Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [82], C).
2. 2.Show
   Provide routine analgesia prior to the dressing procedure.
   To prevent unnecessary procedural pain. E
3. 3.Show
   Ensure there is adequate lighting and that the patient is comfortable and in a position where the wound can be accessed and viewed easily. Assemble all necessary equipment.
   To allow access to the area for dressing change. Dressing application can be complicated and prolonged so the patient should be in a comfortable position for the procedure. E

Procedure

1. 4.Show
   Use aseptic technique and sterile equipment (as listed above).
   To prevent infection (Fraise and Bradley [33], E).
2. 5.Show
   To remove the NPWT dressing, put on sterile gloves.
   To reduce the risk of cross‐infection (Pudner [89], E).
3. 6.Show
   Clamp the dressing tubing and disconnect it from the canister tubing. Allow any fluid in the canister tubing to be sucked into the canister. Switch off the pump and clamp the canister tubing.
   To prevent spillage of body fluid waste from the tubing or canister. E
4. 7.Show
   Remove and discard the canister (if full or at least weekly).
   To prevent the pump alarm sounding and for infection control. E
5. 8.Show
   Carefully remove the occlusive film drape by gently lifting one edge and then stretching the drape horizontally and slowly removing it from the skin.
   To prevent damage to the peri‐wound skin. E
6. 9.Show
   Carefully remove the wound filler.
   To prevent damage to newly formed tissue within the wound bed and prevent pain. E
7. 10.Show
   Irrigate with sterile 0.9% sodium chloride if indicated.
   To remove surface debris/necrotic tissue (Milne [73], E).
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   Debride the wound if applicable and dry the peri‐wound area.
   To remove loose necrotic tissue, which may be a focus for infection (Vowden and Vowden [111], E).
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   To apply the dressing, cut the NPWT foam/gauze filler to fit the size and shape of the wound. Appropriate foam or gauze should be used if tunnelling and undermined areas are present.
   The foam should fit the wound exactly to ensure full benefit of the NPWT. E
10. 13.Show
    Avoid cutting the foam over the wound bed.
    To prevent loose particles of foam falling into the wound. E
11. 14.Show
    Apply a skin barrier, drape or thin hydrocolloid to the peri‐wound if required.
    To prevent epidermal stripping on dressing removal. To protect vulnerable wound edges and to help achieve an air tight seal (Schreiber [93], E).
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    Place the foam into the wound cavity.
    The whole wound bed must be covered with foam. If multiple pieces of foam are used, they must all touch each other to ensure the negative pressure is transferred to each piece. E
13. 16.Show
    A non‐adherent wound contact layer should be used under the foam/gauze filler for protection in the case of a friable wound bed or exposed blood vessels, tendons, bone or muscle.
    The extracellular matrix requires a trauma‐free dressing removal (Ellis [28], E).
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    Cut the occlusive film drape to size and apply it over the top of the foam. The film should extend 5 cm from the wound margin and not be stretched or applied under pressure. Note: do not compress the foam into the wound.
    To obtain a good seal around the wound edges. E
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    Choose a location on the sealed occlusive film drape to apply the tubing where the tubing will not rub or cause pressure. Cut a hole through the film (size dependent on system being used), leaving the foam intact.
    To reduce the risk of pressure injury to the skin. E
16. 19.Show
    Align the opening of the port over the hole in the film. Apply gentle pressure to anchor the port to the film.
    To ensure correct position and seal of the pad (Smith & Nephew [96], C).
17. 20.Show
    To commence the NPWT, insert the canister into the pump until it clicks into place. Do not clamp any part of the canister tubing.
    The click indicates the canister is positioned correctly and is secure. E

    The pump will sound an alarm if the tubing is clamped or not connected. E
18. 21.Show
    Connect the dressing tubing to the canister tubing.
    To complete the circuit set‐up. E
19. 22.Show
    Press the power button and follow the on‐screen instructions to set the level and type of pressure required according to the instructions from the patient's NPWT prescriber.
    To ensure the therapy is set to the individual requirements of the patient (Milne [73], E).
20. 23.Show
    When therapy has commenced, the foam should collapse into the wound, be firm to touch and have a wrinkled appearance (Smith & Nephew [96]).
    Any small air leak will prevent the foam dressing from contracting; reassessment will be required. E

Post‐procedure

1. 24.Show
   Document the dressings and settings, frequency of changes, wound description and exudate in the patient's notes.
   To provide a record of care in the patient's care plan (NMC [82], C).