About the Negative Pressure Wound Therapy (NPWT) Process

Negative pressure wound therapy (NPWT) is a medical procedure that uses a vacuum, tubing and dressing to treat a wide variety of burns, acute, chronic and complex wounds. The vacuum, or “wound vac” control unit, is connected to the wound via tubing and a clean dressing that pulls fluid away from the open wound and protects the area from infection.

In this post, we’ll look at the types of wounds NPWT is used for and briefly describe the process.


Uses for NPWT

As described in our recent post on wounds and wound healing, NPWT can be used to help treat and heal:

• Diabetic ulcers

• Bedsores (also known as pressure ulcers)

• First- and second-degree burns

• Trauma and gunshot wounds

• Surgical wounds, especially those with a high risk of infection

• Other complex wounds with large amounts of drainage

Negative pressure therapy is often used in hospitals and clinics but can also be used in homes by visiting home health care providers.

The NPWT process has become increasingly popular over the past 20 years, in part because it is non-invasive, can be administered in many settings and provides just the right amount of moisture necessary for healing while also protecting wounds from outside contaminants, such as dirt and bacteria.

The Process

After cleaning (a process also known as debridement), a sterile, open-cell foam or gauze is cut to fit the size of the wound and packed into the opening. Next, the wound is covered with a clear, thin dressing that creates an airtight seal around the wound.

A vacuum pump, or control unit, is attached to the dressing with tubing, which pulls fluid and dead tissue away from the wound and into a collection canister. The vacuum can be adjusted to regulate the strength of the suction (from -125 to -75 mmHg, depending on the patient and the wound being treated) and the length of time.

Dressings must be changed regularly during treatment. Removal and changing of dressings is usually pain-free and minimizes damage to any new skin forming around the healing wound; however, patients can experience varying of levels of pain during NPWT, depending on the location and type of wound, so pain medications are often used alongside this therapy.
 

Important considerations

Negative pressure therapy can be a highly effective, efficient and economical way of treating complex and chronic wounds IF:

• Healthcare providers are properly trained on procedures and use of all equipment

• The wound is routinely checked for any signs of infection or change

• The dressing around the wound remains clean and is regularly changed

• The drainage tubes are connected properly to the collection canister

• Drainage is flowing correctly into the canister (e.g., the tubes are not clogged, bent or blocked in any way) and the negative pressure seal is intact

• The collection canister is monitored and changed regularly
  

For more information about negative pressure wound therapy and continuing education courses on NPWT for healthcare and insurance professionals, please contact The Wound Vac Company.

Copy of Lidocaine and Wound Management

The Use of Lidocaine in Managing Wounds

by Aletha Tippett, MD

What is Lidocaine?

Aletha Tippett, MD

Lidocaine is typically used to reduce sensation in tissue in a specific area. Lidocaine can be either injected or applied topically, depending on need. This topical anesthetic is popular because of its low cost and minimal side effects. Once applied, lidocaine typically takes about four minutes to begin affecting sensation, and effects can last for between a half hour and three hours, depending on dosage. One of the main benefits of lidocaine is its rapid onset of action; while stronger or longer-acting substances may be preferred for surgical procedures, lidocaine’s fast-acting nature makes it perfect for reducing pain in a wound.

Lidocaine has been my go-to product for wound care for over 20 years. I always use viscous lidocaine applied to any dressing. A patient might need systemic pain relief also, but the application of topical lidocaine is very effective to help alleviate local pain of wounds. Since I have used lidocaine so long for thousands of wounds I can say it definitely helps the healing of wounds. Having a nearly 100% healing rate speaks to that.

The newest thing that I found out about lidocaine was recently published in Wounds regarding lidocaine's bacteriostatic properties. A study was conducted with surgical wounds, some had lidocaine applied, others had saline applied. The post-surgical infection rate with the lidocaine wounds was much less than the wounds with saline application. This tells me why I rarely had wound infections in all the years treating wounds with lidocaine.

Tips for the Application of Lidocaine

To use lidocaine to treat pain in a wound, just apply a small amount, about 1-2 grams, of oral viscous lidocaine to the dressing. then apply this side to the wound. Because of its viscous nature, lidocaine can be used on any type of dressing. Apply the side of the dressing with the lidocaine to the wound. The affects should begin within a few minutes, providing pain relief to your patient. Change daily or as needed and provide further systemic pain relief if necessary.

