Whats everyone using and how is it working? I've always used gauze but know there has to be products for this by now. I started a thread called surgicel but only got 1 reply, thought this might get more feedback.
We use DStat with mixed results. Unfortunately we have not had the opportunity to trial other products. So I am also hearing some success stories.
Darilyn Cole, RN, CRNI, VA-BC
PICC Team Mercy General Hospital Sacramento, CA
Our picc team at Florida Hospital has used Bioseal CVC (formerly Pro QR) for all picc line insertions since 2006. Formerly we used Surgicel for problem bleeds, but would frequently have to used 2 or more applications to provide hemostasis which added cost to the insertion process. Bioseal CVC used on every picc insert has eliminated the need for 24-48 hour dressing changes hospital wide. The product is a powder that when in contact with blood will form a seal at the insertion site causing hemostasis within 2 min. The seal also provides a microbial barrier until the dressing is changed at one week. We place about 450 piccs per month and this has been a great time saver and cost containment product for us. The product was presented at the AVA conference in Las Vegas last Sept. by our hospital.
Thanks, that is the second reply talking about Bioseal. I went on the website and checked it out. Do you put a biopatch or CHG on top? Also what about seeing the site since its brown? Is it expensive? Thanks for the info, this forum has so much info.
I'm impressed with the PICC number you have, 400 insertions/month. Do you use tip location system? How many PICC nurses you have? How big is your hospital? Do you mind to share your information?
The facility where I work has a 24 hour Venous Access Services Department. We place picc lines 24/7. There are 1200 beds at our facility. At this time we use the Navigator for our tip location device and place Xcela piccs. The MD's are usually very proactive with venous access and most of the time we place the piccs within 48 hours of admission. Our team consists of about 45 RNs, 3 PCTs, 2 ALPNs and 2 Education Specialists. Let me know if you have any further questions. I don't mind sharing.....
thanks for all the info
Very impressive numbers including the number of staff members ! Other than PICC insertions, what else are you responsible for ? Thanks in advance.
David Bruce RN
We use Surgicel..once bleeding has stopped, drsg changed and Biopatch applied...I think most important is hold pressure with Surgicel in place and resist the urge to change drsg for at least 24 hours after bleeding has stopped.
Angela Williams RN BSN CRNI
Clark Memorial Hospital
Thanks Angela for the input on surgicel but I used to hold pressure for 5 minutes on pt. with elevated INRs and/or low platelets and the surgicel just never seemed to work, am I missing something? do you have to wet it with saline first?
I thinking of starting my own business and want to figure out my materials. I looked into surgicel and some of the packages cost almost $50! Am I looking at the wrong size, thanks.
Our hospital does not use Biopatch-there is no need for Biopatch over the powder. If your facility has protocol to use Biopatch, you can apply it with the 7 day dressing change as the Bioseal CVC will have provided the microbial barrier and hemostasis until the first 7 day dressing change. Our facility uses Tegaderm CHG after the initial 7 days.There is no need to reapply the Bioseal CVC after the 7days unless your patient is an active bleeder and the seal from the powder has become dislodged. (the bioseal powder forms a seal like a scab at the insertion site so nothing goes in or out at the site) As for pricing, you'll have to contact a sales representative from the company, not sure how much our facility pays per application. (definitely a cost savings without having to do a 24-48 hour dressing change and decreases the contact with the line preventing CRBSI's). Maybe your facility could do a trial of the product to see if it maks a difference for your team. Good luck !!
The next issue of JAVA will have the study performed at Florida Hospital, due for mailing on 6/25. A great point about bioseal is that your line does not have to be bleeding/oozing to be effective. (posted by the author)
Lauren Blough, RN, BS, CRNI, VA-BC
Clinical Development Manager
Biolife, LLC "Makers of StatSeal"
Can Bioseal be used for tunelled catheter insertion sites in IR and CVC's in the ICU as well?
Does the scab last longer than one week and if so, does it act like a stabiliizing device keeping the line from migrating out?
