Patent Publication Number: US-2011054810-A1

Title: Determining pressure

Description:
The present invention relates to apparatus and a method for the application of topical negative pressure (TNP) therapy to wounds. In particular, but not exclusively, the present invention relates to a method and apparatus for determining a negative pressure generated by a pump without requiring use of a specific pressure sensor. 
     There is much prior art available relating to the provision of apparatus and methods of use thereof for the application of TNP therapy to wounds together with other therapeutic processes intended to enhance the effects of the TNP therapy. Examples of such prior art include those listed and briefly described below. 
     TNP therapy assists in the closure and healing of wounds by reducing tissue oedema; encouraging blood flow and granulation of tissue; removing excess exudates and may reduce bacterial load and thus, infection to the wound. Furthermore, TNP therapy permits less outside disturbance of the wound and promotes more rapid healing. 
     In our co-pending International patent application, WO 2004/037334, apparatus, a wound dressing and a method for aspirating, irrigating and cleansing wounds are described. In very general terms, this invention describes the treatment of a wound by the application of topical negative pressure (TNP) therapy for aspirating the wound together with the further provision of additional fluid for irrigating and/or cleansing the wound, which fluid, comprising both wound exudates and irrigation fluid, is then drawn off by the aspiration means and circulated through means for separating the beneficial materials therein from deleterious materials. The materials which are beneficial to wound healing are recirculated through the wound dressing and those materials deleterious to wound healing are discarded to a waste collection bag or vessel. 
     In our co-pending International patent application, WO 2005/04670, apparatus, a wound dressing and a method for cleansing a wound using aspiration, irrigation and cleansing wounds are described. Again, in very general terms, the invention described in this document utilises similar apparatus to that in WO 2004/037334 with regard to the aspiration, irrigation and cleansing of the wound, however, it further includes the important additional step of providing heating means to control the temperature of that beneficial material being returned to the wound site/dressing so that it is at an optimum temperature, for example, to have the most efficacious therapeutic effect on the wound. 
     In our co-pending International patent application, WO 2005/105180, apparatus and a method for the aspiration, irrigation and/or cleansing of wounds are described. Again, in very general terms, this document describes similar apparatus to the two previously mentioned documents hereinabove but with the additional step of providing means for the supply and application of physiologically active agents to the wound site/dressing to promote wound healing. 
     The content of the above references is included herein by reference. 
     However, the above apparatus and methods are generally only applicable to a patient when hospitalised as the apparatus is complex, needing people having specialist knowledge in how to operate and maintain the apparatus, and also relatively heavy and bulky, not being adapted for easy mobility outside of a hospital environment by a patient, for example. 
     Some patients having relatively less severe wounds which do not require continuous hospitalisation, for example, but whom nevertheless would benefit from the prolonged application of TNP therapy, could be treated at home or at work subject to the availability of an easily portable and maintainable TNP therapy apparatus. 
     GB-A-2 307 180 describes a portable TNP therapy unit which may be carried by a patient clipped to belt or harness. It will be appreciated however that there may be certain inaccuracies associated with the provision of a desired pressure at a wound site. It is therefore desirable to be able to measure pressure in a TNP system accurately and promptly 
     It will be appreciated that with prior known pump units a problem is that the pressure provided by the pump must fall within predetermined desired threshold values. As the pump wears over time or when certain environmental factors change the pressure provided by the pump can vary which can cause complication or non ideal environments. Also certain known prior art pump systems are noisy during operation or when pressure control is initiated can cause ‘quiet’ or ‘loud’ periods. This can be of concern to a user. It will also be appreciated that a lack of smooth speed responses can reduce operational lifetimes as the pump rarely experiences full duty cycles. Still furthermore fluctuations in pressure can result in pain to a user. 
     One way to control and monitor pressure is to utilise one or more pressure sensors. However these are costly, are prone to error and can be unresponsive to rapid pressure changes. 
     It is an aim of the present invention to at least partly mitigate the above-mentioned problems. 
     It is an aim of embodiments of the present invention to provide a method and apparatus of determining a negative pressure generated by a pump of a topical negative pressure (TNP) system. 
     It is an aim of embodiments of the present invention to provide control of a suction pump of a topical negative pressure system without requiring a pressure sensor in the system. 
     According to a first aspect of the present invention there is provided a method of determining pressure in a topical negative pressure (TNP) system, comprising the steps of:
         determining a pumping speed associated with a pump element of the TNP system:   determining a flow rate in a flow path associated with the pump element; and   determining pressure in the flow path responsive to the pumping speed and flow rate.       

