Decreasing Wound Healing Time With Use of Negative Pressure Wound Therapy With Instillation

Purpose: Pressure injuries negatively impact patients by causing pain, decreasing quality of life, increasing the risk of infection, and increasing length of stay. 3 million patients per year are affected by pressure injuries. The cost to treat pressure injuries is approximately $10 billion annually in the United States (Doughty & McNichol, 2016). Treatment for hospital acquired Stage 3 and Stage 4 pressure injuries are not reimbursed by the Centers for Medicare and Medicaid Services. Through clinical experience; Stage 3 and Stage 4 pressure injuries have taken up to a year or more to fully granulate requiring weekly sharp debridements and multiple treatment modalities. Negative Pressure Wound Therapy with instillation (NPWTi) decreases healing time and lessens financial burden. NPWTi has been shown to disrupt biofilm (Yang MD, Goss MD, Alcantaraz MD, Schultz PhD, & Lantis II MD, 2017), increase granulation tissue formation, remove infectious material and protects from external contamination sources while delivering the prescribed therapy (KCI, 2015).

Objective: To optimize wound healing with the use of NPWTi.

Outcomes: A 68 year old paraplegic, malnourished female was admitted with an unstageable sacral/coccygeal pressure injury. MRI confirmed coccygeal osteomyelitis. Sharp debridement was performed to remove eschar on day 2 of admission. Post debridement; wound Stage 4 pressure injury with exposed bone along with yellow slough tissue. NPWTi of normal saline was initiated on day 4 of admission. The patient received weekly conservative sharp debridements along with NPWTi dressing changes three times a week. Full granulation was achieved in six weeks of treatment. She was discharged from the hospital and is followed outpatient by a wound care center.

Conclusion: NPWTi granulated a full thickness wound in six weeks. The patient’s quality of life was improved by allowing her to return home sooner.