CS14-034 Reducing Management Costs and Optimizing Patient Outcomes Utilizing Negative Pressure Wound Therapy with Instillation for Complex Wounds

Denise Gilmore, BSN, RN, CWOCN1, Nicole Harris, BN, RN, CWOCN1 and Kristina Fawcett, MSN, FNP-C, CWS2, (1)Wound/Ostomy, Banner Thunderbird Medical Center, Glendale, AZ, (2)Valley Wound Care Specialists, Scottsdale, AZ
Today’s health care environment requires optimal patient outcomes.  It is imperative that the management of complex wounds be the most efficient while utilizing the best treatments available to decrease cost and inpatient length of stay.   An innovative, cost-effective approach in management of complex wounds is the use of Negative Pressure Wound Therapy using primary instillation (NPWTi) from presentation to closure.

A 2008 study comparing traditional wet to moist wound healing to NPWTi, found that patients had fewer inpatient days (Gabriel, Shores, Heinrich, Baquai, Kalina, Sogioka & Gupta).  NPWTi promotes granulation tissue, reducing bioburden and promoting earlier surgical intervention such as flaps, grafts or even primary closure.  NPWTi is also used to remove debris, bacteria and exudates.  Following are three case studies all using a solution of Vancomycin 2GM + Gentamicin 240mg in 1000ml normal saline. 

Case #1:  patient presented with necrotizing fasciitis of buttock.  Day one, silver sulfadiazine was used.  Day four, NPWTi was initiated instilling 36ml.  Day eight, wound was surgically closed and day nine patient was discharged. 

Case #2:  patient presented with infected wound to right hand secondary to a cat scratch.  Day four:  treatment consisted of silver mesh and hydrogel.  Day five:  first surgical debridement and placement of NPWTi instilling 10ml.  Day ten:  wound was closed using skin grafting and patient discharged on day eleven. 

Case #3: patient presented with necrotizing fasciitis of perineum.  Day one:  first surgical debridement with antibiotic soaked fluff gauze to wound post operatively.  Day two:  second debridement with NPWTi placement instilling 20ml.  Day twelve:  surgical flap closure completed and patient discharged on day eighteen. 

Cost effective and advanced treatments need to be used for optimizing patient outcomes.  Decreased inpatient length of stay to close the complex wound is only one of the many cost savings.   NPWTi has shown accomplishment of these objectives.