1. Specialty Therapies for Wound Care
Diane L. Krasner
PhD, RN, FAAN
&
Lia van Rijswijk
DNP, MSN, RN, CWCN
Module #11

2. Objectives
To describe the use of Specialty Therapies to augment, supplement or enhance usual wound care
To appraise the role of nurses when specialty therapies are used for wound care

3. Specialty Therapies for Wound Care
Modalities used to augment, supplement or enhance usual wound care may be selected to: - Help meet goals of patient care (e.g., contain exudate, reduce odor) - Facilitate healing (e.g., when wound fails to heal using moisture retentive dressings)
Krasner DL, Sibbald RG, Woo KY, Norton L. (2012) Interprofessional Perspectives on Individualized Wound Device Product Selection. WoundSource White Paper. Kestrel Health Information. Downloadable at

4. Also described as: - Adjunctive Therapies - Alternative Therapies
Negative Pressure Wound Therapy followed by Delayed Primary Closure
Photos by Dr. Diane L. Krasner, Used with permission

5. Selection / use often linked to a Healthcare Specialty:
Examples: Hyperbaric Oxygen Therapy (HBOT) - Hyperbaric Physicians, Nurses, Technicians, Respiratory Therapists Pulsed Lavage - Surgeons, Podiatrists
Warriner RA, Wilcox JR, Barry R. (2014) The Role of Oxygen and Hyperbaric Medicine.
In: Krasner, D.L. (Ed). Chronic Wound Care: The Essentials. Malvern, PA., HMP Communications .
Downloadable at

6. Selection/Use Often Linked to a Healthcare Specialty:
Examples (continued): Electrical Stimulation and Pulsed Electromagnetic Field Therapy - Physical Therapists, Nurses Ultrasound - Physical Therapists

7. Many Specialty Therapies for Wound Care Involve the Use of Devices that Require Special Guidelines for Use:
Example: Negative Pressure Wound Therapy (NPWT)
FDA Safety Alert. Negative Pressure Wound Therapy (NPWT) Systems – Preliminary Public Health Notification. U.S. Food and Drug Administration Website. Published February 24, Available at:
FDA Safety Communication. Update on Serious Complications Associated with Negative Pressure Wound Therapy Systems. U.S. Food and Drug Administration Website. Published February 24, Available at:

8. Always Review Medical Device:
Indications
Contraindications
Precautions (warnings)
Guidelines for Use
Smith APS, Whittington K, Frykber R, de Leon JM. (2014) Negative Pressure Wound Therapy.
In: Krasner, D.L. (Ed). Chronic Wound Care: The Essentials. Malvern, PA., HMP Communications . Downloadable at

9. Examples of Contraindications and Precautions:
NPWT should not be used for debridement - remove slough and eschar from the wound bed prior to using NPWT.
NPWT should be used with caution in patients who are on anti-coagulation therapy or when vital structures are exposed.
Implement measures to protect against backsplash when using high pressure irrigation (pulsed lavage).
Brady, EH. Strategies for the effective management of challenges associated with negative pressure wound therapy WoundSource White Paper. Kestrel Health Information.
Available at
Beitz J.M. & van Rijswijk, L. Developing Evidence-Based Algorithms for Negative Pressure Wound Therapy in Adults with Acute and Chronic Wounds: Literature and Expert-based Face Validation Results. Ostomy Wound Manage 2012; 58(4),50-69.
Available at

10. Nurses’ Roles with Specialty Therapies for Wound Care include:
Monitoring the patient and the wound status (including surrounding skin)
Monitoring device function (e.g. NPWT, HBOT)
Applying certain device dressings (e.g. NPWT)
Assisting with the delivery of treatments (HBOT)
Educating patients and their Circle of Care

11. Nurses’ Assess/Monitor for & Report Complications:
Examples:
Changes in patient status (e.g., changes in vision following HBOT)
Pain
Delayed wound healing / increasing wound size
Bleeding
Device malfunction

12. SAFETY IS THE #1 CONCERN REMEMBER:
Device-related adverse events should be reported to manufacturer or the
United States Food and Drug Administration at:

13. Caution: Off-label Use of Devices
Know your Facility
Chain-of-Command

14. Communication & Documentation of:
Device Specifics & Dressing Details
(Physician Order Usually Required)
Example for NPWT:
Specific device type & brand
Continuous or intermittent
Pressure setting
Dressing change frequency
Type of foam/gauze used
Type of interface dressing used
Type of cleansing solution used
Type of pain medication/pre-medication

15. Device Use Issues Cost Access
Knowledge/Skills of Patient and his/her Circle of Care
Prescriber Knowledge
Evidence-based Practice
Healthcare Staff Education

16. “Five Rights” Right dressing materials
Right device (& orders)
Right dressing materials
Right teaching/learning (documented)
Right instructions (in writing)
Right communication & transitions of care

17. Key Nursing Concepts Assessment Caring Communication Education
Evidence-based Practice
Healing
Pain
Safety
Treatment

18. Key Nursing Diagnoses Alteration in Comfort r/t
Impaired Skin Integrity
Impaired Tissue Integrity
Potential for Injury
Knowledge Deficit r/t
Self Care Deficit r/t

19. Key Nursing Practice Issues
When using NPWT, always cleanse the wound before applying a new dressing (foam or gauze) and drape.
Stay within your scope of practice. Communicate with your supervisor or use your facility chain-of-command if you are concerned about the use of a device, the patient/wound response or if you are concerned that you are practicing outside your scope of your practice.

20. Websites for Further Information on Types of Wounds
- Association for the Advancement of Wound Care
- Canadian Association for Wound Care
- National Pressure Ulcer Advisory Panel
- World Union of Wound Healing Societies
- Wound Ostomy Continence Nurses Society