Some nurses at my facility use tape along the CVCC or PICC dressing edges to create a window around the entire dressing. They feel it "secures" the dressing better. My view is that it adds additional tape residue, increases bacterial growth and infection risks as well as compromises skin integrity. We currently use a Tegaderm HP dressing in our sterile dressing kits with skin prep and a small roll of sterile tape which is intended to secure the lumens as they exit the dressing. I know there have been studies regarding tape and bacteria growth, but these studies were with non-sterile rolls. I think tape can become a sticky gooey mess and needs to be limited on central line dressings. Thoughts??
Kelly Rolfsen RN CRNI
Forum topic
Mon, 04/07/2014 - 01:02
#1
additional tape on central line dressings
The first place I would look is the instructions for use from the specific brand of TSM dressing you are using. What does that manufacturer state about adding tape to the edges? I think that a TSM dressing correctly applied after the antiseptic and the skin protection solution has thoroughly dried does not require tape around the edges, but it sounds like your staff has experience to the contrary. Are you certtain that the skin protectant solution is actually being used? I agree with you on all the points about adding tape. I would monitor the exact process being used by these nurses and correct any problems. I would monitor the number that come loose as that is an indication for immediate change of the dressing. Are you sure the size of dressing is adequate to cover the insertion site, securement device, and extension legs? How are those extension legs being secured? All of these factors could lead to a dressing that pulls up easily and the staff nurses answer is to add more tape. Maybe a change in technique is what is actually needed. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Our policy does not include windowing the dressing with tape. We had CVCC dressing change competencies 2 years ago which emphasized using skin prep and allowing it to fully dry, as well as the CHG. We secure the area where the lumens exit the catheter with a small piece of sterile tape with a chevron. The tegaderm edges typically seal well if this process is used. My PICC department rounds on all central lines daily and do most of the changes, but the floor RN is to change the dressing if we are unavailable. I think much of this is because some nurses have done this at other facilities and that "how we always do it" rather than looking at what this practice is doing to the patients skin. I was looking to see if there were any specific studies stating it is not best to use so much additional tape. I have not seen research on this practice since it only makes common sense that is can be harmful.
I am not aware of any research on this practice either. Your outcomes may indicate that it is time for repeating this competency since it has been 2 years, and especially if there has been turnover in your nursing staff. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you Lynn. I appreciate your input.
Kelly Rolfsen RN CRNI
At the risk for a shameless plug, but we can relate. Our daughter could not use tape to secure her lines. Her skin became irritated and infected from the tape, no matter what kind nurses tried. We used an IV 3000 for the dressing and then her wrap managed the lines without tape. Because the wrap kept her lines secure, we did not need to use any extra tape at the site and the nurses at the Jimmy Fund agreed. There are some videos and pictures on our website. Check them out and if you want a sample email us. I hope this helps.
Mike
CareAline™ Products are unique, one-of-a-kind Line Management systems/garments for PICC, Central Lines, PEG Tubes & G/GJ Tubes
CareAline.com
We have had some of these issues as well. We use Cavilon Barrier film in our dressing change kits. Making sure that the CHG and the barrier film dry before the next layer is added is essential, as you know. We have also been recommending that once the dressing is on, to use the Cavilon (or whatever skin prep you use) and go over the skin/dressing connection. This helps to seal the edges of the dressings and helps to extend the life to 7 days. Certainly helps on our CF pts. who are so sweaty.
I also think that having nurses not on your team doing dressing changes 'occasionally' may be a reason that they are using tape. They don't want the dressings to come off, but don't do the procedure often enough to really develop the skill. This can make them nervous.
Janine Pritchett, RN-BC, BSN, VA-BC
Clinical Educator - Vascular Access