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cbusch
biopatch vs tegaderm CHG

My facility is researching the biopatch and tegaderm to use with our central lines. Would like further information on which one is used and why it was chosen?

I have clinical studies from both but would like further information.

Thank you

Rhonda Wojtas
tegaderm chg

We use the Tegaderm Chg simply because you can see and assess the insertion site.

Rhonda Wojtas, RN VA-BC

momdogz
Biopatch.

Chlorhexidine needs to be in contact with skin to be effective.  Tegaderm CHG does not reach around the underside of the catheter, and CHG does not migrate all by itself.  Bacteria live several layers into the skin, especially around hair follicles and sebaceous glands, and if there is no CHG reaching them the bacteria will colonize the extraluminal portion of the catheter.

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

mary deschneau
Tegaderm CHG dressing-migration of CHG activity under a catheter

 

Tegaderm CHG -The concept of migration of CHG activity under a catheter.
in vitro study:
 A section of catheter was placed on agar and the CHG gel is placed over the catheter. After the gel and catheter are removed, the agar surface was inoculated with bacteria. There is no growth underneath the catheter even though there was no direct contact with the gel pad. This is a significant factor in demonstrating the activity zone of Tegaderm CHG even where the gel pad does not touch.
 
An  in vivo study was conducted to further demonstrate that the skin under a catheter is protected with CHG from the gel pad.
In a simulated wear study, healthy volunteers wore Tegaderm™ CHG dressings over sections of catheter for 7 days.  At each of days 1, 2, 4 and 7, dressings and catheters were removed, and the skin under the gel pads was sampled with 3M™ Transpore™ surgical tape.  The small areas under the catheters were isolated from the larger areas under the gel for analysis to eliminate the potential for CHG crossover from the gel areas. This sensitive analytical tool called MALDI or Matrix-assisted laser desorption/ionization, detected CHG on the skin isolated directly under the catheters, and  that the relative amounts of CHG recovered from skin under the catheters increased with dressing wear time up to 7 days. 
The concept of CHG migration in moisture has been confirmed by the detection of CHG on skin isolated from under catheters in this wear study.  
 
CHG migrated with normal body moisture to provide coverage to the skin under these catheters, even though there was no direct contact with the gel pad.
 
 
 

 Mary Deschneau RN, BSN,  VA-BC

Leigh Ann Bowegeddes
Tegaderm CHG - The concept of migration of CHG activity

I must respectfully disagree, with the disclaimer that I do consult for Biopatch, as Mary works as an employee for 3M.

The problem with in vitro is that it does not always simulate what happens in vivo. Remember that the agar plate is mostly water. Some things tend to float around on water. The skin, however, is hydrophobic, and does not facilitate floatation of substances. As CHG is a molecule, rather than a living entity, it cannot walk around on its own.

The second referenced study was, as stated, on healthy volunteers. These catheters were not actually inserted into the skin, and the skin used (correct me if I misunderstand this, Mary) was on the patients' backs. I see the point of what Mary is telling us, but this still does not answer the primary question, "Is it proven to reduce CR-BSI?" At this point, there is no scientific evidence to show that this product specifically reduces CR-BSI. The studies done with Biopatch cannot be extrapolated to include Tegaderm CHG, as the mode of delivery is not identical. For this reason, SHEA-IDSA Guidelines for Prevention of CLABSI and new CDC Draft Guidelines for the Prevention of Intravascular Catheter-related BSI include recommendations that are worded to describe only Biopatch, not Tegaderm CHG. The Tegaderm CHG package insert states that it has not been proven to reduce CR-BSI. For these reasons, and the issues we saw with skin irritation and sticking to the catheter, and the decrease in infection we experienced with Biopatch, we have chosen to stay with Biopatch.

It is my understanding that there is some research to be done in Italy on the Tegaderm product.

Leigh Ann Bowe-Geddes, BS, RN, CRNI

Vascular Access Specialist

University of Louisville Hospital

gretchen
we trialed both at our

we trialed both at our Children's Hospital and chose Biopatch for a couple of reasons....1.  It will fit under an accessed port as well as using it for PICCs, CVLs, etc.  (our PICU also uses it for around chest tube sites).  2.  We found the Tegaderm CHG gel pad too sticky, and lines were pulled partially out and at least one totally D/C'd while trying to remove the dressing.

amaguila2009
CDC Guidelines

Thinking of what these institutions stand for (SHEA and CDC), they should not be circumscribed in their recommendations.

Angelo M. Aguila, MSN, RN, VA-BC
Vascular Access Nurse
[email protected]

ImN2Fun2
Biopatch has serious problems IMHO

In two years since Tegaderm CHG has launched, lets take a look at what medical professionals are finding out about Tegaderm CHG today in 2010:

 

A) First Data from Independent Hospitals DOES EXIST for the asking that shows Tegaderm CHG reduces CRBSI. This independent hospital data is out there for the asking. Unfortunately many people think we need to wait for the big CRBSI study when we can get data on the product today.

B) Floor Nurses like Tegaderm CHG better because it is easier to apply, gives them full visibility of the insertion site so they can see infections vs. finding them under a obclusive biopatch

C)Tegaderm CHG, will be publishing a CRBSI Study but given the fact we have so many new types of infections these days, I imagine it is taking much longer to complete the study. Until then, published data from independent hospitals is ready for the asking.

D) Tegaderm CHG DOES migrate under the catheter unlike what some claim. There are 2 published studies that prove it does. You must remember the gel pad is in a aquaous state and CHG begins migrating immediately.

