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Is the disposable NPWT- PICO safe to use with HBO if the battery pack is removed during treatment but the dressing is left on the patient? Patient has recently had transmetatarsal amputation and I believe would benefit from NPWT. We use KCI Vac with HBO but have not used the PICO.
May 1, 2019 by Beth Hirsch, Nurse Practitioner
8 replies
Jeff Mize
RRT, CHT, CWCA
Beth, Thanks for your questions. The dressing can stay intact and the pump NPWT suction must be discontinued during hyperbaric oxygen therapy. The following is our procedure
NPWT PROCEDURE
1. Prior to entering the chamber, disconnect the NPWT therapy unit and canister from the dressings by securing the clamps on the dressing and canister tubing. Disconnect the tubing.
2. The NPWT electrical unit and canister must not enter the chamber.
3. The drainage tube connector on the patient side should be taped and covered with gauze to contain any secretions in the tubing.
4. Once the gauze is in place, unclamp the tubing to allow pressure equalization in the NPWT tubing and dressing.
5. Place a moist 100% cotton hand towel or towel (depending upon size) over the entire dressing.
6. After the hyperbaric treatment, reconnect the NPWT therapy unit to the drainage tubing and dressing.
Turn on the NPWT unit.
7. Confirm the dressing has no air leaks and that suction works properly. Reseal dressing, if necessary.

Please let me know if you have any additional thoughts or questions. Jeff
May 1, 2019
Samantha Kuplicki
MSN, APRN-CNS, AGCNS-BC, CWS, CWCN-AP, RNFA
Hi Beth! Thanks for your question. The PICO unit cannot enter the HBO chamber.

Below you’ll see the complete Instructions for Use:

https://cms.possiblewithpico.com/files/pdfs/PCCE-66-0215-USE_picoClinicalGuidelines_02_09_15_digital.pdf

“Hyperbaric oxygen treatments
The National Fire Protection Agency (NFPA) Code 99, chapter 20 addresses HBO compatibility and materials considered to be potentially hazardous. Materials/compounds such as petrolatum, mineral oil, silk, wool, some synthetic materials, titanium and magnesium are felt to undergo rapid oxidation and therefore are potential risks in an HBO environment. Materials/compounds such as cotton and polyester are not felt to undergo rapid oxidation and therefore are not potential risks in an HBO environment.
Per the Undersea and Hyperbaric Medicine Society the discretion for use of products in the HBO environment is under the oversight of the program Medical Director.
Additional recommendations:
There are two potential options to consider when patients treated with NPWT, including traditional NPWT therapy and the use of PICO, undergo hyperbaric oxygen therapy treatments (dives).
Option one:
Remove the dressing before the dive and cover the wound with moist (saline) gauze or other dressing described in the facility’s hyperbaric protocol. After dive is completed, clean surface of wound and surrounding tissue. Replace PICO dressing and initiate NPWT.
Option two:
Since hyperbaric treatments are usually daily, Monday–Friday, and some are twice a day, the removal of the dressing prior to each dive may become too irritating to the surrounding tissue
or uncomfortable for the patient and cause added cost. In these cases, the Medical Director of the hyperbaric chamber can authorize the following procedure: Prior to entering the chamber, disconnect the PICO pump from the PICO dressings by disconnecting the Quick Click Connector. The PICO unit does not enter the chamber. Leave the end caps open during the dive to allow pressure changes in the PICO tube and dressing.
For patients being treated with PICO, disconnect the pump unit from the dressing tubing and do
not allow the pump to enter the HBO chamber. Once the patient is in the chamber, the end of the connector should be covered by a 4in. x 4in. gauze dressing. After the dive, reconnect the PICO unit to the dressing and turn the therapy ON. Check the dressing for air leaks and seal, if necessary.“
May 1, 2019
Tiffany Hamm
BSN, ACHRN, CWS
Hi Beth,

Thank you so much for your question. Yes, the PICO dressing, clear wound drape, and tubing may enter the chamber but the battery pack can NOT.
Here is the procedure:
To provide a process for effectively managing patients with wound V.A.C. therapy in place during hyperbaric oxygen therapy.

