Advice
The technology
The technology
Prevena (Kinetic Concepts Inc. an Acelity Company) is a wound management system that is placed over a closed surgical incision. The device applies continuous negative pressure. This helps promote healing by holding the incision edges together, drawing fluid and exudate out of the wound, reducing oedema and stimulating perfusion. The device is single use and can stay in place for up to 7 days. Prevena is available in a range of sizes and can be customised to fit any incisions.
Prevena uses a stabilisation layer to make sure there is full and airtight adhesion to the skin. The part of the device touching the incision contains 0.019% ionic silver to minimise bacterial growth within the dressing.
Innovations
The company claims that Prevena is innovative because the device uses 2.5 cm of foam filler which, when 125 mmHg negative pressure is applied, gives uniform pressure across the wound. The company claims that this stops gaps in the dressing where excess fluid would otherwise collect. The foam filler also reduces lateral tension holding the edges of the wound together.
The Prevena 125 Therapy Unit provides the negative pressure. This unit has an innovative VisiCheck LED display that tells the patient or staff of the leak rate of the system so that any problems are identified at an early stage. The device can also be attached to other vacuum-assisted closure systems, allowing for more flexibility.
Current care pathway
The aim of closing an incision after surgery is to start the healing process. In some cases, there may be post-surgical complications such as infection, seroma, haematoma, dehiscence, delayed healing and abnormal scarring, especially in people at high risk of developing surgical site complications. People could be considered to be at high risk because of intrinsic patient factors, such as uncontrolled insulin-dependent diabetes, renal dialysis, poor physical status (based on the American Society of Anaesthesiologists physical status classification) and a high BMI. A patient may also be considered at risk if they have emergency procedures such as a caesarean section or elective procedures such as cardiac or colorectal surgery.
Post-surgical care of an incision site is aimed at promoting healing, avoiding complications and minimising scarring. According to NICE's guideline on preventing and treating surgical site infections, patients should have post-surgical care that involves:
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applying wound dressings using aseptic techniques
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wound cleaning with sterile saline for up to 48 hours and cleaning with tap water afterwards
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antibiotics, if a surgical site infection is suspected
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debridement (which may involve surgery) to remove the dead tissue if dead or infected tissues seem to be slowing down the healing process
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these are as well as other infection prevention measures at the pre- and intra-operative stages of a surgical procedure.
NICE has also published medical technologies guidance on PICO negative pressure wound dressings for closed surgical incisions.
Population, setting and intended user
Prevena would be used instead of conventional post-surgical wound dressings to manage closed surgical incision wounds. The company claim that Prevena can provide the most benefit to people who are at increased risk of surgical site infection. For example, people with obesity, diabetes, renal insufficiency, poor nutrition, traumatic injury, chronic obstructive pulmonary disorder and those having emergency surgery.
It would be applied by healthcare professionals. It could be used in an inpatient setting, to prevent surgical site complications peri-operatively, with treatment continuing in an outpatient department or community setting.
Costs
Technology costs
Prevena kits (including dressing, fluid collection canister and vacuum-assisted closure connector) are priced at £299 and £351 depending on size; this is more expensive than current standard of care. Prevena kits can also be bought without a vacuum-assisted closure unit so that they may be used with existing equipment.
|
Dressing |
Size |
Cost |
Cost of dressing only (for use with existing pressure units) |
|---|---|---|---|
|
Prevena Peel & Place System Kit |
6 cm × 13 cm |
£299 |
£179 |
|
Prevena Peel & Place System Kit |
6 cm × 20 cm |
£299 |
£179 |
|
Prevena Plus System Kit − customisable |
6 cm × 90 cm |
£351 |
£233 |
Costs of standard care
No standard list of dressings for closed surgical incisions has been identified. The costs described below are for a selection of dressings in the NHS supply chain catalogue.
|
Dressing |
Size |
Cost |
|---|---|---|
|
Tegaderm |
10 cm × 10 cm |
£1.29 |
|
Mepore |
10 cm × 12 cm |
£0.55 |
|
Opsite |
10 cm × 12 cm |
£0.55 |
Resource consequences
Over 30 NHS trusts and hospitals have ordered Prevena from the company.
The company claims that using Prevena is likely to lead to cost savings because of reduced incidence of surgical site infections and other complications. This in turn could lead to reduced readmissions, reoperations, length of stay and antibiotic use.
The company provides staff training through online resources and employs clinical advisers to provide advice and training in hospitals.