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Nan Morris
antibiotic ointment use for central line removal

I'm gathering data to support the use of some form of petroleum (ointment or gauze) in our practice during central line dressing removal.  The practice of using the ointment or gauze is well supported (INS, a multitude of offical procedures, cases in the literature) but a roadblock I'm being faced with is the use of antibiotic ointment with central line dressings is not allowed due to the incidence of site infections with this practice. Is this acceptable with removal since the dressing are left in place for a shorter period of time?  Is there a reference to support this?  Thank you, Nancy

andie44
We use Petroleum Jelly - come

We use Petroleum Jelly - comes in a single use size. It works well

 

Thanks

lynncrni
 An antiseptic or

 An antiseptic or antimicrobial ointment is not required. This language changed in the 2011 INS Standards to allow for a petroleum-based ointment. Infection prevention is not the goal of this practice. Preventing air emboli is the goal, Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Nan Morris
another related question

Thank you, I knew that air embolism was the issue, but was unsure about an antibiotic ointment as an option, as I've seen it in mentioned in several procedures. Happy to use the plain, sterile petroleum ointment

In reviewing the INS procedure for the removal of CVC, though, another question came to mind.  I assumed the ointment would be used during the removal process, as well as on the dressing.  The procedure states to apply gauze to the insertion site during the withdrawal, hold pressure for 30 seconds, and then apply ointment to exit site, cover that with gauze and a TSM dressing. Could I please have clarification on this?  Mosby's Skills states "As the catheter exits the site, apply pressure with a petroleum-based ointment and sterile gauze".  This seems much safer to me.  Thanks, Nan

Robbin George
30 seconds of pressure on the

30 seconds of pressure on the exit site when removing a CVC sounds incorrect

It's more like 5 minutes or more if the patient is anticoagulated

Robbin George RN VA-BC

Robbin George RN VA-BC

lynncrni
 Exit site at or below the

 Exit site at or below the level of the heart. Remove the securement methodk; slowly withdraw the catheter. Pressure until hemostasis, agree with Robbin that 30 sec is not adequate and it is more like 5 min or more, depending upon the coagulation, etc. After hemostasis, then quickly switch the hand held gauze for a gauze prepared with the ointment. Tape it into place. There are no studies to recommend a specific time for the patient remaining supine. You will find practices of 15, 30, and 60 minutes. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

[email protected]
Petroleum dressing on CVC removal...

 This subject became part of a recent discussion with the question being; Is a petroleum based dressing necessary when removing a PICC ? Are there any studies citing frequency of air embolism from a PICC site ? Intuitively this seems like a very unlikely event.

David

David Bruce RN

lynncrni
 No studies, but I have heard

 No studies, but I have heard anecdotal stories of VAE associated with PICC removal. It can happen if all risks are present and nothing has been done to mitigate those risks such as closing the puncture site. The skin-to-vein tract can be connected to a well-established fibrin sheath that can act as a conduit for air once the catheter has been removed. If the paitent is fluid volume depleted, and they stand up and take a deep breath before the site has healed, VAE is possible. No one has quantified this risk. I would agree that it is a low risk but it is a risk nonetheless. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Glenda L Dennis
VAE

 This is certainly a rare occurance but it has happened with devastating, life long injury.  The young woman who's PICC was removed improperly will live with the result of her brain injury from air embolism and the nurse who wasn't properly trained and thought, "how hard can it be to remove a PICC", will never completely heal from the event.

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