs or body cavitiesDo not place V.A.C. dressing over exposed arteries or veins
13Clinical Efficacy 300 wounds treated (acute, subacute, and chronic) 296 wounds improved with an rate of granulation tissue formationWounds were treated until completely closed, split-thickness skin graft applied, or flap rotatedAnnals of Plastic Surgery, 1997
14Cost Effectiveness of V.A.C. Therapy Retrospective chart review of 1032 Medicare home care patients61% faster healing rate38% less costOstomy/Wound Management, 1999
15APN Orders for V.A.C. Therapy Location of woundSize 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)Frequency of dressing changes – usually every 48 hours
16Application of the V.A.C. Visiting Nurse Home caregivers and patients able to apply and remove V.A.C.
17Dressing Application Overview Place foam in woundCover with semi-occlusive dressingSecure tubingConnect tubing to the V.A.C. therapy unit
18Operating the V.A.C. Unit Insert canister securely in unit Connect dressing tubing to canister tubingPress power button ONFollow promptsStart therapyTherapy should be on 24 hours each day
20Monitoring and Progression of Wound Healing Weekly wound measurementsSigns of healingOozing of blood as granulation occursWound bed becomes redderGradual in wound drainage in dimensions of woundAverage length of treatment is 4-6 weeks
21Ambulatory OptionsFor the patient who is goes to work or school, a battery powered model is available.Wound must be minimally draining.
22Termination of V.A.C. Therapy Adequate granulation base achieved allowing for:Changing to conventional dressing changesSplit-thickness skin graftFlap closure
23Reimbursement Guidelines for Home V.A.C. Therapy Medicare BComplete Initial Statement of Ordering Physician (ISOP) (available atFax ISOP to KCIMail completed original ISOP to KCIPrivate InsuranceComplete above stepsSome insurers may require additional information, such as clinical notes, before issuing authorization for coverageMedicaidNot currently covered in NJ
24Additional Information 1-877-WOUNDVACV.A.C. Recommended Guidelines for Use: Physician and Caregiver Reference Manual (Kinetic Concepts, Inc.)
25Key Points Non-invasive active therapy for wound healing Indicated to treat a variety of acute & chronic woundsDressing changes every 48 hoursReimbursable under Medicare B & most private insurers