E) Tegaderm CHG was proven to work for 10 days but is a 7 day dressing. The amount of CHG on the skin increases the longer the tegaderm chg is left on.

F) Even though some central line teams tell you there is "No Issue" with Biopatch, more than 35% of the hospitals in the USA place it on incorrectlyBiopatch is placed on Upside down, it is often not placed flush with the skin and sometime never gets put on at all. This is a documented fact. Tegaderm CHG is a peel and stick and eliminates the Misapplication issue. Misapplication of Biopatch adds extra cost at the very time hospitals need to be saving money.

G) With Tegaderm CHG, a whole step is eliminated. No more disc and then a cover dressing is needed. Instead Tegaderm is peel and stick.

H) Dr. Dennis Maki who first wrote on Biopatch has now commented on Tegaderm CHG and said the following and I quote: "the integrated CHG Transparent dressing provided superior prevention of flora regrowth on prepped sites and progressive kill of cutaneous microflora on unprepped sites. The integrated CHG transparent dressing is easier to apply, reliably secures the catheter and permits continuous inspection of the insertion site."

I) Tegaderm CHG absorbs more fluid than Biopatch but at a different uptake rate. One is a sponge and one is aquaous gel pad. The technology is different on how they both absorb and the rate of absorption but Tegaderm CHG does absorb more fluids than biopatch.

J) In many hospitals, there are no dedicated PICC teams to change dressings 24/7. Floor nurses love the fact Tegaderm CHG is a all in one dressing/antimicrobial  and you just peel the backing off and stick it on.

K) People are naturally resistant to change.

L) Visibility of the insertion site is a big deal. By the time an infection gets to 2.5 cm, it can be a significant infection that is occluded with the biopatch because it is occlusive. One would see this with Tegaderm CHG

M) Skin Flora Regrowth is documented as the #1 cause of CRBSI and Tegaderm CHG way out performs biopatch according to studies in stopping skin flora regrowth. There are all kinds of papers on this

N) Any stickyness of Tegaderm CHG helps to secure the catheter and can be eliminated by use of an alcohol swab upon removal IF ithis occurs.

Simply put, Nurses from all over the USA had input into the design of Tegaderm CHG because they were asked what did they disliked about Biopatch. Tegaderm CHG then corrected those issues. Today Tegaderm CHG is the next logical step in Antimicrobial dressings.

Go out and get the independent hospital studies or do one yourself in your own hospital. Don't wait for the big CRBSI study to be published because data is already published.

Leigh Ann Bowegeddes
Two questions that come to

Two questions that come to mind are:

1. Who are you? It is my understanding that if you work for a manufacturer in any capacity you must identify yourself and provide disclosure to make product specific comments on this site.

2. Why is this pending TCHG study not listed on Clinicaltrials.gov?

Leigh Ann Bowe-Geddes, BS, RN, CRNI

Vascular Access Specialty Team

University of Louisville Hospital

Louisville, KY

Clinical Consultant, Biopatch

 

cbusch
Scub the hub camparign and using CHG

We will be going to utilizing the CHG scrubs for the hubs. However there is new information out that states this isn't the best option. The srub the hub campaign encouraged it but a pre told me that there is a FDA warining about using it on the hub. That it breaks down the compostion of the hub. Does anyone have any further information on this?

Thank you for your help

Carol

 

 

 

Carol Busch RN,VA-BC, CPUI
PICC/Vascular Access Nurse

pfintonis
we use the biopatch. We tried

we use the biopatch. We tried both, but found the tegaderm chg to be difficult to remove and easily pulls catheter out from the site when changing dressings.....wow just read the rest of the posts. when used correctly, i'm sure they both reduce crbsi's. you heave to try them both and see which works better for you. given the debate, I bet both companies are willing to give you free trials.

ILP
Not difficult to remove at all

Tegaderm CHG is easily removed with a alcohol prep pad or a few drops of sterile saline from a prefilled syringe. The gel pad just releases.

I find that once you touch an alcohol pad to the chg gel pad, it release almost immediately. I like the fact tegaderm chg is a one step dressing change and chg protection device. Any sticking if experienced at all is easily negated.

 

I Puckett

Tulane

Margieh
Margieh's picture
Tegraderm CHg

I find many pt's develop skin irritations with the the statlocks and I see many Biopatch's applied incorrectly. I don't see where that is going to be a problem with this dressing. I love it!

Margie Hood RN

Helen
povidone oinment or bacitracin over exit site of Central lines

any such practice in your area? please update. I only see NKF 2000 update reagrding use of the product.

helen

kathykokotis
Scrub access sites

There is no market labeled product currently with CHG to scrub access sites.  Current products are market approved or market indicated by the FDA for skin only

For skin the following applies to the package instructions on the back.  15 second scrub and 30 second dry which is 45 seconds.  CHG is not a quick disinfectant.

To my knowledge no studies have been published on plastic and CHG as it has not been market indicated by the FDA for this application

Kathy Kokotis RN BS MBA

Bard Access Systems

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

kathykokotis
Scrub access sites

There is no market labeled product currently with CHG to scrub access sites.  Current products are market approved or market indicated by the FDA for skin only

For skin the following applies to the package instructions on the back.  15 second scrub and 30 second dry which is 45 seconds.  CHG is not a quick disinfectant.

To my knowledge no studies have been published on plastic and CHG as it has not been market indicated by the FDA for this application

Kathy Kokotis RN BS MBA

Bard Access Systems

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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