Is it considered best practice or the standard of care to have an impregnated disc applied to all central lines? It was my understanding they are very effective the first week post insertion, but there after there is not been substantial evidence of a difference. In home care we are currently using these on patients that have a high risk for infection, (immunesupressed, risk of non-compliance, poor environment, etc). Should these be placed on all patients? Is there any documentation of this?
A CHG-impregnated sponge dressing is supported by evidence and is addressed in the draft of the new CDC guidelines document that was out for review last November. That final document should be available by the end of the summer. The INS standards of practice are also in review and revision and will be out Jan/Feb 2011.
A silver-impreganted sponge dressing has no evidence to support it use and that is not addressed in the CDC document.
I can not recall the details of the CHG sponge studies but I think you may be getting this confused with the timelines for the presence of biofilm. Studies have shown that there is more biofilm on the outer catheter surfaces within the first week of catheter insertion and after that there is more biofilm on the internal lumen surfaces. All CHG dressings (sponge and gel dressing) would work on the skin as the source of the organisms. Therefore it would be reasonable to assume that they are most effective within that first week, however you will need to check the published studies or wait for those new guidelines and standards to be released. 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
The exact wording of the 2011 CDC Guideline is :"Chlorahexidine Impgregnated Sponge dressing IF the rate of infection is not decreasing despite adherence to other strategies (ie., education and training, maximal sterile barrier precautions, and >0.5% chlorahexidine preparations with alcohol for skin antisepsis)" pagte 8 from the CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011.
Frankly I also did NOT know there was a Sponge Dressing out there as the manufacturer clearly refers to it as a
"Protective disc with CHG" per the manufacturer exact words. (See Ethicon360.com [email protected])
IF is the key word in the CDC guidelines which makes this recommendation a UN-RESOLVED ISSUE according to the CDC, not a category 1B as some people seem to think it is. I take the above to mean use a chlorahexidine impregnated sponge Only IF education & Training, Sterile Precautions and CHG skin antisepsis is not working.
Our product and standards committee would like to trial an IV dressing product for patients that are reacting to tegaderm and other transparent adhesives. Anyone having good success reducing reactions (not CHG specifically) to adhesives? Recommendations that you can share? We received a patient billed as "highly allergic" to adhesives and tape who had a SorbaView shield dressing in place. Any experience with this product?
Thanks in advance, g
My relpy went above your question:)
Valorie Dunn,BSN, RN, CRNI, PLNC
I would never put a dressing of any kind on any patient without using a skin protectant solution, ever!! I think this solution goes a long way to keep the dressing and stabilization device adherent to the skin while protecting the skin at the same time. You do have to avoid placing this solution directly under the site where the Biopatch or CHG gel would go as it will block the effectiveness of the CHG. 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 have been using SorbaView for over a year and absolutely love it. My pts with sesitive skin have good luck with it as long as the nurses allow the CHG to completely dry before applying it. I have very sensitive skin and trialed it on myself before I would use it on patients and my arm was completely clear when I removed it several days later. However, I had the nursess do annual skills using my arm with my PICC line taped to it and several of them didn't let the CHG dry completely and it about ripped the hide off my arm. It does stableize the line but I caution the nurses to use extra caution when you get close to the insertion site while removing it because I personally have had a couple of patient that the window has suck to and the first one I removed it from I actually pulled the line out a couple of CM. Bottom line is I love it, the nurses love it and the patients find it more comfortable than some other securement devices. And it saves several minutes of nursing time.
I do not work for any product companies and my reply is based strictly on my hands on experience. Valorie
Valorie Dunn,BSN, RN, CRNI, PLNC
Be very careful what skin protectant you select because products that contain PVM-MA, neutralize the effect of CHG. Some of these products include Aplicare from Bard, Sureprep from Medline and Triad plus. If you put down say Chloraprep and then one of the before mentioned skin preps, you neutralize the chloraprep CHG protection. This is a well documented fact that many simply overlook.
Furthermore imho, the Sorbaview dressing is easily soiled, higher priced and has the potential to cause more skin tears than say a Tegaderm transparent dressing. I believe the Sorbaview is way over hyped and under performs. Be prepared to see a 25 to 50% cost increase in your dressing budget if you use sorbaview.