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AN ISO 13485:2003 CERTIFIED COMPANY
INTRODUCTION OF
CLOSED CYCLIC NEGATIVE PRESSURE WOUND THERAPY
in management of wounds
By SIDDHARTH MANDAL CEO
TRIAGE HEALTHCARE TECHNOLOGIES +91 9971722111
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What is Closed Cyclic Negative Pressure Wound Therapy(CCNPWT)?
Negative Pressure Wound Therapy also widely known as NPWT, WOUND VAC or TNP(Tropical Negative Pressure) is a widely accepted wound
management modality today, i.e.,
A specially designed foam dressing applied on a wound bed, sealed with a PU/PE drape further
connected with a drainage tubing to regulated / controlled negative pressure source.
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How does CCNPWT promote wound healing? •Removing excess fluid (infections and non-infectious), allowing tissue decompression •Stimulates granulation tissue formation by increasing vascular perfusion, •Encourages mechanical stretching, approximates wound edges, enhances overall wound contraction •Protects wound from microbe imbalance •Maintains a moist wound healing environment
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CONSUMABLES
PORTFOLIO
ALL PRODUCTS ARE CERTIFIED
ALL PRODUCTS ARE MANUFACTURED UNDER STRICT PARAMETERS OF ISO 13485:2003
SINGLE USE ONLY
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1. Rinse the wound thoroughly & Debride majority of necrotic tissues
2. Cut the foam dressing in the shape of the wound
3. Place it on the wound bed & seal with PU drape
4. Make a small hole in the centre
5. Stick the drainage tubing aligning the hole made
6. INITIATE the Therapy & observe
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CCNPWT creates an Environment of Wound Healing at the Cellular Level
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CCNPWT THERAPY DRESSING BENEFITS
Flexible foam dressing adapts to the contours of deep & irregular surface of the wound bed Specially designed hydrophobic, non-linear networked foam dressing removes bacteria colonised wound exudate The CCNPWT foam dressing aggressively promotes uniform healthy granulation tissue throughout the wound bed
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AN ISO 13485:2003 CERTIFIED COMPANY
CCNPWT THERAPY DRESSING BENEFITS
Flexible foam dressing adapts to the contours of deep & irregular surface of the wound bed
Specially designed hydrophobic, non-linear networked foam dressing removes bacteria
colonised wound exudate
The CCNPWT foam dressing aggressively promotes uniform healthy granulation tissue
throughout the wound bed
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CCNPWT provides a closed sterile & moist wound
healing environment
Promotes granulation tissue formation, recent
studies suggest mechanical stretching may result in
increased mitosis (Cell Replication)
Controlled Negative Pressure Therapy decreases
wound volume approximating wound edges, helps
uniformly draw wounds closed
Promotes continuous wound debridement by
removing wound debris & bacteria colonized wound
output/interstitial fluid allowing tissue decompression
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Contd.. Reduces oedema
Reduces bacterial load
Stimulates cell proliferation
Enchances dermal perfusion
Promotes micro angiogenesis
Protects wound from re-infection, cross infection or spreading further infection
Promotes Skin Graft/Flap uptake (The flexible foam dressing gently presses the skin graft or flap ensuring full contact with the wound bed
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Increased Perfusion Morykwas Michael J, Argenta Louis C, Shelton-Brown Erica I, McGuirt Wyman: NPWT: A New Method for Wound
Control and Treatment: Animal Studies and Basic Foundation. Annals of Plastic Surgery, 1997
Peak blood flow recorded at 125 mmHg
Study helped establish original pressure
protocol with Foam Dressing (400-600
micron pore-size)
Hypothesized that reduction in oedema
decompresses small blood vessels and
increases flow
Frank Ischaemia and Wound Hypoxia
Positive effect on perfusion with 100-125 mmHg
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Reduction of Inhibitory Factors Morykwas Michael J, Argenta Louis C, Shelton-Brown Erica I, McGuirt Wyman: NPWT: A New Method for Wound
Control and Treatment: Animal Studies and Basic Foundation. Annals of Plastic Surgery, 1997
Reduction of oedema has positive effect in wound
healing
Reduction of inhibitory factors contained in
interstitial fluid (chemical)
Decompression of small blood vessels, which
restores flow (mechanical)
Negative Pressure Wound Therapy increases perfusion and oxygenation, therapy likely enhances resistance to infection
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WHAT TYPE OF WOUNDS BENEFIT FROM CCNPWT?
