When a picc line is removed we are putting on a sterile occlusive dressing as part of the proper air embolism prevention protocol.
Our policy says that the dressing should be changed and the access site assessed every 24 hours until the site is epithelialized.
I , however, had been doing it as I saw in our HCA corporate initiative; leaving the sterile occlusive dressing on for 72 hours. This worked well, especially when we are taking picc lines out and sending patients home in a couple of hours. I would tell them to keep the dressing on for 3 days, it is ok to get wet and they can remove dressing after 3 days. ( of course to call or come to hospital if any problems)
but....since I now realize and see in the INS standards that the whole 24 hours reassessment thing is the standard. What are you all doing about the dressing on pts you are sending home that day?
Thanks in advance, Gina Ward R.N., CPAN
Thanks for bringing this to my attention about the 24 hour assessment. My recent literature search on air embolism revealed recommendations for keeping the dressing on for at least 24 hours to allow time for the tract to heal, but we all know that each patient is different in their healing time. My opinion is that longer dressing periods would not be a problem as long as it is occluded with a petroleum-based ointment. I also know the standard says antiseptic ointment but infection is not the issue. Occluding the skin to vein tract is the issue and this can be done with any type of petroleum gauze. Neosporin or Betadine ointment is not necessary. 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...... I was thinking could we re assess the dressing and be sure it is intact and clean every 24 hours on the inpatients, and then if it needs attention change it. I agree every patient is going to heal at a different rate. So, if it is already healed and sealed, keeping the dressing on for 72 hours is fine if it remains clean. Versus, removing the dressing every 24 hours, and if needed replacing with an identical bandage, when it was already clean and covered. Or , would this be going against the approved standards that refer to assessinig the site.
So, what happens if we continue doing as I was doing and this is not in alignment with the INS standards. Is that now a potential legal problem?
Back to the original question; if we adhere to this rule then what do we do with OPs? Tell them to change and look at the dressing every 24 hours and re seal with dressing ( a bandaid they could apply, but I dont believe they could manage a sterile occlusive dressing.
Thanks so much, Gina
Gina Ward R.N., VA-BC
The issue is a sealed or healed skin-to-vein tract. I have never found any research that estabilshes a specific length of time, but this idea of a dressing for 24 hours is in the literature. Then the specific question you raise is about assessment. How do we actually know when the tract is healed and when it is safe to forgo the use of an occlusive dressing? Is that at 24 hours or should it be extended to 72 hours? There is a case report of a skin-to-vein tract remaining attached to a fibrin sheath producing an air embolism when the patient went outside to smoke a cigarette. This occurred within 30 minutes of removal and was subsequently documented on a CT scan. They were actually able to see the air in the sheath along the same path as the catheter had taken. So everything came together - the open conduit, an upright patient taking a deep breath to smoke. I actually think that 24 hours on the dressing is sufficient but see no problem with leaving an occlusive dressing on for 72 hours. There would be no "legal problem" unless there is a lawsuit filed due to a complication. That complication would more than likely be an air embolism. I have never seen any reports of an air embolism occuring longer than 30 minutes after catheter removal. I would not worry about changing this dressing. I would write a policy to leave it on for either 24 hours or 72 hours, your choice. This patients are more than likely going to be discharged and not in a setting where assessment and redressing is likely. So choose a time period, and educate the patient about what to be aware of should an air embolism occur. 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
I agree, I have been informing my patients to leave on for 3 days as well. Wouldn't a sterile, transparent dressing such as a tegaderm do the trick as the site can be clearly seen without necessarily removing the dressing for the 3 days. Just a thought.
Definitely not! You will need an ointment based gauze in addition either covering it with tape or transparent membrane dressing to be occlusive. 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