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PICO

Single Use Negative Pressure Wound Therapy

PICO Negative Pressure Wound Therapy

About PICO

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: 

PICO negative pressure wound therapy indications

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

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PICO dressing

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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

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Improved capacity

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

 

PICO hospital image

Improved profitability

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

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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

PICO in Use

Trouble Shooting Guide

PICO button
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.

Size (cm) Size (inches) Available pad area (cm) Available pad area (inches)
10 x 20 4 x 8 5 x 10 2 x 4
10 x 30 4 x 12 5 x 20 2 x 8
10 x 40 4 x 16 5 x 30 2 x 12
15 x 15 6 x 6 10 x 10 4 x 4
15 x 20 6 x 8 10 x 15 4 x 6
15 x 30 6 x 12 10 x 25 4 x 10
20 x 20 8 x 8 15 x 15 6 x 6
25 x 25 10 x 10 20 x 20 8 x 8
15 x 20 Multisite (Small) 6 x 8 121cm2 48.4 inches2
20 x 25 Multisite (Large) 8 x 10 246cm2 98.4 inches2

PICO button
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.

 

PICO button
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

 PICO Carry CaseEnlarge Image

 

 

PICO is small enough to fit into a pocket or handbag. It’s very discrete.

A bag is also available to carry PICO. This can be ordered using code 66800918

 

Safety and Electromagnetic Compatibility Information

Please click on your country to download your EMC data

 

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)

Indications

PICO Single Use Negative Pressure Wound Therapy system is indicated for patients who would benefit from a suction device (Negative Pressure Wound Therapy) as it may promote wound healing via removal of low to moderate levels of exudate and infectious materials.

PICO Single Use Negative Pressure Wound Therapy System is suitable for use in both a hospital and community setting and approved for the following indications.

  • Acute wounds
  • Chronic wounds
  • Flaps and grafts
  • Partial-thickness burns
  • Subacute and dehisced wounds
  • Surgically closed incision sites
  • Traumatic wounds
  • Ulcers (such as diabetic or pressure)

 

Use with Fillers

PICO is compatible with the standard fillers of foam and gauze used with conventional NPWT if this is necessary1 .

A filler would be required if the PICO dressing on its own does not make intimate contact with the wound bed. This may be the case with wounds such as sinus’s, wounds with undermined edges and those with uneven surfaces.

 

Open Wounds

Application, Removal and Mode of Action

View the application and removal of PICO on different wound types:

Shallow Wound <0.5cm

Application, removal and Mode of Action of PICO on shallow wounds less than 0.5cm. 

 

Deeper Open Wound 0.5cm - 2cm Foam Filler

Application, removal and Mode of Action of PICO* on deeper open wounds using a foam filler. Wounds treated with the larger sizes of PICO should generally be no more than 2cm in depth. 

 

Deeper Open Wound >0.5cm Gauze Filler

Application, removal and Mode of Action of PICO on deeper open wounds using a gauze filler. Wounds treated with the larger sizes of PICO should generally be no more than 2cm in depth. 

 

Application of PICO multisite to awkward areas – Heel Application

 

Closed Incisions

Surgically Closed Incisions

Application, removal and Mode of Action of PICO on surgically closed incisions.

 

Skin Grafts

Application, removal and Mode of Action of PICO on grafts. 

 

Fluid Management

The PICO dressing has been uniquely designed to manage fluid in 2 ways2. The first is absorption into the superabsorbent layer and the second is by transpiration of the moisture through the breathable top film.

As fluid is removed from the wound bed, it first enters the airlock layer then is rapidly pulled away by the hydrophilic superabsorbent layer2. This part of the dressing forms a gel which acts to hold the fluid securely away from the wound.

Once the gel forms underneath the film at the top of the dressing, the film starts to evaporate off the moisture2 and an equilibrium is established to balance the amount of fluid in the dressing at any one point in time. This action prevents the dressing becoming heavy with fluid on the patient.

 

References

1. Report reference DS/11/021/R1 – Wound model investigation of the compatibility of PICO with a range of wound fillers and a wound contact layer. Sarah Roberts, March 2011 

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

Evidence

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

Type of Evidence Key Points Title and Author Document
In- vivo study PICO functions in the same manner as traditional NPWT systems with regard to fluid handling, pressure transmission, tissue contraction and changes in blood flow. Malmsjo et al. Biological effects of a disposable, canisterless negative pressure wound therapy system. Document on eplasty.com
Prospective open label controlled study Patients receiving PICO had less surgical site complications, (compared to conventional dressings) resulting in shorter hospital stay. Readmission rates lower with PICO Selvaggi et al. New advances in negative pressure wound therapy (NPWT) for surgical wounds of patients affected with Crohn’s disease. Document on Pubmed
Community evaluation of PICO on open wounds Positive outcomes obtained.
98% patient satisfaction with PICO
99% nurse satisfaction with PICO
PICO allows patient mobility whilst facilitating wound healing.
PICO was cheaper in use compared to conventional NPWT
Hurd T. Evaluation the costs and benefits of Innovations in chronic wound care products and practices T Hurd Supplement
Product case report Following adoption of woundcare education for midwives, a change to OPSITE PostOp for low risk (<BMI35) patients and PICO for high risk (>BMI35) patients, the infection rate for high risk patients dropped to 1/138 and there were zero readmissions. Bullough L et al. Changing wound care protocols to reduce postoperative caesarean section infection and readmission Copy of Bullough poster ( displayed EBCOG 2014)
Review of 33 clinical papers RCT evidence for reduction in dehiscence and infection in orthopaedic trauma and sternal incisions after post-operative NPWT of two and four fold respectively.
Gaps in understanding in MoA
Likely that wound breaking strength is more rapidly achieved, haematoma and seroma are reduced as is oedema.
Effects on perfusion outside of reduced oedema still in the balance.
Insufficient data to identify optimum levels of negative pressure.
Karlakki S et al. Negative Pressure Wound Therapy for management of the surgical incision in orthopaedic surgery.
A review of evidence and mechanisms for an emerging indication.
Document on Pubmed
Clinical Evaluation Real time pressure monitoring showed continuous delivery of NPWT.
Trial confirmed the ability of the simplified single use device to function consistently over the expected wear time.
Hudson et al. Simplified negative pressure wound therapy: clinical evaluation of an ultraportable no canister system Document on Pubmed
Cases studies Selection of wounds treated with PICO. Practical usage.   Case Study Cards

Patient Information

Patient Perspectives on PICO

Hear what the first patients who were treated with the PICO system have to say about their experience:

 


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