MERCY HEALTH GUIDELINES FOR THE USE OF NEGATIVE PRESSURE THERAPY - RENASYS™ & PICO™ A comprehensive, holistic assessment of the patient should be undertaken prior to commencing negative pressure therapy including; general health, nutritional status, psychosocial wellbeing and wound related pain1 Ensure wound bed preparation has been attended to in order to provide an optimal healing environment2  AIMS OF NEGATIVE PRESSURE THERAPY3:     Set treatment aims for each reduce oedema from the periwound and remove exudate individual patient & from the wound bed evaluate at each dressing optimize healing environment and reduce wound size increase microvascular blood supply & promote healthy granulation tissue INDICATIONS FOR USE4: CONTRAINDICATIONS FOR USE6: • • • Renasys™ or Pico™ negative pressure therapy is indicated for; o dehisced surgical wounds where the wound has exudate that cannot be contained within traditional dressings o chronic & traumatic wounds Ensure all wounds that are to have negative pressure therapy applied have been appropriately debrided to remove necrotic or sloughy tissue prior to the application of Renasys™ or Pico™ Renasys™ or Pico™ may be considered to be applied prophylactically in patients who are considered high risk of surgical wound breakdown. This includes5: • patients with a BMI of > 35 • patients with a history of wound breakdown or delayed healing • patients on corticosteroids • patients with diabetes • patients with multiple comorbidities • history of a previous caesarean section The decision to use Renasys™ or Pico™ prophylactically will be based upon a comprehensive assessment of the patient. RENASYS™ 7 INDICATIONS FOR USE : Wound depth > 2cm Wound exudate: High level of exudate Use foam or gauze filler Consider using ACTICOAT™ Flex under Renasys™ if infection present or suspected Reassess at each dressing change Dressing to be changed 2-3 times/week • • • • • Wounds with necrotic tissue or eschar Caution if used over exposed organs, blood vessels or tendon – must be under medical supervision Do not use in malignant wounds (except where palliative care is appropriate to enhance quality of life) Do not use in wounds where there is untreated or suspected osteomyelitis Do not apply if a patient has severe peripheral arterial disease Do not apply to wounds where there is a fistulae, sinuses or undermining of undefined aetiology Do not apply where there is uncontrolled bleeding of the wound bed or where a patient is taking anticoagulants where the risk of bleeding is heightened PICO™ INDICATIONS FOR USE8: Wound depth up to 2cm Wound exudate – nil/low to moderate Use no filler if wound < 0.5cm Use foam or gauze filler if wound 0.5 – 2cm If infection present or suspected, apply Acticoat™ Flex on wound base Designed to stay in place for up to seven days NEGATIVE PRESSURE THERAPY SHOULD BE STOPPED WHEN ONE OR MORE OF THE FOLLOWING9:  When the original goals of therapy have been met  When there is 100% granulation tissue & the tissue is level with the surrounding skin  When there is no notable improvement after two consecutive dressing changes REFERENCES: 1-4. European Wound Management Association (EWMA). (2007). Position Document: Topical negative pressure in wound management. London: MEP Ltd. 5. Karlakki, S., Brem, M., GIannini, S., Khanduja, V., Stannard, J. Martin, R. (2013). Negative pressure wound therapy for management of the surgical incision in orthopaedic surgery. BJR, 2(12), 273-284. 6-9. Smith & Nephew (ND). Renasys – Negative Pressure Wound Therapy Clinical Guidelines.