Hi all -
For those of you placing a Biopatch at the time of insertion, are you routinely doing a 24 or 48 hour dressing change? At my facility, we routinely change the dressing every 7 days. I'd like to know what the "community" at large is practicing.
(I changed our policy over 2 years ago, My hospital management is inquiring why we no longer perform 24 hour dressing changes) I believe there is good evidence to back this practice up as well as substantial cost savings.
Thanks in advance for your help.
If there is no gauze and a biopatch we do not do the 24 hour after insertion dressing change.
Valorie Dunn, RN, BSN, CRNI
Infusion Therapy Coordinator
Home Health Pharmacy
St. Elizabeth Regional Health
Valorie Dunn,BSN, RN, CRNI, PLNC
We also changed our practice a few years ago. We only apply guaze if there is active bleeding. We just try to take the extra time to achieve hemostasiis before applying the dressing. It is hard to resist the temptation to slap on a gauze dressing in order to run to the next picc insertion.
Darilyn Cole, CRNI
Mercy General Hospital
Darilyn Cole, RN, CRNI, VA-BC
PICC Team Mercy General Hospital Sacramento, CA
I agree that as long as there is no gauze being used, the site is clean and dry of any blood or discharge and a biopatch is in place and intact beneath a TSM dressing then once a week, no longer than 7 days, is appropriate. As Darilyn said if you take care at the time of insertion then there is no reason to change a dressing in 24 hours. Sometimes old habits, such as post-insertion 24 hour dressing changes, are hard to break or change but we must move on.
Marvin Siegel RN CRNI
Director of Clinical Services
Town Total Health
We used to always place gauze and then transparent dressing over picc site for post insertion bleeding. What I found was that I was doing alot of 24 hour dressings and the dressing was clean and dry. I decided to assess each insertion upon completion and determine which one would benefit from a gauze dressing and which one could have a biopatch. The reason you do the 24 hour dressing is because of the gauze dressing and the blood on the site. I also felt that any unecessary dressing change was exposing the patient to an increase risk of infection. I found this to work out great. It has saved me so much time. I always go and assess every picc line 24 hours after to insertion ( next day) . If it is clean and biopatch, great, if not I change it.
Gina Ward R.N., CPAN
Gina Ward R.N., VA-BC
The 24- hour dressing change with PICCs actually began due to the technology being used in the early days. The insertion needles were very large compared to the PICC itself. This meant lots of bleeding for some patients. Thus the need to change the dressing within 24 hours. That is no longer the case with MST insertion. So you simply need to alter your practice based on this change in technology. No blood means no need to change the dressing. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
Thanks for the input everyone. I appreciate it.