     The invention is comprised in part of an overall apparatus for the provision of TNP therapy to a patient in almost any environment. The apparatus is lightweight, may be mains or battery powered by a rechargeable battery pack contained within a device (henceforth, the term “device” is used to connote a unit which may contain all of the control, power supply, power supply recharging, electronic indicator means and means for initiating and sustaining aspiration functions to a wound and any further necessary functions of a similar nature). When outside the home, for example, the apparatus may provide for an extended period of operation on battery power and in the home, for example, the device may be connected to the mains by a charger unit whilst still being used and operated by the patient. 
     The overall apparatus of which the present invention is a part comprises: a dressing covering the wound and sealing at least an open end of an aspiration conduit to a cavity formed over the wound by the dressing; an aspiration tube comprising at least one lumen therethrough leading from the wound dressing to a waste material canister for collecting and holding wound exudates/waste material prior to disposal; and, a power, control and aspiration initiating and sustaining device associated with the waste canister. 
     The dressing covering the wound may be any type of dressing normally employed with TNP therapy and, in very general terms, may comprise, for example, a semi-permeable, flexible, self-adhesive drape material, as is known in the dressings art, to cover the wound and seal with surrounding sound tissue to create a sealed cavity or void over the wound. There may aptly be a porous barrier and support member in the cavity between the wound bed and the covering material to enable an even vacuum distribution to be achieved over the area of the wound. The porous barrier and support member being, for example, a gauze, a foam an inflatable bag or known wound contact type material resistant to crushing under the levels of vacuum created and which permits transfer of wound exudates across the wound area to the aspiration conduit sealed to the flexible cover drape over the wound. 
     The aspiration conduit may be a plain flexible tube, for example, having a single lumen therethrough and made from a plastics material compatible with raw tissue, for example. However, the aspiration conduit may have a plurality of lumens therethrough to achieve specific objectives relating to the invention. A portion of the tube sited within the sealed cavity over the wound may have a structure to enable continued aspiration and evacuation of wound exudates without becoming constricted or blocked even at the higher levels of the negative pressure range envisaged. 
     It is envisaged that the negative pressure range for the apparatus embodying the present invention may be between about −50 mmHg and −200 mmHg (note that these pressures are relative to normal ambient atmospheric pressure thus, −200 mmHg would be about 560 mmHg in practical terms). Aptly, the pressure range may be between about −75 mmHg and −150 mmHg. Alternatively a pressure range of upto −75 mmHg, upto −80 mmHg or over −80 mmHg can be used. Also aptly a pressure range of below −75 mmHg could be used. Alternatively a pressure range of over −100 mmHg could be used or over −150 mmHg. 
     The aspiration conduit at its distal end remote from the dressing may be attached to the waste canister at an inlet port or connector. The device containing the means for initiating and sustaining aspiration of the wound/dressing may be situated between the dressing and waste canister, however, in a preferred embodiment of the apparatus embodying the present invention, the device may aspirate the wound/dressing via the canister thus, the waste canister may preferably be sited between the wound/dressing and device. 
     The aspiration conduit at the waste material canister end may preferably be bonded to the waste canister to prevent inadvertent detachment when being caught on an obstruction, for example. 
     The canister may be a plastics material moulding or a composite unit comprising a plurality of separate mouldings. The canister may aptly be translucent or transparent in order to visually determine the extent of filling with exudates. However, the canister and device may in some embodiments provide automatic warning of imminent canister full condition and may also provide means for cessation of aspiration when the canister reaches the full condition. 
     The canister may be provided with filters to prevent the exhaust of liquids and odours therefrom and also to prevent the expulsion of bacteria into the atmosphere. Such filters may comprise a plurality of filters in series. Examples of suitable filters may comprise hydrophobic filters of 0.2 μm pore size, for example, in respect of sealing the canister against bacteria expulsion and 1 μm against liquid expulsion. 
     Aptly, the filters may be sited at an upper portion of the waste canister in normal use, that is when the apparatus is being used or carried by a patient the filters are in an upper position and separated from the exudate liquid in the waste canister by gravity. Furthermore, such an orientation keeps the waste canister outlet or exhaust exit port remote from the exudate surface. 
     Aptly the waste canister may be filled with an absorbent gel such as ISOLYSEL (trade mark), for example, as an added safeguard against leakage of the canister when full and being changed and disposed of. Added advantages of a gel matrix within the exudate storing volume of the waste canister are that it prevents excessive movement, such as slopping, of the liquid, minimises bacterial growth and minimises odours. 
     The waste canister may also be provided with suitable means to prevent leakage thereof both when detached from the device unit and also when the aspiration conduit is detached from the wound site/dressing. 
