Transcript VACUUM ASSISTED CLOSURE (V.A.C.) THERAPY: An Advanced

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
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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
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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
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Manufactured
by Kinetic
Concepts, Inc.,
San Antonio,
TX.
Clinical Benefits of V.A.C. Therapy
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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
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Acute wounds
Full-thickness surgical wounds
Chronic wounds
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Stage 3 pressure ulcers
Stage 4 pressure ulcers
Diabetic ulcers
Venous stasis ulcers
Traumatic wounds
Dehisced wounds
Stage 3 Pressure Ulcer
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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
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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
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Ulceration
associated with
venous
hypertension
Johns Hopkins Medical Images
Diabetic Foot Ulcer
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Diabetics are prone
to foot ulcerations
due to both
neurologic and
vascular
complications
Wound Care Information Network
V.A.C. Therapy Precautions
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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
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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
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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
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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
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
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Application of the V.A.C.
Visiting Nurse
 Home
caregivers and
patients able to
apply and
remove V.A.C.
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Dressing Application Overview
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Place foam in
wound
Cover with semiocclusive dressing
Secure tubing
Connect tubing to
the V.A.C. therapy
unit
Operating the V.A.C. Unit
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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
 Therapy
OFF
 Canister is full
 Air leak
Monitoring and Progression
of Wound Healing
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Weekly wound measurements
Signs of healing
– Oozing of blood as granulation occurs
– Wound bed becomes redder
– Gradual  in wound drainage
–  in dimensions of wound
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Average length of treatment is 4-6
weeks
Ambulatory Options
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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
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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
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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
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1-877-WOUNDVAC
www.woundvac.com
V.A.C. Recommended Guidelines for
Use: Physician and Caregiver
Reference Manual (Kinetic Concepts,
Inc.)
Key Points
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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