Evaluating Efficiency and Complication Rates of Topical Negative Pressure Therapy in the Home Care Setting
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Abstract: Background. Topical negative pressure (TNP) therapy has been used since 1995 and growing evidence has facilitated its adoption as the standard of care in wound care. Despite its widespread use, literature on the use of TNP therapy in the home care setting is scarce. Methods. A retrospective study of 140 patients treated with TNP therapy in the outpatient department at a single institution between December 2005 and October 2008 was performed. Results. A total of 140 patients with 146 wounds were treated with TNP therapy. There were 74 male and 66 female patients (mean age was 58 years). In total, 92% of patients had a positive outcome. A total of 38 complications occurred, six of which eventually resulted in a negative outcome. The remaining 32 had positive outcomes. Thirteen complications were considered typical for home care treatment, one of which had a negative outcome. Conclusion. Healing rates in the home care setting seem to be comparable to rates reported for patients treated in the hospital. Complication rates are low in both hospital and home groups.
Address correspondence to:
Pascal Steenvoorde, MD, PhD, MSc
Medical Spectrum Twente
Enschede, The Netherlands
Haaksbergerstraat 55
7513 ER Enschede
Email: p.steenvoorde@mst.nl
Topical negative pressure (TNP) therapy is a noninvasive procedure where negative pressure is used to treat acute, subacute, or chronic wounds. The TNP system incorporates a polyurethane or polyvinyl alcohol foam dressing (Kinetic Concepts Inc [KCI], Houten, The Netherlands) that maintains porosity under suction and equalizes the pressure applied across the wound bed.1,2 This procedure is thought to provide various mechanisms that support healing, increase local blood flow, reduce edema, stimulate formation of granulation tissue and cell proliferation, remove soluble healing inhibitors, reduce bacterial load, and draw wound edges together.1,2 However, the reduction of bacterial load has been debated.3
The therapy has been utilized since 1995 and growing evidence caused the adoption of TNP as the standard of care in wound care management.1,2,4,5 TNP is an expensive therapy, especially in a clinical setting. However, it is stated that TNP could prevent high costs because of factors such as faster healing times.1,3,5 Treatment in a home care setting avoids escalating costs associated with hospitalization.5 Complications intrinsic to TNP, such as skin maceration, which occur in the clinical setting will probably also occur in the home care setting. Some complications are exclusive to the home care setting. For instance, a blind patient burned part of the TNP apparatus while cooking at home—fortunately, the patient was not severely harmed. Complications associated with TNP and venous thrombosis is another example, which the authors have addressed previously.6
Published TNP research mainly contains studies performed in a clinical setting. Patients also can be treated in the home with a mobile TNP unit. Evidence regarding the safety and efficiency of TNP therapy in the home care setting is limited.7,8 The aim of this single-center, retrospective study was to investigate if TNP therapy in a home care setting is just as feasible, effective, and safe compared to a clinical setting.
Methods
Patients. Retrospective data comprised 140 patients who were treated at home with TNP therapy during the period of December 2005 through October 2008 and were treated initially in the Rijnland Hospital (Leiderdorp, The Netherlands).
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