If a patient on NPWT reports severe pain, which action is most appropriate?

• A. Change the wound filler
• B. Change the NPWT unit brand
• C. Obtain wound cultures
• D. Avoid placing drainage tubing over bony prominences

Answer: (A)

Severe pain with NPWT usually comes from how the wound interface is packed. The wound filler (foam or gauze) must fill the cavity and contact the wound bed without pressing on edges or creating uneven pressure. When packing is improper—too tight, not contoured to the wound, or with foam fragments—it can irritate tissue and cause sharp or deep pain. Replacing and properly re-packing the wound filler allows the negative pressure to be distributed evenly, removes any irritants, and typically relieves the pain. After changing the filler, recheck the dressing, confirm the correct pressure, and ensure the seal is intact.

The other options don’t address the root cause of the pain: changing the unit brand won’t fix tissue irritation at the wound interface, obtaining wound cultures isn’t indicated for pain without signs of infection, and avoiding tubing over bony prominences is good practice but won’t resolve pain caused by the packing material itself.