     The canister may have suitable means to prevent emptying by a user (without tools or damage to the canister) such that a full or otherwise end-of-life canister may only be disposed of with waste fluid still contained. 
     The device and waste canister may have mutually complementary means for connecting a device unit to a waste canister whereby the aspiration means in the device unit automatically connects to an evacuation port on the waste canister such that there is a continuous aspiration path from the wound site/dressing to an exhaust port on the device. 
     Aptly, the exhaust port from the fluid path through the apparatus is provided with filter means to prevent offensive odours from being ejected into the atmosphere. 
     In general terms the device unit comprises an aspirant pump; a flowmeter to monitor fluid flow through the aspirant pump; a control system which controls the aspirant pump in response to signals from sensors such as the pressure monitoring means and the flowmeter, for example, and which control system also controls a power management system with regard to an on-board battery pack and the charging thereof and lastly a user interface system whereby various functions of the device such as pressure level set point, for example, may be adjusted (including stopping and starting of the apparatus) by a user. The device unit may contain all of the above features within a single unified casing. 
     In view of the fact that the device unit contains the majority of the intrinsic equipment cost therein ideally it will also be able to survive impact, tolerate cleaning in order to be reusable by other patients. 
     In terms of pressure capability the aspiration means may be able to apply a maximum pressure drop of at least −200 mmHg to a wound site/dressing. The apparatus is capable of maintaining a predetermined negative pressure even under conditions where there is a small leak of air into the system and a high exudate flow. 
     The pressure control system may prevent the minimum pressure achieved from exceeding for example −200 mmHg so as not to cause undue patient discomfort. The pressure required may be set by the user at a number of discreet levels such as −50, −75, −100, −125, −150, −175 mmHg, for example, depending upon the needs of the wound in question and the advice of a clinician. Thus suitable pressure ranges in use may be from −25 to −80 mmHg, or −50 to −76 mmHg, or −50 to −75 mmHg as examples. The control system may also advantageously be able to maintain the set pressure within a tolerance band of +/−10 mmHg of the set point for 95% of the time the apparatus is operating given that leakage and exudation rates are within expected or normal levels. 
     Aptly, the control system may trigger alarm means such as a flashing light, buzzer or any other suitable means when various abnormal conditions apply such as, for example: pressure outside set value by a large amount due to a gross leak of air into system; duty on the aspiration pump too high due to a relatively smaller leakage of air into the system; pressure differential between wound site and pump is too high due, for example, to a blockage or waste canister full. 
     The apparatus of the present invention may be provided with a carry case and suitable support means such as a shoulder strap or harness, for example. The carry case may be adapted to conform to the shape of the apparatus comprised in the joined together device and waste canister. In particular, the carry case may be provided with a bottom opening flap to permit the waste canister to be changed without complete removal of the apparatus form the carry case. 
     The carry case may be provided with an aperture covered by a displaceable flap to enable user access to a keypad for varying the therapy applied by the apparatus. 
     According to a second aspect of the present invention, there is provided apparatus for determining pressure in a topical negative pressure (TNP) system, comprising:
         a pump element, that provides negative pressure in a flow path;   a flow meter arranged to determine a flow rate in the flow path; and   a processing unit that determines a pumping speed associated with the pump element and determines pressure in the flow path responsive to the pumping speed and flow rate.       

     Embodiments of the present invention enable pressure in a TNP system to be measured without the requirement for one or more pressure sensors. This enables pressure to be determined without necessity for a costly dedicated pressure sensor which can be prone to error. 
     Embodiments of the present invention provide a measurement of pressure in a TNP system utilising a flow meter and processing unit that determines a pumping speed associated with a pump element of the TNP system. The flow meter can be placed anywhere along a flow path to a achieve pressure calculations. This provides a very versatile pressure sensing technique which can be utilised to measure pressure in locations where a pressure sensor would not otherwise be usable. 
     Embodiments of the present invention provide a back up pressure measurement which can improve safety. In such instances one or more pressure sensors may optionally be utilised. 
     Additionally embodiments of the present invention reduce part count in a TNP system in which a flow meter is already often useful or necessary. 
