The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Negative pressure wound therapy for the open abdomen.
This guidance updates and replaces NICE interventional procedure guidance 322 (December 2009).
Negative pressure wound therapy (NPWT) for the open abdomen may be used in the management of patients with an open abdominal wound (laparostomy) when the gut and other intraperitoneal organs are exposed. The abdomen is left open as part of the surgical treatment of complex intra-abdominal problems that make closure difficult, such as severe sepsis, abdominal trauma and after grafting of ruptured aortic aneurysms.
First-line management of the open abdomen may include use of dressings or impermeable devices (e.g. Bogota bag) to protect the exposed organs and limit leakage of fluid. The abdomen may be left to heal by secondary intention or delayed closure may be done using sutures, mesh repair, skin grafts, muscle flaps or a combination of these. The choice of closure technique depends on the size of the wound and other clinical considerations.
In addition to the OPCS-4 codes used to classify the procedure performed which resulted in the open abdomen (i.e. repair of ruptured abdominal aneurysm or gastrointestinal tract surgery) the following OPCS-4 codes are assigned to indicate that negative pressure wound therapy has been applied to the abdomen:
S57.7 Dressing of skin using vacuum assisted closure device NEC
Z92.6 Abdomen NEC
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.