This practice originated with the beginning of PICC insertions. We were placing very large gauge needles and then leaving a smaller gauge catheter. This left a puncture site larger than the remaining PICC, which allowed for bleeding within the first 24 hours or so. Now that practice is virtually gone and the small needle used does not allow for the same amount of bleeding around the PICC. If you have no bleeding there is no need to change the dressing at 24 hours. So the "evidence" is derived from the rationale for why we were originally doing this and the change in technology. I do not know of any actual studies on this, and I would venture to guess that we may never see any. Lynn
So, Lynn, you recommend going right to a weekly dressing change? We still place a folded 2x2 at the insertion site which gets removed at the Day 1 dressing change. You are right, there is rarely any bleeding anymore with the reverse taper, but there are often times when we have had to pull the catheter back due to initial placement in the RA, so we lose the taper and there may be some oozing. Then it is nice to have that little square of gauze to absorb. If the gauze is used, the dressing can't go a week, right?
we switched directly to a weekly dressing change about a year and a half ago and have had great success with it. I understand what you mean when you have to retract the catheter a few cm due to RA positioning, in those instances we may hold pressure until the bleeding stops and in some rare instances, we do have to place a gauze and do a 24 hour dressing change, but this is VERY rare. We are using the biopatch and place these at insertion and scheduled the next dressing change in 7 days providing no problems with the dressing (non-occlusiveness, wet, soiled) occurs during that time. Not only will this help with decreasing risks of infection due to less manipulation with the catheter, but also will help with cost savings in your facility. If you consider that a picc dressing kit (with biopatch included) costs about $14 per kit and say you place 100 picc lines per month. Eliminating that 24 hour dressing change could save you $1400 per month, even more if you consider those lines you place for home antibiotic therapy and are discharged less than a week after picc placement. That could be a cost savings of $16,800 per year. After reading Sophie Harmage (hope I spelled her name correctly) article about bundling and zero infections in an AVA Journal last year, we adopted the weekly dressing change. Hope this helps.
This practice originated with the beginning of PICC insertions. We were placing very large gauge needles and then leaving a smaller gauge catheter. This left a puncture site larger than the remaining PICC, which allowed for bleeding within the first 24 hours or so. Now that practice is virtually gone and the small needle used does not allow for the same amount of bleeding around the PICC. If you have no bleeding there is no need to change the dressing at 24 hours. So the "evidence" is derived from the rationale for why we were originally doing this and the change in technology. I do not know of any actual studies on this, and I would venture to guess that we may never see any. 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
So, Lynn, you recommend going right to a weekly dressing change? We still place a folded 2x2 at the insertion site which gets removed at the Day 1 dressing change. You are right, there is rarely any bleeding anymore with the reverse taper, but there are often times when we have had to pull the catheter back due to initial placement in the RA, so we lose the taper and there may be some oozing. Then it is nice to have that little square of gauze to absorb. If the gauze is used, the dressing can't go a week, right?
Wendy Erickson RN
Eau Claire WI
Wendy
we switched directly to a weekly dressing change about a year and a half ago and have had great success with it. I understand what you mean when you have to retract the catheter a few cm due to RA positioning, in those instances we may hold pressure until the bleeding stops and in some rare instances, we do have to place a gauze and do a 24 hour dressing change, but this is VERY rare. We are using the biopatch and place these at insertion and scheduled the next dressing change in 7 days providing no problems with the dressing (non-occlusiveness, wet, soiled) occurs during that time. Not only will this help with decreasing risks of infection due to less manipulation with the catheter, but also will help with cost savings in your facility. If you consider that a picc dressing kit (with biopatch included) costs about $14 per kit and say you place 100 picc lines per month. Eliminating that 24 hour dressing change could save you $1400 per month, even more if you consider those lines you place for home antibiotic therapy and are discharged less than a week after picc placement. That could be a cost savings of $16,800 per year. After reading Sophie Harmage (hope I spelled her name correctly) article about bundling and zero infections in an AVA Journal last year, we adopted the weekly dressing change. Hope this helps.
Karen