Pressure ulcers Full thickness and partial thickness burns Diabetic / Neuropathic ulcers Venous Insufficiency ulcers Post-operative and dehisced surgical Traumatic Wounds Skin Flaps and Grafts Explored fistulas
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WHEN IS CCNPWT CONTRAINDICATED? • Wounds containing malignant tissue • Untreated osteomyelitis • Necrotic tissue such as slough or eschar • Unexplored or non-enteric fistulas • Exposed or unprotected organs, blood vessels
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WHAT CONDITIONS INDICATE CAUTION?
• Active bleeding or patient on anticoagulant therapy • Proximity of blood vessels, organs, muscle, and fascia requiring protection • Irradiated vessels and tissue • Bony fragments • Untreated malnutrition • Non-compliant or combative behaviour
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Fixation of skin graft (mesh-grafts) or flap until the graft has taken (4-6 days). In these special cases,
Topical Negative Presure Therapy is used for the secure fixation
of a split skin graft to the wound
The soft foam helps gently press the graft/flap onto the wound bed and thus ensures full contact between the graft and the
underlying wound bed, irrespective of the wound contours and the formation of pockets, also continuously drains out the
wound output, ensures infection free graft uptake
CCNPWT helps in Flaps & Graft uptake
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DRESSING APPLICATION TECHNIQUE
STEP 1 : DEBRIDE & CLEAN THE WOUND WITH ISOTONIC SOLUTION
STEP 2 : CUT THE FOAM DRESSING IN THE SHAPE OF WOUND AND PLACE IT ON WOUND BED
STEP 4 : STICK THE MAPC TUBING DISTAL END KEEPING SYMMETRY WITH HOLE IN CENTRE & CONNECT WITH THE NEGATIVE PRESSURE SOURCE
STEP 3: SEAL THE WOUND WITH SEMI-PERMEABLE DRAPE & MAKE A SMALL HOLE IN THE CENTRE
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INDICATED for TRAUMA WOUNDS
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DIABETIC FOOT
ULCERS
INDICATED for
Granulation after 3 days of application
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Indicated for all Grade II, III & IV Pressure Ulcers
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INDICATED FOR VENUS/ARTERIAL
LEG ULCERS
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INDICATED FOR ABDOMINAL
COMPARTMENT SYNDROME
Infected Laprotomy
**Please seek advice for special Dressing selection
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Venus Leg ulcer with complications of sickle cell anaemia
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CCNPWT
application
for 10 days
20 days
post follow-up
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ROAD ACCIDENT LACERATION
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Road Accident case : with no vessels for primary closure
(results of 13days NPWT Dressing Application)
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INFECTED COMPOUND FRACTURE
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AFTER Ist DRESSING CHANGE
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AFTER 2nd DRESSING CHANGE
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FOLLOW-UP POST FLAP
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Crushed Injury
Amputation
CCNPWT
applied for
4 days
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ROAD ACCIDENT LACERATION Patient : HBsAg Positive
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CCNPWT
Applied for 7 days
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PRESSURE ULCER (GRADE IV)
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Result of 8 days / 2 dressing change
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WHAT INTERVENTIONS WILL MAXIMIZE
HEALING?
Debride wound prior to Negative Pressure
Therapy
Off load pressure ulcers consistently
Minimize time off NPWT to < 4 hours in a day
Manage co-morbid condition
Increased blood flow
Reduce oedema
Minimize infection
Control blood glucose level
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WHAT ARE THE EXPECTED OUTCOMES?
• May observe increased exudate and wound size during
the first 48-72 hours due to the decompression of interstitial
space and removal of extra-cellular fluid and debris.
• Gradual reduction of fluid and surface area should be
observed with each assessment.
• Colour of wound bed should become a deeper red as
perfusion to the site increases.
• Measurements should decrease weekly.
• If healing is not observed in a week, treatment should be
re-evaluated.
• The average treatment with NPWT is 1-4 weeks. Length of
treatment is determined by goals of therapy.
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HOW DO YOU MANAGE WOUND WITH CCNPWT?
Change dressing two/three times per week.
Monitor frequently
Observe wound and peri-wound area for signs and
symptoms of infection
Remove dressings carefully to protect new tissue
growth.
Bright gush flow red blood in canister requires
immediate evaluation.
Measure and document per facility protocol
Note : To initiate it is recommended to follow CCNPWT protocol, to ensure optimal results, as
ithese are tried and tested protocol designed by various CCNPWT expert wound managers
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WOUND ASSESMENT
CHART
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WOUND ASSESMENT
CHART
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AN ISO 13485:2003 CERTIFIED COMPANY
WOUND TREATMENT PLAN CHART
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Thank you for your patience For any queries feel free to contact our local
representative
or visit www.npwtindia.com email: info@npwtindia.com
or npwtindia@gmail.com
Care : +91 9971722111/9650440444