Mechanism
Negative pressure (typically -125 mmHg) applied to wound bed through foam and sealed drape. Mechanisms: wound contraction, cellular proliferation, edema reduction, perfusion, granulation stimulation. Can accelerate healing by 2-3x.
Indications & Contraindications
Indications: acute and chronic wounds, diabetic foot ulcers, pressure injuries, surgical dehiscence, grafts/flaps. Contraindications: malignancy in wound, untreated osteomyelitis, unexplored fistulas, necrotic tissue with eschar, exposed vasculature/organs/nerves.
Nursing Management
Assess: seal integrity (no leaks), pressure setting, exudate, periwound skin, pain. Change dressing q48-72h (more frequently if infected). Pain management: premedicate, less foam, lower pressure. Monitor for bleeding, infection, maceration. Teach: alarm recognition, activity restrictions.
Important Notes
- Never place NPWT foam directly on exposed blood vessels or organs — can cause fatal bleeding.
- NPWT contraindicated in untreated osteomyelitis — treat infection first.
Clinical Tips
- Premedicate with analgesics 30-60 min before NPWT dressing changes — can be painful.
- Use skin prep (no-sting barrier film) on periwound skin before applying drape — protects from maceration.
Summary
NPWT accelerates wound healing through negative pressure — requires careful patient selection, intact seal, regular dressing changes, and monitoring for complications.