So, if you have not used lidocaine for wound care, consider starting to use it. You will be very happy with the outcome.

Note: Aletha Tippett, MD, is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, a family physician, and international speaker on wound care.  This article was originally published as part of the WoundSource Trending Topics series; permission for its use on this blog was provided by the author. 
 

References

1. Lidocaine Hydrochloride (Local)". The American Society of Health-System Pharmacists. Archived from the original on 2015-09-06. Retrieved Aug 26, 2015.
2. WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Archived (PDF) from the original on 13 December 2016. Retrieved 8 December 2016.
3. "Lidocaine HCL". International Drug Price Indicator Guide. Retrieved 27 August 2015.
4. J. P. Nolan & P. J. F. Baskett (1997). "Analgesia and anaesthesia". In David Skinner, Andrew Swain, Rodney Peyton & Colin Robertson. Cambridge Textbook of Accident and Emergency Medicine. Project co-ordinator, Fiona Whinster. Cambridge, UK: Cambridge University Press. p. 194. ISBN 9780521433792. Archivedfrom the original on 2017-09-08.

Lidocaine and Wound Management

The Use of Lidocaine in Managing Wounds

by Aletha Tippett, MD

What is Lidocaine?

Aletha Tippett, MD

Lidocaine is typically used to reduce sensation in tissue in a specific area. Lidocaine can be either injected or applied topically, depending on need. This topical anesthetic is popular because of its low cost and minimal side effects. Once applied, lidocaine typically takes about four minutes to begin affecting sensation, and effects can last for between a half hour and three hours, depending on dosage. One of the main benefits of lidocaine is its rapid onset of action; while stronger or longer-acting substances may be preferred for surgical procedures, lidocaine’s fast-acting nature makes it perfect for reducing pain in a wound.

Lidocaine has been my go-to product for wound care for over 20 years. I always use viscous lidocaine applied to any dressing. A patient might need systemic pain relief also, but the application of topical lidocaine is very effective to help alleviate local pain of wounds. Since I have used lidocaine so long for thousands of wounds I can say it definitely helps the healing of wounds. Having a nearly 100% healing rate speaks to that.

The newest thing that I found out about lidocaine was recently published in Wounds regarding lidocaine's bacteriostatic properties. A study was conducted with surgical wounds, some had lidocaine applied, others had saline applied. The post-surgical infection rate with the lidocaine wounds was much less than the wounds with saline application. This tells me why I rarely had wound infections in all the years treating wounds with lidocaine.

Tips for the Application of Lidocaine

To use lidocaine to treat pain in a wound, just apply a small amount, about 1-2 grams, of oral viscous lidocaine to the dressing. then apply this side to the wound. Because of its viscous nature, lidocaine can be used on any type of dressing. Apply the side of the dressing with the lidocaine to the wound. The affects should begin within a few minutes, providing pain relief to your patient. Change daily or as needed and provide further systemic pain relief if necessary.

So, if you have not used lidocaine for wound care, consider starting to use it. You will be very happy with the outcome.

Note: Aletha Tippett, MD, is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, a family physician, and international speaker on wound care.  This article was originally published as part of the WoundSource Trending Topics series; permission for its use on this blog was provided by the author. 
 

References

1. Lidocaine Hydrochloride (Local)". The American Society of Health-System Pharmacists. Archived from the original on 2015-09-06. Retrieved Aug 26, 2015.
2. WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Archived (PDF) from the original on 13 December 2016. Retrieved 8 December 2016.
3. "Lidocaine HCL". International Drug Price Indicator Guide. Retrieved 27 August 2015.
4. J. P. Nolan & P. J. F. Baskett (1997). "Analgesia and anaesthesia". In David Skinner, Andrew Swain, Rodney Peyton & Colin Robertson. Cambridge Textbook of Accident and Emergency Medicine. Project co-ordinator, Fiona Whinster. Cambridge, UK: Cambridge University Press. p. 194. ISBN 9780521433792. Archivedfrom the original on 2017-09-08.