NOTE: V.A.C. suction will be discontinued during hyperbaric oxygen therapy.

1. Prior to entering the chamber, disconnect the V.A.C. therapy unit and canister from the dressings by securing the clamps on the dressing and canister tubing. Disconnect the tubing.
2. The V.A.C. electrical unit and canister must not enter the chamber.
3. The drainage tube connector on the patient side should be taped and covered with gauze to contain any secretions in the tubing.
4. Once the gauze is in place, unclamp the tubing to allow pressure equalization in the V.A.C. tubing and dressing.
5. Place a moist 100% cotton hand towel or towel (depending upon size) over the entire dressing.
6. After the hyperbaric treatment, reconnect the V.A.C. therapy unit to the drainage tubing and dressing. Turn on the V.A.C. unit.
7. Confirm the dressing has no air leaks and that suction works properly. Reseal dressing, if necessary.

Since this is an item that is not on the go list, it would be wise to complete a prohibited items' authorization form which should be signed by both the safety director and Medical Director. I have attached links to the Go-No-Go topic in the HBO knowledge base under the safety tab and the Prohibited Items Authorization Form. In addition, I will direct you to the HBO Knowledge base. Choose the Operations tab followed by Ancillary Equipment and Negative Pressure Wound Therapy. Should you have any further questions, please don't hesitate to ask.

Go-No-Go: https://woundreference.com/app/topic?id=prohibited-item-reminder
Prohibited Items Authoriztion Form: https://woundreference.com/files/1687.pdf
Policy on NPWT and HBO: https://woundreference.com/app/topic?id=ancillary-equipment#negative-pressure-wound-therapy

Thank you,
Tiffany
May 1, 2019
Eugene Worth
MD, M.Ed., FABA, ABPM/UHM
Just for the sake of unanimity, I’ll agree that the PICO unit cannot be in the hyperbaric chamber. Now, the inquisitive side of me asks, “Why not?” It’s battery powered and doesn’t exceed the limit of DC voltage allowed in the chamber, so ... again ... “Why not?”

I looked at the product information brochure and searched for the battery type and voltage. I could not find the specifications. Hence, I must think that the battery is a potentially explosive type ... Lithium, but what composition? Can’t be recharged ...

Does anyone have manufacturer specifications on the battery composition and voltage. That would help us make a reasonable decision independently of the manufacturer.

Thanks.

Gene
May 1, 2019
Samantha Kuplicki
MSN, APRN-CNS, AGCNS-BC, CWS, CWCN-AP, RNFA
Dr. Worth, I share your inquisitive spirit, and not being satisfied with the generic answer of ‘no’, was initially searching for why the pump couldn’t enter as well. The PICO I have used runs on 2 AA alkaline batteries.
May 1, 2019
Eugene Worth
MD, M.Ed., FABA, ABPM/UHM
Ahhhh, now we’re getting somewhere! So, alkaline batteries are no safety/fire risk in the chamber (at least in my book), as long as they aren’t ‘manipulated’ during the treatment. So, one wonders if the compression/decompression cycles would damage internal parts ... or the display membrane ... or, simply that the company didn’t want to test it, so the easiest recourse is to say, “No GO” and leave it at that.

I’ll back away from this one and retain the unanimity of “No Go.”

Gene
May 1, 2019
Beth Hirsch
Nurse Practitioner
Thank you for your quick replies. I notice that the PICO clinical guidelines do not include the part about covering with moist cotton towel so I am curious about the rationale for that part of the procedure.
May 3, 2019
Jeff Mize
RRT, CHT, CWCA
Beth,
Thanks for the follow-up question. We recommend the moistened towel or gauze for a couple of reasons. The additional moisture on the dressing, in this case, the PICO foam will reduce the potential for an inadvertent spark and keep the dressing cool. That is, maintaining the largest possible gap between the actual temperature of the foam and the product flash point. Let us know if you have any additional thoughts or questions. Jeff
May 3, 2019
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