I have reviewed the recently published INS Standards and also attended 2 recent webinars on dressings sponsored by AVA. The 2021 INS Standards have clarified what a comrpromised dressing constitues, somewhat paraphrased here:
Dressing changes are recommended to be done immediately if lifted, detached on any border or within the transparent window
Question #1: While I understand the implications of the dressing descriptions and recommended actions, I also wonder if there was any thought about medical trauma for special populations? I work in pediatrics where dressing changes induce medical trauma and I am getting push back about the new INS Standards as they may apply to pediatrics. I am interested the VAD communities thoughts on this concern.
I have been asked what the standard is for when a port dressing may need changed before the 7 day limit on an accessed port. what is the recommendation for also changing the needle? I reviewed some prior posts, however I want to stay as UTD on recommendations.
Thank you for your feedback.
Linda Tirabassi RN CNS CPNP
There was a neonatal and a pediatric person on the committee, so yes we did write this based on the evidence available. There is an additional statement about neonatal patients in that same SOP. Also did you read Standard 55 Catheter Associated Skin Injury?
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 Lynn for your information. Yes I did review Std 55 as well. We did a one week daily observation of our patients dressings in the Hem/Onc unit only. Interestingly, 74% were fully intact, 20% were reinforced for small lifts and the remainder had very small outer border lifts observed, such as a small area on a corner. The nurses have expressed concerns for changing dressings when the outer border has a marginal small lift, which is very subjective, I know. Neonates and NICU patients are in a league of their own. We do have a policy and procedure for CASI based on the Appendix C article.
The AVA webinars I attended made it very clear that any lifted dressing along the border should have the dressing changed immediately per new SOP. We obviously want the safest and best care for our patients, and also align with SOP, yet it seems that we need to balance some clinical judgement. I am interested in how other children's hospitals are integrating this standard?
In addition, Lynn and the VAD community, What is the recommendation for changing the Huber needle with an unscheduled dressing changes?
Thanks again, I will be interested to view your additional comments and others for my questions. It is so helpful to have this listserv to post to the broader VAD community and I am grateful for having it available.
Linda Tirabassi PhD RN CNS CPNP
For those dressings that are slightly lifted on the corner or side, I would focus more on the reasons for that. Are you routinely using some type of skin barrier solution or gum mastic under the dressing to enhance the adhesiveness and protect the skin? That would be my first recommendation - used from the beginning religiously on each dressing change. Then the lifting problem will virtually go away.
For change of the port access needle, that is a judgment call. In SOP 28, there is no recommendation for changing the port needle when it is accessed on a continuous basis. The original 7 days comes from the original manufactuerer and all others followed their lead. There are virtually no studies on this issue. If 7 days is your policy, and the dressing change is needed with a day or 2 of that change, I probably would change the needle at the same time. If more than a couple of days, I would not change the needle. The port septum can withstand a limited number of punctures. Check with the manufactuer for the number they recommend for the device in use. A chest port may be rated for up to 2000 punctures while a smaller port body, often used in the upper arm or for peds can only withstand 750. How long will this port be needed? How can you extend the life of the port body be reducing the number of punctures without increasing infection or extravasation risk? Adequate port needle stabilization, excellend skin antisepsis, and maintaining an intact dressing constantly would be my focus.
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