    
    
     
       In order that the present invention may be more fully understood, examples will now be described by way of illustration only with reference to the accompanying drawings, of which: 
         FIG. 1  shows a generalised schematic block diagram showing a general view of an apparatus and the constituent apparatus features thereof; 
         FIG. 2  shows a similar generalised schematic block diagram to  FIG. 1  and showing fluid paths therein; 
         FIG. 3  shows a generalised schematic block diagram similar to  FIG. 1  but of a device unit only and showing power paths for the various power consuming/producing features of the apparatus; 
         FIG. 4  shows a similar generalised schematic block diagram to  FIG. 3  of the device unit and showing control system data paths for controlling the various functions and components of the apparatus; 
         FIG. 5  shows a perspective view of an apparatus; 
         FIG. 6  shows a perspective view of an assembled device unit of the apparatus of  FIG. 5 ; 
         FIG. 7  shows an exploded view of the device unit of  FIG. 6 ; 
         FIG. 8  shows a partially sectioned side elevation view through the interface between a waste canister and device unit of the apparatus; 
         FIG. 9  shows a cross section through a waste canister of the apparatus of  FIGS. 5 to 8 ; 
         FIG. 10  illustrates how a pump speed can be measured and selected; 
         FIG. 11  illustrates how pressure generated by a pump can be controlled; 
         FIG. 12  illustrates how pressure may be calculated without a pressure sensor; and 
         FIG. 13  illustrates a relationship between flow rate, pressure and pump speed. 
     
    
    
     Referring now to  FIGS. 1 to 4  of the drawings and where the same or similar features are denoted by common reference numerals. 
       FIG. 1  shows a generalised schematic view of an apparatus  10  of a portable topical negative pressure (TNP) system. It will be understood that embodiments of the present invention are generally applicable to use in such a TNP system. Briefly, negative pressure wound therapy assists in the closure and healing of many forms of “hard to heal” wounds by reducing tissue oedema; encouraging blood flow and granular tissue formation; removing excess exudate and may reduce bacterial load (and, therefore, infection). In addition the therapy allows for less disturbance of a wound leading to more rapid healing. The TNP system is detailed further hereinafter but in summary includes a portable body including a canister and a device with the device capable of providing an extended period of continuous therapy within at least a one year life span. The system is connected to a patient via a length of tubing with an end of the tubing operably secured to a wound dressing on the patient. 
     More particularly, as shown in  FIG. 1 , the apparatus comprises an aspiration conduit  12  operably and an outer surface thereof at one end sealingly attached to a dressing  14 . The dressing  14  will not be further described here other than to say that it is formed in a known manner from well know materials to those skilled in the dressings art to create a sealed cavity over and around a wound to be treated by TNP therapy with the apparatus of the present invention. The aspiration conduit has an in-line connector  16  comprising connector portions  18 ,  20  intermediate its length between the dressing  14  and a waste canister  22 . The aspiration conduit between the connector portion  20  and the canister  22  is denoted by a different reference numeral  24  although the fluid path through conduit portions  12  and  24  to the waste canister is continuous. The connector portions  18 ,  20  join conduit portions  12 ,  24  in a leak-free but disconnectable manner. The waste canister  22  is provided with filters  26  which prevent the escape via an exit port  28  of liquid and bacteria from the waste canister. The filters may comprise a 1 μm hydrophobic liquid filter and a 0.2 μm bacteria filter such that all liquid and bacteria is confined to an interior waste collecting volume of the waste canister  22 . The exit port  28  of the waste canister  22  mates with an entry/suction port  30  of a device unit  32  by means of mutually sealing connector portions  34 ,  36  which engage and seal together automatically when the waste canister  22  is attached to the device unit  32 , the waste canister  22  and device unit  32  being held together by catch assemblies  38 ,  40 . The device unit  32  comprises an aspirant pump  44  and an aspirant flowmeter  48  operably connected together. The aspiration path takes the aspirated fluid which in the case of fluid on the exit side of exit port  28  is gaseous through a silencer system  50  and a final filter  52  having an activated charcoal matrix which ensures that no odours escape with the gas exhausted from the device  32  via an exhaust port  54 . The filter  52  material also serves as noise reducing material to enhance the effect of the silencer system  50 . The device  32  also contains a battery pack  56  to power the apparatus which battery pack also powers the control system  60  which controls a user interface system  62  controlled via a keypad (not shown) and the aspiration pump  44  via signals from sensors  48 . A power management system  66  is also provided which controls power from the battery pack  56 , the recharging thereof and the power requirements of the aspirant pump  44  and other electrically operated components. An electrical connector  68  is provided to receive a power input jack  70  from a SELV power supply  72  connected to a mains supply  74  when the user of the apparatus or the apparatus itself is adjacent a convenient mains power socket. 
