We have a patient that developed a granuloma at the cvad exit site that became infected- there's bleeding and purulent drainage. Aside from IV abx therapy we are doing daily gauze dressing changes with betadine and alcohol- betadine first then alcohol. It appears that the exit site bleeds more so every time we use the alcohol to clean off the betadine. Is it appropriate to just clean with betadine and not use the alcohol until the exit site wound is not so raw?
Removing any povidone iodine solution with alcohol was never a good practice and should not be done. Any site cleaning should always begin by first cleaning the skin to remove oils, dried blood, etc. If necessary this can be done with sterile saline instead of alcohol for compromised skin such as this. Then apply the povidone iodine and allow it to dry for 2 full minutes and leave it on the skin. Also why daily dressing changes? Do you need to assess this site that often? This adds more irritation, IMHO. With gauze dressings, you should be changing it every 48 h. 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