Negative Pressure Wound

Therapy in Diabetic
Patients
NURS 470
Lauren Austin, Jordan Staab, Mari Aquino, Jen Riedel, Christina Etchart,
Susanna Scheidt, Paeyton Scholfield, Alex Buechler, Kassidi Koepke
 Introduction

• General issue: Effectiveness of current

diabetic wound treatment.

• Significance for nursing: Nurses are primarily

responsible for wound care.
• Decrease in time spent on wound care
• Education/training
• Documentation changes
What is Best Practice for Diabetic wound
care?

• Is negative pressure wound therapy more

effective than standard wound care, such as
debridement, infection control, wound cleaning
to the site, off-loading of pressure source, and
dressing changes with moist gauze, in decreasing
the healing rate of a wound (considering time and
size until complete closure of the wound) in
patients with diabetic ulcers?
(Tuncel, Turan, Bayraktar, Aydin & Erkorkmaz, 2012)
What is Negative Pressure Wound Therapy?

• https://www.youtube.com/watch?v=KiPVzfcD1_A

(Play from 20 sec. – 2.20 secs)

 Summary of Current Practice

• NATIONAL: STATE: LOCAL:

• Debridement • Compression • Debridement
wraps
• Local wound care - • Hyperbaric oxygen
• Grafts therapy
Advanced moisture
wound therapy
• Hyperbaric • Dressing selection
• Infection control oxygen therapy
• Special shoes
• Offloading of • Dressings
pressure

(Liu et al., 2017) (Advanced Foot & Ankle Specialists of Arizona, 2017)
Literature Research Findings

• Negative pressure therapy

decreased diabetic wound
healing time compared to
standard wound care
• Less dressing changes are
required with negative pressure
therapy than standard wound
care
 Literature Research Findings

• Negative pressure therapy

decreased diabetic would
depth and surface area.
• Negative pressure therapy
had a higher success rate of
ulcer closure.
• Negative pressure therapy
has anti-inflammatory
effects.
 Summary of Strengths and Limitations:

• Strengths • Weaknesses
• Randomized- • Small population
controlled trials. size

• Quantification of • Short observation

wound changes time (less than one
(size, depth, and month)
diameter reduction)

• Quantitative studies.
Evidence Based Nursing Recommendations:

• Implement negative pressure therapy:

• Through commercially available Vacuum Assisted Closure

system
OR
• Through a modified technique in order to reduce cost:
• Suction
• Ryle’s tubing
• Foam
• OpSite dressing
 Overall Implementation into Nursing Practice:

Present the plan Hospital

Make a task Establish a to the
Compile research purchases the
group budget institutional board supplies

Lay a Foundation  2-3 Months Implement changes  3-18 Months

Make a
Provide Implement Evaluate
standardized Educate staff
supplies practice effectiveness
protocol

Implement changes  3-18 Months Sustain and

spread  12-24
months
Cost Analysis:

• Wound therapy costs:

• Negative Pressure wound therapy: VAC system and labor.
• Standard wound therapy: Dressing and labor.
• Non-Wound therapy costs:
• Antibiotic therapy, acute inpatient services, extended care stays (skilled
nursing facility), rehabilitation clinic visits, or other outpatient surgical
procedures.

(Driver & Blume, 2014)

Cost Analysis

Type of Treatment: Non-therapy wound cost Wound therapy cost:

Negative Pressure Wound $7,265.93 $4,718.47
Therapy
Advanced Moist Wound $11,245.17 $2,312.34
Therapy
(standard therapy)

*Per patient

(Driver & Blume, 2014)

Cost Analysis:
(Per Patient) Total Average Costs Average Cost per Patient

Negative Pressure Wound $1,941,472.07 $11,984.40

Therapy

Advanced Moist Wound $2,196,315.86 $13,557.51

Therapy
(standard therapy)

(Driver & Blume, 2014)

Cost Analysis:

• Overall, the cost of wound therapy with the

implementation of a Negative Pressure system is
more expensive compared to standard treatment.
• However, considering the non-therapy expenses,
it is actually cost effective.
 Risk vs Benefit:
• Institution
• Risk: invested of time and money in new idea, possible poor
staff response
• Benefit: decreased risk of hospital acquired infection and
reduced costs from shorter hospital stays
• Nursing:
• Risk: More complex wound care management system
• Benefit: decreased amount of dressing changes
• Patient:
• Risk: limited mobility if attached to wall suctioning
• Benefit: more effective wound closure, shorter hospital stay
Evaluation:
• SMART:
• The average total time of wound closure per patient will decrease
within six months of implementation of new negative pressure wound
therapy.
• The average cost of wound treatment per patient will be less
expensive compared to the price of standard wound treatment options
over a six month time period.
• The average wound depth and surface area treated with negative
pressure wound therapy will decrease in size at a faster rate
compared to wounds treated with standard wound therapy within six
months of implementation.