       FIG. 2  shows a similar schematic representation to  FIG. 1  but shows the fluid paths in more detail. The wound exudate is aspirated from the wound site/dressing  14  via the conduit  12 , the two connector portions  18 ,  20  and the conduit  24  into the waste canister  22 . The waste canister  22  comprises a relatively large volume  80  in the region of 500 ml into which exudate from the wound is drawn by the aspiration system at an entry port  82 . The fluid  84  drawn into the canister volume  80  is a mixture of both air drawn into the dressing  14  via the semi-permeable adhesive sealing drape (not shown) and liquid  86  in the form of wound exudates. The volume  80  within the canister is also at a lowered pressure and the gaseous element  88  of the aspirated fluids is exhausted from the canister volume  80  via the filters  26  and the waste canister exhaust exit port  28  as bacteria-free gas. From the exit port  28  of the waste canister to the final exhaust port  54  the fluid is gaseous only. 
       FIG. 3  shows a schematic diagram showing only the device portion of the apparatus and the power paths in the device of the apparatus embodying the present invention. Power is provided mainly by the battery pack  56  when the user is outside their home or workplace, for example, however, power may also be provided by an external mains  74  supplied charging unit  72  which when connected to the device  32  by the socket  68  is capable of both operating the device and recharging the battery pack  56  simultaneously. The power management system  66  is included so as to be able to control power of the TNP system. The TNP system is a rechargeable, battery powered system but is capable of being run directly from mains electricity as will be described hereinafter more fully with respect to the further figures. If disconnected from the mains the battery has enough stored charge for approximately 8 hours of use in normal conditions. It will be appreciated that batteries having other associated life times between recharge can be utilised. For example batteries providing less than 8 hours or greater than 8 hours can be used. When connected to the mains the device will run off the mains power and will simultaneously recharge the battery if depleted from portable use. The exact rate of battery recharge will depend on the load on the TNP system. For example, if the wound is very large or there is a significant leak, battery recharge will take longer than if the wound is small and well sealed. 
       FIG. 4  shows the device  32  part of the apparatus embodying the present invention and the data paths employed in the control system for control of the aspirant pump and other features of the apparatus. A key purpose of the TNP system is to apply negative pressure wound therapy. This is accomplished via the pressure control system which includes the pump and a pump control system. The pump applies negative pressure; the pressure control system gives feedback on the pressure at the pump head to the control system; the pump control varies the pump speed based on the difference between the target pressure and the actual pressure at the pump head. In order to improve accuracy of pump speed and hence provide smoother and more accurate application of the negative pressure at a wound site, the pump is controlled by an auxiliary control system. The pump is from time to time allowed to “free-wheel” during its duty cycle by turning off the voltage applied to it. The spinning motor causes a “back electro-motive force” or BEMF to be generated. This BEMF can be monitored and can be used to provide an accurate measure of pump speed. The speed can thus be adjusted more accurately than can prior art pump systems. 
     According to embodiments of the present invention, actual pressure at a wound site is not measured but the difference between a measured pressure (at the pump) and the wound pressure is minimised by the use of large filters and large bore tubes wherever practical. If the pressure control determines that the pressure at the pump head is greater than a target pressure (closer to atmospheric pressure) for a period of time, the device sends an alarm and displays a message alerting the user to a potential problem such as a leak. 
     In addition to pressure control a separate flow control system can be provided. A flow meter may be positioned after the pump and is used to detect when a canister is full or the tube has become blocked. If the flow falls below a certain threshold, the device sounds an alarm and displays a message alerting a user to the potential blockage or full canister. 
