NPWTi-d in 30 Patients: Settings, Usability & Early Outcomes
NPWT With Instillation (NPWTi‑d) in Real‑World Practice: Early 30‑Patient Evaluation From a Kuala Lumpur Wound‑Care Unit
Medical education note: This article is for clinicians and is not a substitute for patient‑specific medical advice.
Quick take
A Kuala Lumpur wound‑care unit conducted an early evaluation in 30 consecutive patients using a new negative pressure wound therapy with instillation and dwell (NPWTi‑d) unit. Clinicians reported rapid wound‑bed improvement, uniform granulation, and no adverse events. Therapy typically ran ≤2 weeks, with many patients moving to grafting or surgical closure after a single treatment cycle. Instillation parameters used in practice were every 2–4 hours, starting at ≈ one‑third of wound volume per cycle, and clinicians could adjust settings in real time without stopping therapy.[1,2]
These observations align with guidance and reviews showing NPWTi‑d can improve wound preparation compared with standard NPWT in appropriately selected complex wounds. Consensus statements generally recommend a dwell time around 10 minutes per cycle and endorse normal saline as the default instillation solution, with adjustments for wound bioburden, location, and patient factors.[3,4]
Study at a glance
(One of the patients in Kuala Lumpur needing advanced wound therapy)
Setting & users. This was a hospital‑based evaluation so multiple clinicians could test usability and patient response; an intuitive multilingual touchscreen interface supported rapid adoption at the bedside. [1,2]
Device features. The platform combines linear infusion for predictable solution delivery with a denser reticulated foam intended to improve wound‑bed contact and fluid distribution, usable either bedside or pole‑mounted.[1]
Change interval. Dressings were changed approximately every 3 days during the evaluation, consistent with NPWTi‑d programs that typically perform changes about three times per week.[1,5]
(Same patient after two cycles of NPWI-t treatment and three weeks recovery)
Results. All 30 patients tolerated therapy with no reported device‑related adverse events. Clinicians described rapid granulation, more uniform fill‑in of cavities, and less pocketing compared with prior experience using standard NPWT, with no significant usability issues noted at the bedside.[1,2]
Duration. No case required more than two weeks of NPWTi‑d; many patients transitioned to grafting or surgical closure after a single treatment cycle once the wound bed had granulated and bioburden was controlled.[1]
Starting parameters used locally. Instillation was scheduled every 2–4 hours with an initial volume target of ≈ one‑third of the calculated wound volume per cycle; volume and timing were then titrated to seal integrity, exudate, and patient comfort—similar to other programs that use ~⅓ wound volume and 10‑minute dwell times.[1,9]
Interpretation. These early signals suggest that NPWTi‑d can be an efficient bed‑preparation tool with good tolerability and workflow fit. However, existing systematic reviews and meta‑analyses still classify the overall certainty of NPWTi‑d evidence as low and emphasize the need for larger, well‑designed comparative trials to quantify effects on closure time, length of stay, and costs.[5,8]
How this lines up with broader evidence
Guidance & consensus. The EWMA 2024 NPWT update and the international NPWTi‑d consensus update describe NPWTi‑d as an adjunct option for complex, contaminated, or infected wounds once adequate debridement is achieved. They typically recommend ~10‑minute dwell times, 2–4‑hour negative‑pressure phases at −125 mmHg, and normal saline as first‑line instillation solution unless a targeted agent is indicated.[4,11]
Effectiveness vs comparators. A 2023 orthoplastic meta‑analysis found NPWTi‑d superior to NPWT or conventional dressings for complete wound closure and reduced complications in orthoplastic wound care, although study quality and heterogeneity limit certainty. A separate RCT‑only meta‑analysis reported that NPWTi produced fewer surgeries and dressing changes and smaller wound area at end of treatment than NPWT alone, with similar time to closure and length of stay.[6,7]
