Previously both of these topics have been listed with few replies. So I am asking again...(1) does anyone have any experience with changing from chloraprep to chlorascrub, particularly in peds? Our facility has decided to change and the Peds VAT is concerned about skin irritation issues. (2) If you are using chlorascrub: have you found a way to drop it on your sterile field if you need an additional chlorascrub? We have been told that because it comes out of the package "wet" it is not to be dropped on a sterile field (could it not be dropped into an empty space in the plastic tray the PICC catheter comes in? Do you have an assistant open the package and you pull it out?) (3) Is anyone willing to report their experience in using chloraprep in infants under 2 months? This has been asked previously also, but although I hear often that many are using this, few will report it. Are there any new recommendations from the manufacturer for this age population?
Thanks!
Holly
RE neonatal use, go to my blog at http://hadawayassociates.blogspot.com/2009/04/skin-antiseptics-in-neonat.... Janet Pettit, a neonatal nurse practitioner provides information about CHG use in neonates.
I can not speak to the incidence of skin irritation with one product vs the other, but interested in reading what others have seen.
RE dropping the wet swabsticks onto a sterile field - this should not be done as the wet solution could easily soak through the sterile barrier and wetness means contamination. PDI has 3 different packages for their swabstick, so you might need to change to the larger quantity for all your PICC insertions. This would ensure that you are covering an adequate amount of skin surface area. Otherwise, you will need to have someone open the packages and the inserter would then need to pull them from the package.
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
Lynn,
I understand the problem of wetness on the sterile field, that is why I mentioned dropping it in an empty plastic tray in the insertion kit that holds other supplies (once they have been removed). I was just wondering what other folks have been doing. As far as Janet's input, I recognize her as a leader in the neonatal vascular field and look forward to seeing her comments, unfortunately that site is blocked content from my work computer, I will have to access it from home.
Holly
If I understand the main difference in the two products it is 2% chlorhexidine gluconate (CHG) vs 3% (or 3.15)? With pediatric patients and especially neonates why would you change to a higher concentration when you already have research supporting the lower concentration? I know it comes down to price, but the who reason there was and is hesitancy in using CHG with neonates is absorption through the skin and irritation (plus lack of research showing safety). CHG does not absorb through the skin as readily as betadine, so that is a plus, but the issue of irritation becomes greater (theoretically) with higher concentrations of the substance.
So I am confused, why would you even consider using a higher concentration of CHG on kids when efficacy with 2% is proven?
Nancy Moureau
Nancy L. Moureau, PhD, RN, CRNI, CPUI, VA-BC
PICC Excellence, Inc.
[email protected]
www.piccexcellence.com
Nancy,
Those were our concerns exactly. We were not involved in the decision. It has been made for, how shall I say this, "stewardship" reasons. I am searching for experience anyone has had in using the higher concentration in peds.
Holly