vacuum assisted closure v a c therapy an advanced system for wound healing in the home setting l.
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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. Learning Objectives. Define Negative Pressure Wound Therapy (NPWT) Discuss guidelines for the appropriate use of NPWT

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vacuum assisted closure v a c therapy an advanced system for wound healing in the home setting

VACUUM ASSISTED CLOSURE (V.A.C.) THERAPY: An Advanced System for Wound Healing in the Home Setting

Susan E. Duffield, BSN, RN, CWOCN

learning objectives
Learning Objectives
  • Define Negative Pressure Wound Therapy (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.
  • Discuss guidelines for the application of NPWT.
  • Explain the basic steps in obtaining insurance reimbursement for NPWT in the home care setting.
v a c therapy a k a npwt
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.
the v a c system
The V.A.C. System
  • Manufactured by Kinetic Concepts, Inc., San Antonio, TX.
clinical benefits of v a c therapy
Clinical Benefits of V.A.C. Therapy
  • Maintenance of moist, protected environment
  • Removal of excess interstitial fluid from the wound periphery
  • Increased local vascularity
  • Decreased bacterial colonization
  • Quantification/qualification of wound drainage
  • Increased rate of granulation tissue formation
  • Increased rate of contraction
  • Increased rate of epithelialization
v a c therapy indications
V.A.C. Therapy Indications
  • Acute wounds
  • Full-thickness surgical wounds
  • Chronic wounds
    • Stage 3 pressure ulcers
    • Stage 4 pressure ulcers
    • Diabetic ulcers
    • Venous stasis ulcers
  • Traumatic wounds
  • Dehisced wounds
stage 3 pressure ulcer
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.

Kinetic Concepts, Inc.

stage 4 pressure ulcer
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.

Kinetic Concepts, Inc.

venous stasis ulcer
Venous Stasis Ulcer
  • Ulceration associated with venous hypertension
  • Johns Hopkins Medical Images
diabetic foot ulcer
Diabetic Foot Ulcer
  • Diabetics are prone to foot ulcerations due to both neurologic and vascular complications

Wound Care Information Network

v a c therapy precautions
V.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.
v a c therapy contraindications
V.A.C. Therapy Contraindications
  • Malignancy in wound
  • Necrotic tissue with eschar
  • Untreated osteomyelitis
  • Fistulas to organs or body cavities
  • Do not place V.A.C. dressing over exposed arteries or veins
clinical efficacy
Clinical Efficacy
  • 300 wounds treated (acute, subacute, and chronic)
  • 296 wounds improved with an  rate of granulation tissue formation
  • Wounds were treated until completely closed, split-thickness skin graft applied, or flap rotated

Annals of Plastic Surgery, 1997

cost effectiveness of v a c therapy
Cost Effectiveness of V.A.C. Therapy
  • Retrospective chart review of 1032 Medicare home care patients
  • 61% faster healing rate
  • 38% less cost

Ostomy/Wound Management, 1999

apn orders for v a c therapy
APN Orders for V.A.C. Therapy
  • Location of wound
  • 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)
  • Frequency of dressing changes – usually every 48 hours
application of the v a c
Application of the V.A.C.
  • Visiting Nurse
  • Home caregivers and patients able to apply and remove V.A.C.
dressing application overview
Dressing Application Overview
  • Place foam in wound
  • Cover with semi-occlusive dressing
  • Secure tubing
  • Connect tubing to the V.A.C. therapy unit
operating the v a c unit
Operating the V.A.C. Unit
  • Insert canister securely in unit
  • Connect dressing tubing to canister tubing
  • Press power button ON
  • Follow prompts
  • Start therapy
  • Therapy should be on 24 hours each day
alarms
Alarms
  • Therapy OFF
  • Canister is full
  • Air leak
monitoring and progression of wound healing
Monitoring and Progression of Wound Healing
  • Weekly wound measurements
  • 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
ambulatory options
Ambulatory Options
  • For the patient who is goes to work or school, a battery powered model is available.
  • Wound must be minimally draining.
termination of v a c therapy
Termination of V.A.C. Therapy
  • Adequate granulation base achieved allowing for:
    • Changing to conventional dressing changes
    • Split-thickness skin graft
    • Flap closure
reimbursement guidelines for home v a c therapy
Reimbursement Guidelines for Home V.A.C. Therapy
  • Medicare B
    • Complete Initial Statement of Ordering Physician (ISOP)(available at www.woundvac.com)
    • Fax ISOP to KCI
    • Mail completed original ISOP to KCI
  • Private Insurance
    • Complete above steps
    • Some insurers may require additional information, such as clinical notes, before issuing authorization for coverage
  • Medicaid
    • Not currently covered in NJ
additional information
Additional Information
  • 1-877-WOUNDVAC
  • www.woundvac.com
  • V.A.C. Recommended Guidelines for Use: Physician and Caregiver Reference Manual (Kinetic Concepts, Inc.)
key points
Key Points
  • Non-invasive active therapy for wound healing
  • Indicated to treat a variety of acute & chronic wounds
  • Dressing changes every 48 hours
  • Reimbursable under Medicare B & most private insurers