1. Susan E. Duffield, BSN, RN, CWOCN
VACUUM ASSISTED CLOSURE (V.A.C.) THERAPY: An Advanced System for Wound Healing in the Home Setting
Susan E. Duffield, BSN, RN, CWOCN

2. Learning Objectives Define Negative Pressure Wound Therapy (NPWT)
Discuss guidelines for the appropriate use of NPWT
Identify patients with wounds who would benefit from NPWT and patients for who this modality would be contraindicated.
Discuss guidelines for the application of NPWT.
Explain the basic steps in obtaining insurance reimbursement for NPWT in the home care setting.

3. V.A.C. Therapy a.k.a. NPWT
NPWT applies continuous or intermittent sub-atmospheric pressure, or suction, to the wound bed via a computerized vacuum pump attached to an open-cell foam sponge that is placed in the wound and secured with an adhesive semi-occlusive dressing. Wound fluids are evacuated via a tubing system placed on the foam at one end and connected to a disposable canister housed in the therapy unit on the opposite end.

4. The V.A.C. System
Manufactured by Kinetic Concepts, Inc., San Antonio, TX.

5. Clinical Benefits of V.A.C. Therapy
Maintenance of moist, protected environment
Removal of excess interstitial fluid from the wound periphery
Increased local vascularity
Decreased bacterial colonization
Quantification/qualification of wound drainage
Increased rate of granulation tissue formation
Increased rate of contraction
Increased rate of epithelialization

6. V.A.C. Therapy Indications
Acute wounds
Full-thickness surgical wounds
Chronic wounds
Stage 3 pressure ulcers
Stage 4 pressure ulcers
Diabetic ulcers
Venous stasis ulcers
Traumatic wounds
Dehisced wounds

7. Stage 3 Pressure Ulcer
Full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to (but not through) the underlying fascia. The ulcer presents clinically as a deep crater with or without undermining adjacent tissue.
Kinetic Concepts, Inc.

8. Stage 4 Pressure Ulcer
Full thickness skin loss with extensive destruction; tissue necrosis; or damage to muscle, bone or supporting structures (e.g. tendon, joint capsule). Note: Undermining and sinus tracts may also be associated with Stage IV pressure ulcers.
Kinetic Concepts, Inc.

9. Venous Stasis Ulcer Ulceration associated with venous hypertension
Johns Hopkins Medical Images

10. Diabetic Foot Ulcer
Diabetics are prone to foot ulcerations due to both neurologic and vascular complications
Wound Care Information Network

11. V.A.C. Therapy Precautions
Acute bleeding, patients on anticoagulants, or difficult wound homeostasis.
Ensure all vessels are adequately protected with overlying fascia, tissue, or other protective barrier.
Greater care should be taken with respect to weakened, irradiated, or sutured blood vessels.

12. V.A.C. Therapy Contraindications
Malignancy in wound
Necrotic tissue with eschar
Untreated osteomyelitis
Fistulas to organs or body cavities
Do not place V.A.C. dressing over exposed arteries or veins

13. Clinical Efficacy 300 wounds treated (acute, subacute, and chronic)
296 wounds improved with an  rate of granulation tissue formation
Wounds were treated until completely closed, split-thickness skin graft applied, or flap rotated
Annals of Plastic Surgery, 1997

14. Cost Effectiveness of V.A.C. Therapy
Retrospective chart review of 1032 Medicare home care patients
61% faster healing rate
38% less cost
Ostomy/Wound Management, 1999

15. APN Orders for V.A.C. Therapy
Location of wound
Size of foam dressing (S, M, L, XL)
V.A.C. Therapy setting (usually 125 mm Hg continuously or intermittently 5 min on/2 min off)
Frequency of dressing changes – usually every 48 hours

16. Application of the V.A.C. Visiting Nurse
Home caregivers and patients able to apply and remove V.A.C.

17. Dressing Application Overview
Place foam in wound
Cover with semi-occlusive dressing
Secure tubing
Connect tubing to the V.A.C. therapy unit

18. Operating the V.A.C. Unit Insert canister securely in unit
Connect dressing tubing to canister tubing
Press power button ON
Follow prompts
Start therapy
Therapy should be on 24 hours each day

19. Alarms
Therapy OFF
Canister is full
Air leak

20. Monitoring and Progression of Wound Healing
Weekly wound measurements
Signs of healing
Oozing of blood as granulation occurs
Wound bed becomes redder
Gradual  in wound drainage
 in dimensions of wound
Average length of treatment is 4-6 weeks

21. Ambulatory Options
For the patient who is goes to work or school, a battery powered model is available.
Wound must be minimally draining.

22. Termination of V.A.C. Therapy
Adequate granulation base achieved allowing for:
Changing to conventional dressing changes
Split-thickness skin graft
Flap closure

23. Reimbursement Guidelines for Home V.A.C. Therapy
Medicare B
Complete Initial Statement of Ordering Physician (ISOP) (available at
Fax ISOP to KCI
Mail completed original ISOP to KCI
Private Insurance
Complete above steps
Some insurers may require additional information, such as clinical notes, before issuing authorization for coverage
Medicaid
Not currently covered in NJ

24. Additional Information
1-877-WOUNDVAC
V.A.C. Recommended Guidelines for Use: Physician and Caregiver Reference Manual (Kinetic Concepts, Inc.)

25. Key Points Non-invasive active therapy for wound healing
Indicated to treat a variety of acute & chronic wounds
Dressing changes every 48 hours
Reimbursable under Medicare B & most private insurers