     Referring now to  FIGS. 5 to 9  which show various views and cross sections of a preferred embodiment of apparatus  200  embodying the present invention. The preferred embodiment is of generally oval shape in plan and comprises a device unit  202  and a waste canister  204  connected together by catch arrangements  206 . The device unit  202  has a liquid crystal display (LCD)  208 , which gives text based feedback on the wound therapy being applied, and a membrane keypad  210 , the LCD being visible through the membrane of the keypad to enable a user to adjust or set the therapy to be applied to the wound (not shown). The device has a lower, generally transverse face  212  in the centre of which is a spigot  214  which forms the suction/entry port  216  to which the aspiration means (to be described below) are connected within the device unit. The lower edge of the device unit is provided with a rebated peripheral male mating face  218  which engages with a co-operating peripheral female formation  220  on an upper edge of the waste canister  204  (see  FIGS. 8 and 9 ). On each side of the device  202 , clips  222  hinged to the canister  204  have an engaging finger (not shown) which co-operates with formations in recesses  226  in the body of the device unit. From  FIG. 7  it may be seen that the casing  230  of the device unit is of largely “clamshell” construction comprising front and back mouldings  232 ,  234 , respectively and left-hand and right-hand side inserts  236 ,  238 . Inside the casing  230  is a central chassis  240  which is fastened to an internal moulded structural member  242  and which chassis acts as a mounting for the electrical circuitry and components and also retains the battery pack  246  and aspiration pump unit  248 . Various tubing items  250 ,  252 ,  254  connect the pump unit  248  and suction/entry port  216  to a final gaseous exhaust via a filter  290 .  FIG. 8  shows a partially sectioned side elevation of the apparatus  200 , the partial section being around the junction between the device unit  202  and the waste canister  204 , a cross section of which is shown at  FIG. 9 . Theses views show the rebated edge  218  of the male formation on the device unit co-operating with the female portion  220  defined by an upstanding flange  260  around the top face  262  of the waste canister  204 . When the waste canister is joined to the device unit, the spigot  214  which has an “O” ring seal  264  therearound sealingly engages with a cylindrical tube portion  266  formed around an exhaust/exit port  268  in the waste canister. The spigot  214  of the device is not rigidly fixed to the device casing but is allowed to “float” or move in its location features in the casing to permit the spigot  214  and seal  264  to move to form the best seal with the bore of the cylindrical tube portion  266  on connection of the waste canister to the device unit. The waste canister  204  in  FIG. 9  is shown in an upright orientation much as it would be when worn by a user. Thus, any exudate  270  would be in the bottom of the internal volume of waste receptacle portion  272 . An aspiration conduit  274  is permanently affixed to an entry port spigot  278  defining an entry port  280  to receive fluid aspirated from a wound (not shown) via the conduit  274 . Filter members  282  comprising a 0.2 μm filter and  284  comprising a 1 μm filter are located by a filter retainer moulding  286  adjacent a top closure member or bulkhead  288  the filter members preventing any liquid or bacteria from being drawn out of the exhaust exit port  268  into the pump and aspiration path through to an exhaust and filter unit  290  which is connected to a casing outlet moulding at  291  via an exhaust tube (not shown) in casing side piece  236 . The side pieces  236 ,  238  are provided with recesses  292  having support pins  294  therein to locate a carrying strap (not shown) for use by the patient. The side pieces  230  and canister  204  are also provided with features which prevent the canister and device from exhibiting a mutual “wobble” when connected together. Ribs (not shown) extending between the canister top closure member  288  and the inner face  300  of the upstanding flange  260  locate in grooves  302  in the device sidewalls when canister and device are connected. The casing  230  also houses all of the electrical equipment and control and power management features, the functioning of which was described briefly with respect to  FIGS. 3 and 4  hereinabove. The side piece  238  is provided with a socket member  298  to receive a charging jack from an external mains powered battery charger (both not shown). 
       FIGS. 10 and 11  illustrate how the pressure provided by a pump of the TNP system can be set, monitored and controlled according to an embodiment of the present invention. As illustrated in  FIG. 10  a determined pressure value  900  is utilised. Embodiments of the present invention may provide this without need for a pressure sensor itself. Alternatively the value may be provided by an optional pressure sensor such as a transducer or the like. 
     Pumping pressure is controlled by an initial pump speed setting system which utilises the provided pressure value and sets a desired pump speed responsive to the given pressure and a predetermined pressure set by a user, and a further control loop system in which actual pump speed is monitored and compared with the determined pump speed. Pumping is actually controlled responsive to the comparison. 
     As illustrated in  FIG. 10  the determined pressure is converted into a digital value in an analogue digital converter  1000  and the value scaled to thereby filter pressure reading before being fed into the control loop to thereby minimise the effect of noise in the reading thereby reducing jitter. This also helps minimise false alarms due to over or under pressure situations. 
     Pump speed control is achieved by implementing a control loop in hardware or software. The measured scaled pressure provides an input  1002  into the pressure controller whilst a further input  1003  is provided by a user entering a desired pressure via a user interface. The pressure controller  1004  takes the pressure set point and the actual provided indication of pressure as inputs to deliver a new desired pump speed as its output Vset. The determined pressure values are averaged over a certain number of previous readings before feeding a value to the control loop. This minimises jitter and noise and serves as a first dampener of pump response. 