Jim Nabors Would Just Cry

by Dr. Michael Miller

For those of you not as familiar with the Hoosier State as you should be, I used to think it was essentially paradise. Jim Nabors of Gomer Pyle fame is our ubiquitous, tuneful icon with his always well-received “Back Home in Indiana” as a mantra to that source of pride.  Our former Governor “My Man” Mitch Daniels was a genius who, using a combination of intelligence, common sense and the persuasive powers of a midwest Svengali, created an economic model that our neighbors can only lust after. Our medico-legal climate is among the best in the US and well it should be.

However, while there are some extraordinary caregivers and facilities here, a recent US News and World Report curiously showed that almost none of our hospitals made their “Best of” lists in any category. That is not to say there is bad care, but to not have a single facility in an entire state even achieve an honorable mention gives one pause to reflect. The state newspapers were notoriously quiet on this concerning fact, despite their trumpeting of who does what well, when and where.

To give an insight into why this may have happened, I offer the following. Several years ago, our Department of Health created a pressure ulcer task force initiative designed to establish guidelines, which were intended to improve prevention, treatment and reporting. There was a great hullabaloo from the department and the many entities invited to participate regarded the creation of this work as a pressure ulcer paper messiah.

Of course, you must remember that development of pressure-based tissue injuries that are currently called Stage 3 and Stage 4 are to be reported to CMS as they are now considered NEVER EVENTS.  (Dare I use this moment to prognosticate my next blog discussing the complex, stupid and illogical systems currently used to “Stage” these?) And more, these numbers are to be reported as part of a medical errors reporting system.

There is a generally acknowledged fact that for better or worse, despite the very rare “unpreventable” pressure-based tissue injuries, the development of a pressure ulcer in a hospital is as ubiquitous as Facebook lurkers.  With approximately 200 acute care facilities, even the most optimistic (and deluded) health care professionals I have spoken with offer numbers anywhere from five (5) Stage 3 and 4 pressure-based tissue injuries up to 200 per month. Nobody has suggested fewer and there have actually been some who thought there were more. Simple mathematics, using even the low number, would result in approximately 12,000 bedsores developing right here in the Hoosier State (5 bedsores x 200 hospitals x 12 months). 

And so, to cut to the chase, the most recent report from our Indiana Department of Health for medical errors in 2013 was recently published.  It identified the names and numbers regarding the facilities that honestly disclosed their medical errors (based on mandates with severe, punitive actions for failing to do so). Forty-five bedsores were reported!!  Moreover, the officials in charge of this program were outraged because the prior year, there had been 30 reported, which demonstrated a 50% increase!

At this point, I will pause and allow you to re-hinge your jaw from the unquestionable drop it took. 45 bedsores, a 50% increase from a year prior and a national report on health care performance demonstrating that there may be health care here, but it is probably better almost anywhere else? And so, regardless of the veracity of these numbers, they still mandated action.

Of course, the powers that be plodded explosively into action announcing new programs to improve care. When my children were naughty, they were punished. When they lied about being naughty, the punishment increased. Closing my eyes, plugging my ears and telling my wife that I will be creating initiatives to improve their behavior sounds good, but trying to put a patch on a badly broken and dysfunctional wheel is simple bureaucratic buffoonery.

IS the grass greener on your side of the wound dressing? What is your state up to in terms of pressure ulcer prevention, treatment and reporting? As far as our state song sung with such vim and vigor by Jim …perhaps the title needs to be, “Back home anywhere but Indiana.”

Until we ramble together next time.

Dr. Michael Miller is Board Certified in General Surgery by the American Osteopathic Association and initially received his 10-year certification in wound care by the American Academy of Wound Management in 2000 and the American Professional Wound Care Association in 2005.
 

 

His practice has been devoted exclusively to wound care and related issues since 1998. He is one of very few full-time physician wound care specialists in the State of Indiana, as well as the U.S. He has published numerous articles in peer-reviewed journals, written chapters in wound care texts, and presented poster exhibits and podium presentations at numerous domestic and international conferences.

