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Leann Kennedy
Biopatch at insertion

Good morning group, 

Our VAD taskforce is looking at applying the Biopatch at time of insertion.  I've read the previous forum, and also received feedbaack from Lynn (thank you!).  My understanding is the one advantage of Biopatch at insertion is to eliminate the 24 hour dressing change. 

 I asked for research documenting their rationale (which I paraphrased below).  My question...has anyone heard this before?

 ...the inflammatory reaction at insertion site causes swelling and fluid at the site, which can draw in any bacteria within the first 24 hours post-insertion.  This bacteria can travel down the external catheter shaft.  Also, biofilm can start developing within the first 24 hours and could seed any bacteria introduced.  By placing the Biopatch at time of insertion your risk of bloodstream infection associated with line insertion is reduced.

This came from the higher-ups, so I am looking for a response that I could somehow back up with evidence-based practice (they love those words)

Thanks so much.

Leann Kennedy, RN, BSN 

 

Stephen Harris
We have been successfully
We have been successfully placing bio-patches for over a year now. CR-BSI are down and in general we feel that bio-patches are a success. Initially we did away with 24hr. dressing change but we learned it was a mistake. Although the patches absorb something like 7 times their weight in blood many nurses were leaving bloody dressings on pts. for the full 7 days.  We now put on the bio-patch and c0ver it with folded 2X2's and then change it in 24hrs. Our central line dressing kits have a bio-patch in them and thus the bio-patch gets changed also.  The 2X2 insures the 24 hr. dressing change as all CVC with a gauze dressing must be changed q 24 at our hospital.
Nadine Nakazawa
Ask you Biopatch rep for
Ask you Biopatch rep for some references..   Marcia Ryder has described the above sequence of events immediately after catheter insertion.  I believe she has several articles published describing this.  She has also done some lab work documenting bacterial regrowth.

Robert Garcia has an article describing achieving "zero" CRBSIs for short periods of time by implementing the bundle, and others have described similar results.  
Look at the Summer 2006 JAVA article by Ann Earhart.   she describes how they determined an increase in CBRSIs in a skilled nursing facility unit, their assessment of the problem, and their determination that a 24 drsg change using Biopatch at that time made a difference in bringing those rates down to "zero" for a short period of time.   Like with all behavioral changes, you need to keep up the assessment and education in order to maintain those impressive stats.

In two of our ICUs, implementing the Central Line bundle and adding biopatch with the 24 drsg change and weekly or PRN, we've achieved "zero" CRBSIs for periods of time.   CRBSIs are still a problem in our BMT and oncology units, but the overall rates have decreased over time.

Nadine Nakazawa, RN, BS, OCN, CRNI, VA-BC

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