A New Dressing Application Method in Managing Orthopedic Surgical Incison Drainage Utilizing Negative Pressure Wound Therapy

Statement of Clinical Problem:

For hip or knee incisions, JP drains are not always effective in managing drainage.  Excess drainage can lead to complications, ranging from delayed wound healing to discomfort and maceration of skin.  Frequent dressing changes require nursing time and managing drainage is challenging. 

Description of Past Management:

Typical management focuses on frequent absorptive dressing changes.  Dressings are sometimes reinforced rather than changed leading to tissue maceration, discomfort, and skin irritation from tape removal.

Current Clinical Approach:

Between June 2013 and October 2014 the three member team of WOC nurses, in collaboration with orthopedic surgeons, at a large teaching hospital in the Southeastern United States, used negative pressure therapy over closed incisions in 23 hip or knee surgical patients.  In most cases, negative pressure therapy was initiated 2 days postoperatively to manage drainage. The newly developed application method involved: transparent film along either side of incision line adjacent to staples, strip of contact layer with silver to cover staples, ribbon of sterile open cell sponge over the contact layer, occlusive film dressing to cover using negative pressure.  This method differs from use of hydrocolloid to protect skin and provides protection to staples and skin.

Patient Outcomes:

Outcomes for these 23 consecutive patients over 16 months included: elimination of skin maceration; no tissue injury from tape or negative pressure; and dressing changes decreased to twice weekly. Patients reported increased comfort and cost savings were realized due to reduced dressing-related product use.  In addition, there is potential for reduction in length of stay with one case discharged one week earlier than anticipated.

Conclusions:

Use of this new dressing method for negative pressure therapy holds promise in reducing nurses’ burden and product costs. However, additional longitudinal data is warranted, including hospital length of stay and days to wound closure.