Pay attention to the contraindications for NPWT

FDA identifies top concerns

The U.S. Food and Drug Administration Alert warning of the deaths and injuries that resulted from the use of Negative Pressure Wound Therapy (NPWT) outlined the following cautions:

NPWT is contraindicated for patients with these conditions or wound types:

• necrotic tissue with eschar present;

• untreated osteomyelitis;

• non-enteric and unexplored fistulas;

• malignancy in the wound;

• exposed vasculature;

• exposed nerves;

• exposed anastomotic site;

• exposed organs.

Risk factors and characteristics that should be considered before implementation of NPWT:

• patients at high risk for bleeding and hemorrhage;

• patients on anticoagulants or platelet aggregation inhibitors;

• patients with:

– friable vessels and infected blood vessels;

– vascular anastomosis;

– infected wounds;

– osteomyelitis;

– exposed organs, vessels, nerves, tendon, and ligaments;

– sharp edges in the wound (i.e. bone fragments);

– spinal cord injury (stimulation of sympathetic nervous system);

– enteric fistulas.

• patients requiring:

– MRI;

– hyperbaric chamber;

– defibrillation.

• patient size and weight.

• Use near vagus nerve (bradycardia).

• Circumferential dressing application.

• Mode of therapy — intermittent versus continuous negative pressure.