I'm gathering data to support the use of some form of petroleum (ointment or gauze) in our practice during central line dressing removal. The practice of using the ointment or gauze is well supported (INS, a multitude of offical procedures, cases in the literature) but a roadblock I'm being faced with is the use of antibiotic ointment with central line dressings is not allowed due to the incidence of site infections with this practice. Is this acceptable with removal since the dressing are left in place for a shorter period of time? Is there a reference to support this? Thank you, Nancy
We use Petroleum Jelly - comes in a single use size. It works well
Thanks
An antiseptic or antimicrobial ointment is not required. This language changed in the 2011 INS Standards to allow for a petroleum-based ointment. Infection prevention is not the goal of this practice. Preventing air emboli is the goal, Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you, I knew that air embolism was the issue, but was unsure about an antibiotic ointment as an option, as I've seen it in mentioned in several procedures. Happy to use the plain, sterile petroleum ointment
In reviewing the INS procedure for the removal of CVC, though, another question came to mind. I assumed the ointment would be used during the removal process, as well as on the dressing. The procedure states to apply gauze to the insertion site during the withdrawal, hold pressure for 30 seconds, and then apply ointment to exit site, cover that with gauze and a TSM dressing. Could I please have clarification on this? Mosby's Skills states "As the catheter exits the site, apply pressure with a petroleum-based ointment and sterile gauze". This seems much safer to me. Thanks, Nan
30 seconds of pressure on the exit site when removing a CVC sounds incorrect
It's more like 5 minutes or more if the patient is anticoagulated
Robbin George RN VA-BC
Robbin George RN VA-BC
Exit site at or below the level of the heart. Remove the securement methodk; slowly withdraw the catheter. Pressure until hemostasis, agree with Robbin that 30 sec is not adequate and it is more like 5 min or more, depending upon the coagulation, etc. After hemostasis, then quickly switch the hand held gauze for a gauze prepared with the ointment. Tape it into place. There are no studies to recommend a specific time for the patient remaining supine. You will find practices of 15, 30, and 60 minutes. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
This subject became part of a recent discussion with the question being; Is a petroleum based dressing necessary when removing a PICC ? Are there any studies citing frequency of air embolism from a PICC site ? Intuitively this seems like a very unlikely event.
David
David Bruce RN
No studies, but I have heard anecdotal stories of VAE associated with PICC removal. It can happen if all risks are present and nothing has been done to mitigate those risks such as closing the puncture site. The skin-to-vein tract can be connected to a well-established fibrin sheath that can act as a conduit for air once the catheter has been removed. If the paitent is fluid volume depleted, and they stand up and take a deep breath before the site has healed, VAE is possible. No one has quantified this risk. I would agree that it is a low risk but it is a risk nonetheless. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
This is certainly a rare occurance but it has happened with devastating, life long injury. The young woman who's PICC was removed improperly will live with the result of her brain injury from air embolism and the nurse who wasn't properly trained and thought, "how hard can it be to remove a PICC", will never completely heal from the event.