Parameter pragmatics. Expert panels and practical programs commonly aim for 2–4‑hour cycle intervals with dwell times of 10–20 minutes and −125 mmHg suction, and several clinical and mechanistic series describe instillation volumes of approximately one‑third of wound volume as a pragmatic starting point—mirroring the Kuala Lumpur team’s operational settings.[3,9]
Clinician‑ready protocol (built from the cohort + guidance)
1) Indications & triage
Consider NPWTi‑d when you need rapid bed optimization—bioburden management, slough reduction support, and uniform granulation—before definitive closure or grafting, especially in wounds with complex topography, undermining, or heavy exudate after sharp debridement.[3,4]
2) Set‑up & parameters
Solution. Start with normal saline (0.9%) unless a specific antiseptic or antimicrobial solution is indicated (e.g., high biofilm burden, infected hardware), reflecting consensus that saline is the preferred default instillation fluid.[3,4]
Volume. Begin at roughly one‑third of wound volume per cycle, then adjust based on seal integrity, foam saturation, pain, and leakage—an approach supported by published NPWTi‑d technique descriptions and clinical case series.[2,9]
Dwell time. Aim for ~10 minutes of dwell per cycle as a practical starting point, lengthening or shortening based on wound size, fluid pooling, seal reliability, and the solution’s manufacturer guidance.[3,4]
Cycle interval. Program cycles every 2–4 hours. Consider higher frequency (shorter intervals) if exudate, odor, or debris remain problematic, and lower frequency in seal‑challenged locations or fragile periwound skin.[3,5]
Negative pressure. Resume standard NPWT pressure during the suction phase per local protocol—commonly −125 mmHg—then titrate for pain, bleeding risk, and perfusion, consistent with international consensus and NPWT guidance documents.[3,11]
3) Dressing management
Foam contact. Use the denser or wound‑specific foam to achieve full contact with the bed and track into undermined areas, minimizing pockets that can retain exudate or fluid and decrease mechanical stimulation.[3,11]
Change interval. In this cohort, clinicians changed dressings every 3 days; adjust the interval earlier if there are leaks, pain spikes, odor, or rising bioburden. Many NPWTi‑d trials and reviews report therapy durations of ~7–14 days with dressing changes several times per week.[1,5]
4) Decision points
After one cycle (≈3–7 days). If granulation is uniform, pockets are reduced, and exudate or odor are controlled, consider proceeding to closure or grafting rather than automatically continuing additional NPWTi‑d cycles, as seen for many patients in this series.[1,5]
If stalled. If bed preparation plateaus, re‑debride as appropriate and reassess perfusion, systemic infection control, glycemic status, and offloading. Adjust dwell time, instilled volume, and cycle interval, and consider targeted solutions in line with evidence‑based NPWTi‑d recommendations.[3,10]
Safety, documentation & discharge planning
Safety in this cohort. Across 30 patients, no device‑related adverse events were recorded, aligning with other small NPWTi case series from the same centre that reported favourable safety and tolerability.[1,2]
Document. At each change, document wound dimensions and tissue types; solution choice; instilled volume per cycle; dwell time; cycle interval; pressure setting; wear time; pain scores; and reasons to escalate, de‑escalate, or proceed to closure—echoing recommendations from structured NPWTi‑d protocols.[10,11]
Transition to home/community. For stable patients, a unit with a simple multilingual touchscreen and on‑the‑fly parameter changes can support step‑down or outpatient continuity, provided that caregivers are trained and follow the same documentation and alarm‑management routines emphasized in modern NPWT guidance.[1,11]
FAQ
What solution should I start with for NPWTi‑d?
Most consensus statements recommend normal saline as the default starting solution, with antiseptic or antimicrobial options reserved for clearly infected or high‑risk wounds and chosen based on product‑specific evidence and stability.[3,4]
How much fluid per cycle?
A practical starting point is about one‑third of wound volume per cycle, then titrate up or down according to seal reliability, periwound maceration, patient comfort, and observed foam saturation; this “one‑third rule” is described in both institutional series and technical reports.[2,9]
What dwell time and cycle frequency?
