Good morning to all:
There has beed some discussion in our department about the first dressing change on newly inserted PICCs.
I searched in the INS Standards and the INS Policy and Procedures manuals but cannot find the answer to my questions.
Can you help? Here it goes....
What is everyone doing for dressing when they insert a PICC?    When we insert them, if there is no blood oozing from the insertion, we tend to put a Biopatch at the site. We check the site at 24-48 hours and IF we see blood, even a pinhead size, we will change the dressing. Even a minute amount of blood on the Biopatch is very discernable.  Obviously, if we use a gauze due to the patient's bleeding status, we change that dressing at 24-48 hours and apply a Biopatch at that time.
Is there anything written that says we MUST put a gauze at the site at the time of insertion? If so, please guide me to it so I can print it and present it to my collegues.  I have not been able to find any such article, but would love to hear from you all about this issue.
Thanks in advance to all your expert responses.
Maria
Hi Maria,
At our facility, we place a Biopatch at the PICC insertion site at time of insertion on all RN inserted PICC lines (unless there is a bleeding issue). The guideline we follow for changing the dressing is if the Biopatch is less than 50% saturated with blood, we leave it in place. If more than 50% of Biopatch is covered with blood, we change it. The Biopatch continues to be effective even with the presence of drainage. We have been doing this for approximately 9 months now and have very little CRBSI and we also have decreased hospital costs because we eliminated an extra dressing change. Our policy for dressing change frequency is every 7 days and prn if loose or soiled. I don't have any specific articles, but the Biopatch inservice/training CD does talk about the Biopatch working even if drainage is present. Hope this helps you. Vickie
Vickie Teresinski, RN, CRNI
Thank you Vickie:
Yes, I omitted saying that when the PICCs are inserted in Interventional Radiology, a gauze is put at the entry site. We then automatically check the site ourselves with the first dressing change at 24-48 post insertion, since we did not insert the line and have really no idea what the site looks like.
Maria
Maria, There is lots of good articles about placing the biopatch at the time of insertion and then changing them at 7 days. The most recent is in JAMA of 3-29. This study was done in France but it was an independent study of >1400 patients. The hospital already had a very low infection rate but as we know we should all strive for 0%.
They was a 66% decrease in their already low infection rate and went from every 3 days to every 7 days dressing changes with this success. Great article.
We do not change our dressing unless the fluid is oozing out from under the dressing. Chlorahexidine is effective even in the presence of biological matter (blood,pus,etc)
We find if we change the dressing even with the Biopatch covered in blood we pull the clot of the exit site and it continues to bleed. So if it does not leak out we leave for
48 hours and then change. We stopped putting gauze when we switched to Biopatch. We rarely find any oozing. Took us awhile to be comfortable with it.
I always thought it was standard to do a 24hr drsg change on PICC's after insertion. That's been our policy. In looking at INS guidelines, I don't see that. I wonder if we got it from infection control, CDC guidelines. I know it had to come from some source! Anyone else aware of that??
We currently don't routinely use Biopatch, as we have a great infection record. I was trying to suggest if we put Biopatch on @ insertion we could skip the 24hr change and that would eliminate the cost of the first dressing change. We do many more 24h drsg changes than 7 day, as often a PICC is DC'd in a week or less.
Thanks for any input!
Paula Happel, RN, MSN
Mercy Medical, Cedar Rapids, IA
Paula Happel, RN, MSN
Mercy Medical, Cedar Rapids, IA
Changing the first dressing on a PICC is a hold-over practice from the previous method of insertion. So are you using the old through-the-introducer method or the MST method. If MST, then you are probably not seeing the same amount of post-insertion bleeding. As long as the dressing is clean, it does not need to be changed within that 24 hour period. I recently wrote about this issue on my blog and there is a link to the new study on using Biopatch and changing dressings at 7 days. Please visit the blog for more discussion. http://hadawayassociates.blogspot.com/
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