NPWT is an advanced wound management technique to create sub atmospheric pressure in a wound. This is achieved by removal of air from a sealed wound using a specifically designed electrically powered suction pump.

NPWT is indicated for patients with chronic, acute traumatic, sub-acute, and dehisced wounds.

Initiation

In Devon, all NPWT is initiated and supplied through Secondary Care.

Use and provision in a community setting is undertaken by the Tissue Viability Teams, who will provide the relevant training to community staff, and monitor treatment on an ongoing basis.

All NPWT products should be requested via the Tissue Viability Services and not via prescription. Click here for Tissue Viability Service contact details.

GPs should not initiate or prescribe NPWT products, including accessories, dressings, and consumables in primary care.

Robust systems should be in place to assess patient's suitability for starting NPWT, reviewing treatment and discontinuing treatment at appropriate points.

A risk assessment which considers the patient's environment should also be undertaken when considering the use of NPWT in a homecare setting.

Wounds suitable for NPWT include:

• Dehisced surgical wounds
• Diabetic foot ulceration
• Pressure ulceration
• Trauma wounds
• Excised pilonidal sinus wounds

Wounds not suitable for NPWT include:

• Fistulae of unknown origin
• Body cavity wounds near to internal organs
• Untreated osteomyelitis
• Wounds near exposed or damaged blood vessels

Discontinuation

A treatment goal should be defined and NPWT should be discontinued when it is reached.

Other reasons to discontinue NPWT may include:

• When uniform granulation tissue and little depth of the wound is present
• The patient is not tolerating the NPWT, or withdraws consent to treatment
• When the wound volume reduction is less than 15% over a two-week period
• The patient complains of extreme pain
• There is excessive bleeding
• An alternative treatment option is more suitable if there are signs of local or spreading infection

NPWT Systems and Accessories

There are a range of products available, and the product of choice depends on a number of factors including level of exudate of the wound and the mobility of patient.

The quantity supplied should be sufficient to ensure availability when needed, but minimise wastage if therapy is changed. NPWT should not be included on repeat prescribing as it is requested via the Tissue Viability Services only.

Traditional Negative Pressure Wound Therapy (tNPWT)

Traditional NPWT systems include a canister for fluid collection from the wound. The pressure applied is adjustable, with continuous and intermittent modes of operation possible. Often powered by a main electricity source, traditional NPWT devices are mostly used for inpatients but can also be adjusted for use in outpatient care.

ActiV.A.C. Therapy Unit (KCI Medical Ltd)

(tNPWT system)

• Canister with gel 300ml
• Double-sided adhesive hydrogel strip (14cm x 3cm)
• V.A.C polyurethane, acrylic adhesive drape (26cm x 38.7cm)
• SensaT.R.A.C pad (monitoring pad)

INFOV.A.C. Therapy Unit (KCI Medical Ltd)

(tNPWT system)

• Canister with gel 1000ml
• Double-sided adhesive hydrogel strip (14cm x 3cm)
• V.A.C polyurethane, acrylic adhesive drape (26cm x 38.7cm)
• SensaT.R.A.C pad (monitoring pad)

Renasys Touch (Smith + Nephew Healthcare Ltd)

(tNPWT system)

• Canister with solidifier 300ml, 800ml
• Sterile, single-use adhesive gel patch (10cm x 7cm)
• Transparent film drape (20cm x 30cm)
• Additional soft port
• Y-connectors (split connection tube)

Renasys GO (Smith + Nephew Healthcare Ltd)

(tNPWT system)

• Canister with solidifier 300ml, 750ml
• Sterile, single-use adhesive gel patch (10cm x 7cm)
• Transparent film drape (20cm x 30cm)
• Additional soft port
• Y-connectors (split connection tube)

Venturi Avanti (Talley Group Ltd)

(tNPWT system)

• Canister with solidifier 1200ml

Venturi MiNO (Talley Group Ltd)

(tNPWT system)

• Canister 150ml

Single-use Negative Pressure Wound Therapy (sNPWT)

Single-use NPWT can also be known as: pocket, cannister-free, mechanically powered, disposable, portable NPWT.

Some sNPWT devices are canister-free and handle fluid mainly through evaporation from the outer layer of the dressing. Mainly suitable for low to moderate exudate levels. The pressure is applied continuously and is not usually adjustable. sNPWT devices are often battery powered.

NICE MTG43: PICO negative pressure wound dressings for closed surgical incisions (published May 2019, last updated August 2019):

• Evidence supports the case for adopting PICO negative pressure wound dressings for closed surgical incisions in the NHS. They are associated with fewer surgical site infections and seromas compared with standard wound dressings.
• PICO negative pressure wound dressings should be considered as an option for closed surgical incisions in people who are at high risk of developing surgical site infections.

Avelle (ConvaTec Ltd)

(sNPWT system)

• 12cm x 21cm, 12cm x 31cm, 12cm x 41cm
• 16cm x 16cm, 16cm x 21cm
• 21cm x 26cm
• 26cm x 26cm

PICO (Smith + Nephew Healthcare Ltd)

(sNPWT system)

• 10cm x 20cm, 10cm x 30cm, 10cm x 40cm
• 15cm x 15cm, 15cm x 20cm, 15cm x 30cm
• 20cm x 20cm
• 25cm x 25cm

PICO 7 Multisite (Smith + Nephew Healthcare Ltd)

(sNPWT system)

• 15cm x 20cm
• 20cm x 25cm

PICO 14 Multisite (Smith + Nephew Healthcare Ltd)

(sNPWT system)

• 15cm x 20cm
• 20cm x 25cm

NPWT Dressings

Renasys-AB Abdominal (Smith + Nephew Healthcare Ltd)

• Abdominal dressing kit with soft port

Renasys-F Foam (Smith + Nephew Healthcare Ltd)

• Foam dressing kit with soft port (Small, Medium, Large)

Renasys-G Gauze (Smith + Nephew Healthcare Ltd)

• Gauze dressing kit with soft port (Small, Medium, Large)

Renasys-G Drain Kit (Smith + Nephew Healthcare Ltd)

• Gauze dressing kit with a drain
  • Round drain: small (10FR), Large (19FR)
  • Flat drain (10mm)
  • Channel drain (15FR)

V.A.C. Granufoam (KCI Medical Ltd)

• Polyurethane foam dressing (Small, Medium, Large, Bridge)

V.A.C. Simplace EX (KCI Medical Ltd)

• Polyurethane foam dressing (Small, Medium)

V.A.C. Veraflo (KCI Medical Ltd)

• Foam dressing (Small, Medium, Large)
• Cleanse dressing (Medium)
• Cleanse Choice dressing (Medium, Large)
  • Veralink Cassette
  • VeraT.R.A.C Duo Tube set

Venturi (Talley Group Ltd)

• Gauze wound care kit with a portal drain (Standard, Large)

Venturi MiNO (Talley Group Ltd)

• Gauze dressing kit with a portal drain, 20cm x 20cm

NPWT Polyhexamethylene Biguanide (PHMB) Dressings

Kerlix AMD (H&R Healthcare)

• Gauze dressing impregnated with 0.2% PHMB, 11.4cm x 3.7m (roll)
• Gauze sponges impregnated with 0.2% PHMB, 15.2cm x 17.1cm

Wound Liners

In the case of topical negative pressure to line vessels, ligaments, and tendons, please see section 17.2.3 Soft polymer dressings. When intended for use specific to NPWT, these are considered consumables of NPWT and must be initiated and supplied through Secondary Care.