Consensus recommendations favour dwell times of roughly 10–20 minutes followed by 2–4 hours of negative pressure at −125 mmHg, with clinicians shortening dwell in leaky wounds and lengthening it in fibrinous beds.[3,4]
Does NPWTi‑d “beat” standard NPWT?
A 2023 orthoplastic meta‑analysis found NPWTi‑d superior to NPWT or conventional care for wound closure and complication rates, while an RCT‑only meta‑analysis showed benefits in fewer surgeries, fewer dressing changes, and smaller final wound area—but similar time to closure—highlighting both promise and current evidence limitations.[6,7]
Bottom line
In this 30‑patient Kuala Lumpur cohort, a new NPWTi‑d platform was associated with rapid, uniform granulation, no reported device‑related adverse events, and frequent readiness for closure after a single treatment cycle. Starting with normal saline, ~10‑minute dwell times, 2–4‑hour cycles, and instilled volumes around one‑third of wound volume, then individualizing based on seal integrity, pain, and exudate, aligns this real‑world practice with contemporary consensus guidance and meta‑analytic signals that support NPWTi‑d as a powerful bed‑preparation adjunct before definitive closure.[1,6]
References
Hospital Kuala Lumpur Wound‑Care Unit. Early 30‑patient evaluation of a negative pressure wound therapy with instillation and dwell device in complex wounds. Internal observational cohort, Kuala Lumpur, Malaysia; 2025.
Nair HKR, Ng YY. The utilisation of negative pressure wound therapy with instillation (NPWTi) in the management of complex wound—a Malaysian case series. Wounds Asia. woundsasia.com
Kim PJ, Attinger CE, Olawoye O, et al. Negative Pressure Wound Therapy With Instillation: Review of Evidence and Recommendations. Wounds. 2015;27(12 Suppl):S2–S19. PubMed
Kim PJ, de Leon J, et al. Negative pressure wound therapy with instillation: international consensus guidelines update. Int Wound J. 2020;17(1):174–186. PMC
Clinical application and efficacy of negative pressure wound therapy with instillation and dwell time (NPWTi‑d): a systematic review and meta‑analysis. Int Wound J. 2021;18(3):e??? (title and journal per PubMed). PMC
De Pellegrin L, Feltri P, Filardo G, et al. Effects of negative pressure wound therapy with instillation and dwell time (NPWTi‑d) versus NPWT or standard of care in orthoplastic surgery: a systematic review and meta‑analysis. Int Wound J. 2023;20(6):2402‑2413. PMC
Wang G, Xu H, Xu G, et al. Clinical outcomes of negative pressure wound therapy with instillation vs standard negative pressure wound therapy for wounds: a meta‑analysis of randomised controlled trials. Int Wound J. 2023;20(5):1739‑1749. PMC
The Effect of Negative‑Pressure Wound Therapy with Instillation Compared to Current Standard Care on Wound Closure Time of Infected Wounds: A Systematic Review and Meta‑Analysis. Plast Reconstr Surg. 2022;150(4):e??? (systematic review of NPWTi vs standard care in infected wounds). PubMed
Aycart MA, Earle SA, et al. Mechanisms of Action of Instillation and Dwell Negative Pressure Wound Therapy with Case Reports of Clinical Applications. Cureus. 2018;10(9):e3377. PMC
Cortell‑Fuster C, Gaspar‑Carreño M, Achau‑Muñoz R, et al. Negative pressure therapy with instillation for the treatment of infected wounds: recommendations of utilization based on evidence. Farm Hosp. 2019;43(1):6‑12. ScienceDirect
Apelqvist J, Fagerdahl AM, Willy C, Téot L. Negative Pressure Wound Therapy: An Update for Clinicians and Outpatient Care Givers. EWMA Document. J Wound Manag. 2024;25(Suppl 2).ure.
