I am very interested in finding out exactly what type of "ointment" based air occlusive dressing everyone is using when removing a central line to prevent air embolism.  At the present time, we are not placing this type of dressing when a central line is removed and are in the initial stages of changing the practice and policy. The hospital where I come from will not allow betadine ointment to be used. I would really appreciate as much input as possible on this subject.....the exact type of dressing, oinment, etc.Â
Thanks to everyone in advance who responds to my request!
You can use any ointment, but povidone iodine or a triple antibiotic ointment like Neosporin is most commonly used. YOu can even use a Vaseline based gauze, although INS standards do call for an antimicrobial ointment. The point is the petroleum base to seal the puncture site. The anti-infective properties are secondary in this case. Then cover this with gauze and tape over the entire surface. Leave intact for at least 24 hours.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
Thank you Lynn and Mari for your valuable advice!
Patti
Should the ointment be used when an infusaport is deaccessed for chemo? (short duration)? How about a PICC line?? Does the same apply??
**We are a small rural hospital that does not have an IV team, so I really appreciate all your help
The issue is the skin-to-vein tract that is left when the catheter is removed. This leaves and opening for air to be pulled into the vein. So for deaccessing ports, the ointment is not necessary. For removal of all catheters, including PICCs, I believe it is necessary. The risk of air emboli when a PICC is removed is very small, but there is still some risk if everything were lined up to allow it. This would be a skin tract to a fibrin/thrombus extending the course of the catheter up the vein, in a patient that immediately stood up and took a deep breath after removal. It could happen. Also, I think that having the same procedures for removal of all CVCs creates less confusion and therefore a safer setting for all patients. The risk of air emboli is much greater when pulling the line from subclavian or IJ sites though.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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