We plan to evaluate our intervention six months post-implementation.

Summary:

• Introduction.

• Description of Issue.

*See notes for details

Summary

• Supportive studies.

• Best practice discussion.

• Facility application.
Summary

• Cost analysis.

• Risk v. Benefit.
References

• Chiang, N., Rodda, O. A., Sleigh, J., & Vasudevan, T. (2017). Effects of topical negative
pressure therapy on tissue oxygenation and wound healing in vascular foot wounds.
Journal of Vascular Surgery, 66(2), 564-571. doi:S0741-5214(17)30934-5
• Wang, T., He, R., Zhao, J., Mei, J. C., Shao, M. Z., Pan, Y., . . . Jia, W. P. (2016).
Negative pressure wound therapy inhibits inflammation and upregulates activating
transcription factor-3 and downregulates nuclear factor-kB in diabetic patients with foot
ulcerations. Diabetes Metabolism Research and Reviews, 33, 1-9,
doi:10.1002/dmrr.2871
• Sajid, M. T., Mustafa, Q. A., Shaheen, N., Hussain, S. M., Shukr, I., & Ahmed, M. (2015).
Comparison of negative pressure wound therapy using vacuum-assisted closure with
advanced moist wound therapy in the treatment of diabetic foot ulcers. Journal of the
College of Physicians and Surgeons Pakistan, 25, 789-793. doi:11.2015/JCPSP.789793
References cont.

• Galistyan, G. R., Tokmakova, A. Y., Zaitseva,E. L., Doronina, L. P., Voronkova, I.

A., & Molchkov, R. V. (2016). Comparative evaluation of the intensity of
reparative processes in the lower extremity soft tissues of diabetic patients
receiving local negative pressure wound treatment and standard wound care.
Ter Arkh, 10, 19-24. doi:10.17116/terarkh2016881019-24
• Ravari, A., Modaghegh, M. S, Kazemzadeh, G. H., Johari, H. G.,
Mohammadzadeh, V., Sangaki, A., & Shahrodi, M. V. (2013). Comparison of
vacuum-assisted closure and moist wound dressing in the treatment of diabetic
foot ulcers. Journal of Cutaneous and Aesthetic Surgery, 6, 17-20.
doi:10.4103/0974-2077.110091
• Vaidhya, N., Panchal, A., & Anchalia, M. M. (2015). A new cost-effective method
of NPWT in diabetic foot wound. The Indian Journal of Surgery, 77(Suppl 2),
525–529. doi:10.1007/s12262-013-0907-3
References cont.

• Yang, S. L., Zhu, L. Y., Han, R., Sun, L. L., & Dou, J. T. (2017). Effect of
negative pressure wound therapy on cellular fibronectin and transforming
growth factor-β1 expression in diabetic foot wounds. Foot & Ankle
International, 38(8). doi:10.1177/107110071770494
• Driver, V. R., & Blume, P. A. (2014). Evaluation of wound care and health-care
use costs in patients with diabetic foot ulcers treated with negative pressure
wound therapy versus advanced moist wound therapy. Journal of the American
Podiatric Medical Association, 104(2): 147-153. doi:10.7547/0003-0538-
104.2.147
• Blume, P. A., Walters, J., Payne, W., Ayala, J., & Lantis, J. (2008). Comparison
of negative pressure wound therapy using vacuum-assisted closure with
advanced moist wound therapy in the treatment of diabetic foot ulcers: A
multicenter randomized controlled trial. Diabetes Care, 31(4), 631-636.
doi:dc07-2196
References cont.

• Liu, S., He, C. Z., Cai, Y. T., Xing, Q. P., Guo, Y. Z., Chen, Z. L., . . . Yang, L. P.
(2017). Evaluation of negative-pressure wound therapy for patients with diabetic
foot ulcers: Systematic review and meta-analysis. Therapeutics and Clinical Risk
Management, 13, 533-544. doi:10.2147/TCRM.S131193
• Guffanti, A. (2014). Negative pressure wound therapy in the treatment of diabetic
foot ulcers: A systematic review of the literature. Journal of Wound, Ostomy, and
Continence Nursing : Official Publication of the Wound, Ostomy and Continence
Nurses Society, 41(3), 233-237. doi:10.1097/WON.0000000000000021
• Tuncel, U., Turan, A., Bayraktar, M. A., Aydin, U., & Erkorkmaz, U. (2012). Clinical
experience with the use of gauze-based negative pressure wound therapy. Wounds :
A Compendium of Clinical Research and Practice, 24(8), 227-233.
• Advanced Foot & Ankle Specialists of Arizona. (2017). Diabetic Wound Care:
Treating Ulcers to Keep Feet Safe. Retrieved from
http://www.advancedfootankle.com/practice_areas/southeast-valley-diabetic-
wound-care.cfm