Dr. Miller is also a consultant to numerous companies in the wound care industry and provides expert consultations to professionals in the investment and legal industries. In addition to his clinical practice, he owns several patents on wound care devices. Dr. Miller was named the American Osteopathic Foundation's 2010 Physician of the Year.

If All You Have is a Hammer, What Do You Do When You Run Out of Nails?

by Dr. Michael Miller

Over the years of making house calls for wound care, I found that there was a real need for home-based mental health and behavioral care, palliative care, podiatry and lots of other things. We cater to those who are homebound based on the classic definition involving the word “taxing." One of the more prevalent problems affecting all patients involves the nebulous, but ubiquitous, nerve-jangling, aptly named “5th Vital Sign," namely pain.

As a part of my medical group, we have created a program that provides pain management not just to the homebound, but all those whose lives and lifestyles are affected adversely by it. The program is a monument to government bureaucracy, involving multiple layers of paperwork, mental health evaluations, testing of bodily fluids for both illegal and legal substances, and then, the actual evaluation of the patient commences. After all hurdles are vetted and then jumped, then and only then does a prescription for the appropriate nostrum leave the pad.

In wound care, we treat based on the etiology, the location, the related factors, the amounts of drainage, the surrounding tissues and so on, ad nauseum. Not surprisingly, in pain management, the scenario is much different. In wound care the mantra of the dabbler is see the hole, fill the hole. In pain management, the goal is to minimize pain to maximize functionality but the overriding questions are how this is accomplished.

If the ends justify the means, then why not use explosives to kill flies? A recent conversation with a local healer points out that same mentality that has made millions for Bud Light. Their now-famous slogan, “It’s only weird if it doesn’t work,” demonstrates the relationships assumed by disillusioned sports fanatics whose bizarre actions, foods, etc., seem to provide a direct correlation to touchdowns and field goals. Our discussion regarded a quadriplegic patient with no sensation below C5. The “Healer” had kept him on oral narcotics for years because of his “pain." The spirited but limited discussion ended up with his telling me that he had been using narcotics as his main source of pain control for years, that he had a relative with pain management experience whom he consulted “when needed," and that his many years of training included that of pain management.

His reason for the consult to my pain service was that he recognized that in today’s cause célèbre pain management climate, that one single narcotic slip might result in a major fall. I elected to press the issue by asking him why he didn’t just give all his hypertensives one medicine, his infected denizens one antibiotic and why he did not simply write for morphine across the analgesic board since they all worked and that was much easier than actually making a diagnosis regarding specificity. He responded by simply stating that his training provided him sufficient impetus to do as he had been. My thought was that the incomprehensible and confused logic he promoted regarding the differences between nociceptive and neuropathic pain may have been because both start with the letter “N” rather than any actual physiologic differences.

I accepted the consult on behalf of the group and he was genuinely appreciative. The fact that he requested the consult when he was perfectly able to do so himself (at least in his mind) suggests that a schism of major proportions had erupted in his cranium – namely, that of doing what worked versus doing what was physiologically correct but more appropriate.

The indiscriminate, unguided, “I have done it this way for years” mentality does not demonstrate expertise but rather the insipid, pseudo-intellectual detritus of a wound care or pain management Jonathan Gruber.

What I use to treat a patient for their wounds or their pain is based on a myriad of factors – the least of which is “I’ve always done it that way." In my mind, the real question to be considered is, “If one size fits all, then what size is 'ALL?' ”

Until we ramble again.

Dr. Michael Miller is Board Certified in General Surgery by the American Osteopathic Association and initially received his 10-year certification in wound care by the American Academy of Wound Management in 2000 and the American Professional Wound Care Association in 2005.
 

 

His practice has been devoted exclusively to wound care and related issues since 1998. He is one of very few full-time physician wound care specialists in the State of Indiana, as well as the U.S. He has published numerous articles in peer-reviewed journals, written chapters in wound care texts, and presented poster exhibits and podium presentations at numerous domestic and international conferences.

Dr. Miller is also a consultant to numerous companies in the wound care industry and provides expert consultations to professionals in the investment and legal industries. In addition to his clinical practice, he owns several patents on wound care devices. Dr. Miller was named the American Osteopathic Foundation's 2010 Physician of the Year.