     The control sequence used for controlling pump response is given below:
         Defines&gt;&gt;&gt;Constants for control loop: kp, ki, t
           Bounds for output: Vmax, Vmin   
           Inputs&gt;&gt;&gt;Current pressure value: pv,
           Set point value: sp   
           Calculate difference: e=sp−pv   P=kp*e   I=I+ki*e*t   Verify I is between the Vmin and V max bounds   V=P+I   Verify V is between the Vmin and V max bounds       

     Thus the difference between the determined pressure and a desired pressure is calculated and then scaled using experimentally predetermined constants to yield the output value of pump speed Vset. The constants are optimised for best pump response and to minimise pressure overshoot or undershoot. The scaling further dampens the effect of the current pressure difference by taking into account a certain number of previous pressure differences. The control loop is provided to allow only a certain maximum step change in pressure at a time by bounding the output pump speed value within predetermined sensible limits. Thus a sudden change in pressure (due to any reason for example the user changing position) or a change in the pressure set point is fed back to the pump drive circuitry incrementally in small steps rather than as a dramatic change. 
     This mechanism of pump speed control thus results in a better reaction to rapid changes in pressure as the pump does not instantly ‘overreact’. Since the pump does not have a drastic reaction to pressure changes the overall ‘perceived’ noise levels are lower. Gradual adjustment of pump speed also results in lower pump wear and tear which enhances device performance and longevity. Furthermore averaging the determined pressure values before feeding them to the control loop reduces the likelihood of false alarms with respect to over or under pressure situations. 
       FIG. 11  illustrates how accurate speed control of a suction pump on the TNP device allows fine control of a negative pressure applied at a wound site and which thus helps reduce noise during device operation and minimises discomfort to the user. The system provides a control loop that periodically turns off power to a pump motor and records an electromotive force (EMF) generated by a freewheeling element such as a rotor of the pump. The measured EMF is used to calculate the actual pump speed and drive signals supplied to the pump can thus be modified to accurately achieve a desired speed. It will be understood that other embodiments of the present invention can be used with a wide variety of pump types such as oscillating pumps etc. Pump speed is calculated according to the pump type and according to the predetermined relationships. As illustrated in  FIG. 11  a control loop  1100  uses the desired and actual pump speeds at a given instant to accurately determine the drive voltage that needs to be applied to the pump in order to accurately achieve final desired speed and thus pressure. The control loop operates by calculating the difference between the desired speed Vset and the current speed Vcur. The pump controller  1101  scales the difference and optionally accumulates the scaled differences from a certain number of previous iterations. The control loop  1101  outputs a value Vfinal for the pump drive voltage that leads to the pump achieving its final desired speed. The scaling constants for the control are determined experimentally prior to operation to ensure acceptable performance of the device (ie. ability to maintain set pressure at specified wound leak rates). The scaling constants can be calculated in various ways however aptly on a startup conditions to provide a predetermined pressure can be applied. A determined actual pressure will indicate operational parameters indicative of pressure change, leaks, wound size and volumes in the waste canister. Scaling constants are then set responsive to these. 
     The pump control system is responsible for maintaining the pump speed which in turn drives the pressure generated at the wound. The motor speed is controlled by varying a pulse width modulation (PWM) input. The duty cycle of the PWM generator  1102  is controlled responsive to the drive voltage signal Vfinal and the output of the PWM generator is utilised to drive the pump  1103 . 
     The actual speed of the pump is obtained by measuring the terminal voltage across the pump with the current at zero. This is achieved by intermittently turning the pump power off by controlling the PWM generator output. Subsequent to turn off a short period is allowed to wait for the EMF of the freewheeling pump to settle during a certain predetermined time period and thereafter the steady value of the EMF is sampled. This EMF is a direct measure of pump shaft speed. The EMF generated is converted into a digital signal via an analogue digital converter  1104  and then scaled with a scaling unit  1105 . The EMF sampling rate is varied according to pump speed to counter the aliasing and to minimise the effect on pump speed. The EMF sampling rate may be reduced at higher pump speed since the inertia of the pump maintains a more constant motion at high pump speeds. 
     Operation of the control utilised can be summarised by the following control sequence:
         Pump_Speed_Controller
           Turn pump_enable and PWM off   Turn pump_enable on after current drops   Allow EMF to settle   Sample EMF and estimate current speed (Vcur)   new_PWM=PI (Vset, Vcur)   Enable pump PWM   New pump duty cycle=new_PWM   
           End Motor_Controller   PI (Vset, Vcur)
           Defines&gt;&gt;constants kp, ki, t   Inputs&gt;&gt;current motor speed Vcur
               Desired motor speed Vset   
               Calculate difference: e=Vset−Vcur   P=kp*e   I=I+ki*e*t   
           End PI       

       FIG. 12  illustrates how embodiments of the present invention can determine a pressure in a flow path without the need to include a pressure sensor in a TNP system according to embodiments of the present invention. It will be appreciated that a flow meter  48  and pump  44  will often be included in a TNP system and therefore a mechanism for determining pressure without the need for an expensive pressure sensor utilising units already included in a TNP design produce a favourable system. The system measures the flow rate at a pump inlet or some other such desired location as well as determining the speed of the pump via measurement of a back EMF. A known relationship between the pump speed, pressure and flow rate can then be used to calculate the pressure at a location where the flow meter is located. Particularly high or low pressures can be utilised to trigger an alarm condition. 
