PICO (Negative Pressure Wound Therapy) is contraindicated in specific situations where it could be harmful or ineffective.
Contraindications for PICO
PICO, while a valuable tool in wound care, should not be used in the following circumstances:
- Malignancy in the Wound Bed or Margins: PICO is generally not recommended for patients with cancer present in the wound area or its edges. Exception: It may be considered in palliative care to improve the patient's quality of life.
- Untreated Osteomyelitis: If a bone infection (osteomyelitis) has been diagnosed but not yet treated, PICO is contraindicated.
- Non-Enteric and Unexplored Fistulas: PICO should not be used on fistulas that don't connect to the intestines and haven't been thoroughly investigated to determine their origin and nature.
- Necrotic Tissue with Eschar Present: The presence of dead tissue covered by a hard, dry scab (eschar) is a contraindication. The eschar needs to be removed (debrided) before PICO can be considered.
Here's a table summarizing these contraindications:
| Contraindication | Explanation |
|---|---|
| Malignancy in Wound Bed/Margins | Risk of stimulating tumor growth. Use is potentially acceptable for palliative care only. |
| Untreated Osteomyelitis | PICO may exacerbate the infection by drawing fluids into the area. |
| Non-Enteric & Unexplored Fistulas | Risk of complications or spreading infection if the origin and path of the fistula are unknown. The source of the fistula can affect how PICO interacts with its presence |
| Necrotic Tissue with Eschar | PICO is ineffective on dead tissue and can potentially trap infection underneath the eschar. Debridement is necessary before starting therapy. |
Therefore, a careful patient assessment is crucial to identify any contraindications before initiating PICO therapy. Proper wound bed preparation, including debridement when necessary, is also essential to ensure PICO's effectiveness and patient safety.
