PICO^◊

PICO^◊ can help reduce the risk of seroma, haematoma, dehiscence and infection after surgery^1-12

References
1. O’Leary, D.P. et al. Prophylactic negative pressure dressing use in closed laparotomy wounds following abdominal operations. A randomized, controlled, open-label trial: The P.I.C.O. Trial. Annals of Surgery (2016) published ahead of print.
2. Karlakki, S.L. et al. Incisional negative pressure wound therapy dressings (iNPWT) in routine primary hip and knee arthoplasties: A randomised controlled trial, Bone and Joint Research (2016) Vol 5 (Issue 8): 328-337.
3. Nordmeyer, M. et al. Negative Pressure Wound Therapy for seroma prevention and surgical incision treatment in spinal fracture care. International Wound Journal (2015).
4. Hyldig, N. et al. Meta-analysis of Negative-Pressure Wound Therapy for Closed Surgical Incisions. British Journal of Surgery (2016) Vol 103 (issue 5): 477-486.
5. Adogwa, O. Negative Pressure Wound Therapy reduces incidence of post-operative wound infection and dehiscence after long-segment thoracolumbar spinal fusion: a single institutional experience.  The Spine Journal (2014) Vol 14 (Issue 12): 2911-2917.
6. Bullough,L. et al. Implementation of a pathway approach to aim to reduce SSI rates after C-section including use of PICO™ in high risk patients with a BMI ≥35. The Clinical Services Journal (2015) April: 2-6.
7. Matsumoto, T. and Parekh S.G. Use of negative pressure wound therapy on closed surgical incision after total ankle arthroplasty. Foot & Ankle International (2015) Vol 36 (Issue 7): 787-794.
8. Witt-Majchzak, A. et al. Preliminary outcome of treatment of postoperative primarily closed sternotomy wounds treated using negative pressure wound therapy. Polish Journal of Surgery (2014) Vol 86(Issue 10): 456-465.
9. Hester, T. et al. Is single use portable incisional negative pressure wound therapy system suitable for revision arthroplasty. Advances in Orthopaedic Surgery (2015).|
10. Carnali, M. et al. Retrospective study on the use of NPWT in the treatment of pilonidal cysts (sinus pilonidalis) operated on using an open technique or complicated by dehiscence of the surgery site through sepsis. Acta Vulnologica (2016) Vol 14 (Issue 1): 24-39.
11. Holt, R. and Murphy. J. PICO™ incision closure in oncoplastic breast surgery: a case series. British Journal of Hospital Medicine (2015) Vol 76 (no 4) 217-223.
12. Loveluck J., et al. Biomechanical Modeling of the Forces Applied to Closed Incisions During Single-Use Negative Pressure Wound Therapy. Eplasty (2016) Vol 16: 183-195.

Introduction:

In 2011, Smith & Nephew launched a breakthrough in negative pressure wound therapy (NPWT) – the PICO Single Use NPWT System.

The revolutionary dressing technology makes the PICO System canister-free and disposable. So now, you can use NPWT with a wider range of patients in all care settings.

PICO is indicated for: 

Unique 4 layer multi-function dressing design

A unique dressing design in which each layer works together to ensure that negative pressure is delivered to the wound bed and exudate is removed through absorption and evaporation¹

Reducing the burden to healthcare

PICO system has also been shown to have a positive effect on healthcare resource use, reducing readmission and decreasing hospital length of stay and frequency of dressing changes.^5,6,7

Improved capacity

By reducing post-operative complications that can lead to extended hospital stay or readmission.^5,6

Improved profitability

By reducing post-operative complications that can contribute to extended hospital stay/increased treatment costs.^5,7

Improved quality

By reducing complications, which can impact positively on hospital performance indicators (such as Friends and Family Scores).