     As illustrated in  FIG. 12  the TNP wound care system includes a pump  44  required to provide the negative pressure. As noted previously, the back EMF of the pump can be determined during a free-wheeling mode of operation and the voltage generated is known to be directly proportional to the operating speed of the pump. The operating speed of the pump can thus be measured during device operation. 
     Again, as noted above, the pump is kept at a proper operating speed using a feedback mechanism which utilises the measured back EMF as an indication of current pump speed. If a problem occurs with the system, for example, a leak occurs, the feedback mechanism detects this as a decrease in pressure or in flow rate. The feedback mechanism increases the voltage to the pump to compensate. As the voltage increases the back EMF will increase in time. The back EMF indicates pumping frequency. This pump frequency, along with the inlet pressure, can be used as a direct indication of system leaks (flow rate). 
       FIG. 13  illustrates a known relationship between pump speed, flow rate and pressure difference. Here it will be understood that the pressure difference is the absolute pressure (or vacuum) achieved from atmospheric conditions. It will be appreciated that the particular relationship will be dependent upon the characteristics of the pump system and TNP system generally. To calculate a pressure from an available flow rate and pump speed embodiments of the present invention utilise a “look-up table”. This table is predetermined experimentally during set up or product development. The look-up tables are stored as data in a data store or are set out in software utilised by the TNP system. 
     As illustrated in  FIG. 13 , for any TNP system a range of values indicating a predetermined relationship  1300  for pressure can be determined as pump speed varies. This is for a single preset fixed flow rate. Similar relationship curves  1300  indicating how pressure varies with any particular pump speed are determined for many possible fixed flow rate values or ranges during TNP system design. 
     As a result the flow rate determined during use by a flow rate sensor can be used to select from a look-up table of possible flow rate values a pressure and pump speed relationship  1300  for that flow rate or flow rate range. A pump speed can then be compared to the range and a pressure read off. It will be appreciated by those skilled in the art that rather than having a pressure versus pump speed relationship stored in a look-up table for a multitude of flow rate ranges, a pressure versus flow rate relationship could alternatively be determined for fixed pump speeds. A pump speed would thus be utilised to select a specific look-up table storing a relationship between flow rate and pressure. 
     As indicated in  FIG. 13 , as a rough approximation the relationship between flow rate and pump speed for a fixed flow rate is linear at low pump speeds and then tends to flatten as the pump has a maximum flow rate it can maintain regardless of speed. 
     It will be appreciated that the flow meter may be placed in alternative locations, such as in front of the canister or in front of the wound, to achieve pressure calculations. 
     It will also be appreciated that in accordance with embodiments of the present invention a pressure sensor may also additionally be utilised in the flow path of the TNP system. Embodiments of the present invention can thus be utilised in conjunction with an alternative pressure measurement provided by such a pressure sensor as a safety back up. As a result embodiments of the present invention provide increased user confidence and may be utilised to detect early leakages of dressings since pressure can be determined at a further location from where a pressure sensor is located. This can lead to reduced power usage which causes less drain on internal batteries and thus lowers cost. 
     Accurate pump control results in overall lower noise levels during device operation. Specifically abrupt changes in noise are avoided because the pump speed is adjusted frequently and in small steps. Maintaining accurate control of pump speeds can extend pump and battery life. Moreover a steady pump delivers a steady negative pressure thereby minimising patient discomfort. 
     Throughout the description and claims of this specification, the words “comprise” and “contain” and variations of the words, for example “comprising” and “comprises”, means “including but not limited to”, and is not intended to (and does not) exclude other moieties, additives, components, integers or steps. 
     As an alternative to measuring pump speed via the establishment of a back EMF other methods could be adopted according to alternative embodiments of the present invention. For example a speed sensor such as an optical tachometer or the like or other sensor type such as a Hall effect sensor able to determine speed could be included to determine pump speed. 
     Throughout the description and claims of this specification, the singular encompasses the plural unless the context otherwise requires. In particular, where the indefinite article is used, the specification is to be understood as contemplating plurality as well as singularity, unless the context requires otherwise. 
     Features, integers, characteristics, compounds, chemical moieties or groups described in conjunction with a particular aspect, embodiment or example of the invention are to be understood to be applicable to any other aspect, embodiment or example described herein unless incompatible therewith.