Advice
The technology
The technology
NATROX (Inotec AMD) consists of a rechargeable, battery-operated oxygen generator and an oxygen delivery system (ODS). The oxygen generator is reusable so can be used again on different patients. It's a portable device about the size and weight of a mobile phone (107 g). The ODS is a sterile, single-use, web-like device which is placed directly onto the wound bed beneath the wound dressing. This allows any exudate to be managed as normal with the appropriate secondary dressing. Oxygen is delivered continuously to the wound through a flexible tube from the portable oxygen generator. NATROX can be used with other advanced wound therapies and dressings and is supplied with 2 rechargeable batteries.
Innovations
NATROX claims to be the only portable continuous oxygen delivery device for managing wounds available in the UK. It delivers 98% humidified oxygen directly to the wound bed with the aim of stimulating and improving wound healing. Previously, oxygen delivery to wounds has been through hyperbaric oxygen therapy, which is costly and requires people to be confined to either a full body or limb chamber for treatment.
Current care pathway
Wound care depends on the type of wound. Standard care is cleaning and dressing it. The best dressing to use depends on things like wound size and depth, and amount of exudate.
More complicated wounds, for example surgical site infections, diabetic foot problems, venous leg ulcers and pressure ulcers, can result in chronic non-healing wounds and need more advanced care. Care of these types of wounds aims to promote healing and minimise the risk of further complications. For diabetic foot or venous leg ulcer, healthcare professionals record the depth and position of the ulcer and offload or treat it with compression therapy to promote healing. If a non-healing wound is thought to be infected, healthcare professionals take a microbiological sample and prescribe an antibiotic to treat the infection. The wound is cleaned and debrided regularly, and dressed. Clinical staff choose a dressing that will promote healing and manage exudate based on the individual wound. Dressings should be changed or removed using aseptic non-touch technique. Some wounds are treated with topical negative pressure therapy. Chronic non-healing wounds typically need more advanced dressings. People may be referred to a specialist for multidisciplinary care, depending on wound aetiology. Tissue viability nurses assess wounds if they are seriously infected, if there is a differential diagnosis, or if the person has complex comorbidities.
The following guidelines have been identified as relevant to this care pathway:
Population, setting and intended user
NATROX can be used in primary and secondary care by different healthcare professionals, including tissue viability nurses, surgeons and podiatrists in secondary care, and community nurses and podiatrists in primary care. People using the device at home are responsible for ensuring the rechargeable oxygen generator remains charged between dressing and ODS changes. The company says NATROX can be managed by people and their carers at home. Some training is needed. Each treatment lasts 12 weeks, needing 20 to 30 ODS devices.
Costs
Technology costs
NATROX therapy costs between £300 and £500 per 12‑week treatment, depending on the number of ODS needed. The reusable oxygen generator is provided on loan for free, as long as ongoing purchases of the ODS devices are made. The company will loan extra oxygen generators, provided enough ODS devices are bought for further patients. The company reclaims the oxygen generator if ODS devices are no longer ordered. The cost of the technology is in addition to standard care, but the company claims the technology improves healing outcomes and so reduces the resource burden of chronic non-healing and complex wounds.
Costs of standard care
Different dressings are available as standard care for non-healing and complex wounds, priced according to size:
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soft polymer dressing £0.19 to £39.83
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hydrocolloid fibrous dressing £0.97 to £10.37
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antimicrobial dressing £0.18 to £64.13
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PICO negative pressure wound dressings £127.06 to £145.68
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VAC Veraflo treatment £82.06 per wound per day.
The average cost of treating a diabetic foot ulcer with an interactive dressing is £2,990 (based on 77 dressing changes), and £3,380 for non-interactive dressings (based on 118 dressing changes; figures from a report by the NICE resource and impact team). The national tariff for single amputation stump or partial foot amputation procedure for diabetes ranges from £1,692 to £12,767.
Resource consequences
NATROX is used in addition to standard care and so costs more than standard care alone. The company claims the technology could result in savings later on because of improved healing rates and fewer further interventions. Healthcare professionals and people using the device need training to use it, but this is included in the cost of the device.