References

1. Malmsjo, M; Huddleston, E; Martin, R; Biological Effects of a Disposable, Canisterless Negative Pressure Wound Therapy System; Eplasty 2014

2. Data on file reference 1102010 – Bacterial Barrier Testing (wet-wet) of PICO Dressing with a 7 day test duration against S.marcescens; Helen Lumb, February 2011

3. DS.11.057.R2 – In-vitro wound model testing if PICO at a low exudate flow rate; Sarah Roberts, April 2011

4. Hurd T et al: A multicentre in-market evaluation of ALLEVYN Gentle Border, Wounds UK, 2009, Vol 5, No 3;

5. Selvaggi et al., New advances in Negative Pressure Wound Therapy (NPWT) for surgical wounds of patients aff ected with Crohn’s disease; Wound Healing Surgical Technology International XXIV

6. SL Karlakki, AK Hamad, C Whittall, NM Graham, RD Banerjee, JH Kuiper. Incisional negative pressure wound therapy dressings (iNPWT) in routine primary hip and knee arthroplasties: A randomised controlled trialBone & Joint Research (2016) Vol 5 (Issue 8): pp 328-337 doi:10.1302/2046-3758.58.BJR-2016-0022.R1;

7. Bullough L, et al. Reducing C-Section wound complications. The Clinical Services Journal (2015) April 2-6;

8. PICO Full Reference summary list November 2016

Trouble Shooting Guide

Which Dressing Size to Choose

Choose a size of dressing that, when applied, allows coverage of the wound,graft or total length of the incision whilst keeping the port away from the area of injury.

How to Deal with an Air Leak/Low Pressure

• Smooth the dressing and strips against the skin, it maybe that movement has caused the edge to lift a little.
• Once this has been completed, press the orange button and the pump will try to re-establish the vacuum.
• Whilst the pump is running the green light will flash. If the vacuum is successfully re-established the green light will continue to flash.
• If air is still finding a way into the dressing, the yellow leak light will start to flash after approximately 30 seconds. Repeat the smoothing motion and press the orange button until the leak is resolved.

How to Change the Batteries

• Press the orange button to pause the therapy.
• Remove the battery cover from the top of the pump and remove the old batteries.
• Replace with 2 new AA lithium batteries. An indication of which way up each battery should be placed is indicated inside the battery compartment.
• Replace the cover.
• Press the orange button to start the therapy.

PICO in Use: How to Change the Batteries

Carrying PICO

References

¹ Hudson, D; Adams, K; Van Huyssteen, A; Martin, R; Huddleston, E; Simplified Negative Pressure Wound Therapy: clinical evaluation of an ultraportable, no-canister system; International Wound Journal 2013

² Hurd, T; Evaluating the Cost and Benefits of Innovations in Chronic Wound Care Products and Practices; Ostomy Wound Management; June 2013

³ Selvaggi et al; New Advances in Negative Pressure Wound Therapy (NPWT) for Surgical Wounds of Patients Affected with Crohn’s Disease; Wound Healing Surgical Technology International XXIV

⁴ Edwards, J; Use of a portable negative Pressure Wound Therapy System (NPWT) (PICO) for split thickness skin grafts; Nov 2012

⁵ Malmsjo, M; Huddleston, E; Martin, R; Biological Effects of a Disposable, Canisterless Negative Pressure Wound Therapy System; Eplasty

⁶ DS/14/065/R Comparison of pressure transmission through port area of current PICO and Palermo designs

⁷ DS/14/066/R Comparison of pressure transmission through RENASYS drape and Palermo dressings

⁸ Bullough et al; Changing woundcare protocols to reduce post-operative caesarean section infection and readmission, Wounds UK, Vol 10, No 1 2014

⁹ Nuila, L M; 5th NPWT Expert Panel Meeting Frankfurt, March 2014; Negative Pressure Wound Therapy (NPWT) for Prevention of surgical wound complications in implantable cardioverter defibrillator (ICD)

Use with Fillers

To understand how PICO is being used to reduce wound healing complications following high risk procedures including:

• Orthopaedic trauma
• Orthopaedic reconstruction ( hip, knee and spine)
• Cardiothoracics
• Plastic reconstruction - reduction mammoplasty
• Gynaecology – post caesarean section
• General – patients with Crohns disease

Table of Evidence