Yes, Bioseal CVC can be used on all catheters, (tunnelled or percutaneous) My hospital uses it on all CVC insertions placed by nurses or MD's and on CVC removals as part of our air embolism protocol. You can find all the uses for the product on their website: http://www.biosealcvc.com/ The website also has educational tools. The seal stays on the insertion site and falls off on its own either with the first dressing change or subsequent dressing changes. Usually by the first dressing change, the epithelialization around the catheter has formed its own seal. The Bioseal CVC seal does not replace a securement device for the catheter.Thanks for the questions, Susan
Would you contact me via e-mail so I might discuss your location/hospital? I have entertained the thought of moving south. [email protected]
Just read the new issue of JAVA about BioSeal, incredible product. I changed the title from oozing lines to bioseal so this info is easier to find for the next clinician, thanks everybody for the product suggestions.
Just got my first shipment of the Bioseal and as of yet I have used it on two types of patients with great success. We determined first of all that we did not think that it was nessesary to use on all of our lines, but was quite appropriate to use with the patients that had bleeding and oozing issues. First PICC we tried it out on was a man with low platelets, he just kept soaking his dressing. Luckily my rep happened in with a sample for me to try..... It worked wonderful and we had no more bleeding around his insertion site for the remainder of his treatment. The next was a patient with a "leaky PICC". He was oozing a serous drainage and the infusion suite was changing the dressing daily.(not good) We applied the Bioseal and the patient recieved the rest of his chemo regime without any more oozing. We now use the Tegaderm CHG for all of our other PICC's and have started applying them upon insertion thus removing the need for a 24hour dressing change. We plan to continue to use this product and evaluate it further. Would like to hear what others also think.
The only think we noticed with its usage was the fact that upon application the patient's arm should be totally flat or the product will fall off the site, and the application of pressure for 2 minutes after putting it on helps to start the seal process. Make sure you put the tag stating what you have applied right on the dressing, as I forgot the first time, it was'nt relayed in report , of course they did'nt get to read my note, and the nite nurse thought the patient had a serious infection! :)
Cherylanne Perry RN,CRNI
Do you have any data comparing the Bioseal vs. the Biopatch (i.e. reduction of CRBSI). We currently use the biopatch on all of our central lines, but I am curious to learn more about the bioseal. How does it compare cost wise to the biopatch? thanks for the info.
These are two very different products, so I am not sure that they could or even should be compared. Bioseal is to stop bleeding while Biopatch is an antiseptic agent. At APIC, there was a company displaying a combination product that controls bleeding and infection. Company name is Hemcon. I just tried to go to their website but all I get is error messages. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
Lynn is correct, the products are not the same. The article of our experience at FH in Orlando, FL just came out in the most recent JAVA. Our experience shows that we had an infection reduction while using it. BioSeal does create a pH of 2 above the seal which is a microbial barrier. Bacteria cannot survive in that pH environment. The product creates a SEAL so nothing in nothing out. If you go to the Biolife website www.biosealcvc.com you can see the further work that the company has done regarding this product. FH places the bioseal on EVERY PICC insertion and just initiated it for every CVC, percutaneous non-PICC, removal to prevent air embolism and seal the site. You can tell I'm pretty passionate about the product! (I do some consulting for Biolife now) We also use a CHG product with the PICC, 3M Tegaderm CHG at the first dressing Change. The BioSeal keeps the site dry and intact during the first week. Look at the JAMA March 2009 article on Biopatch and see that the first week was requiring 3 dressing changes with the BioPatch. So really these products can work well together. Put the BioSeal on at insertion then apply the BioPatch or the Tegaderm CHG at the first dressing change (7days). The BioSeal 'seal' is there throughout the life of the line!
Cardinal Health is cobranded for the product Lynn is mentioning. It is called GuardIVa. It is an IV dressing that is both antimicrobial and hemostatic. I would be happy to provide information regarding this new product. My email address is attached.
Judy Carrillo RN BSN WCC
Clinical Marketing Manager-West region
email: [email protected]
Does anyone have experience using GuardIVa? If so, what comments to you have about it.
Karen Ratz,RN St. Lukes Hospital, Cedar Rapids,IA
Never head of GuardIVa until this thread, my guess is that since it's Surgicel it is not going to work well on pts prone to bleeding and oozing i.e. coumadin, low platelets, low albumin etc. We have been using BioSeal since it was Pro QR on all our PICC's from peds and above. Works every time unless you peek. Once you understand the technology it's a no brainer. Anyone on here using it on preemies?
Another option is GuardaCare for difficult to manage bleeding. Also, made by HemCon and uses Chitosan. It is in the form of a gauze so no powders or granules and is easy to apply.
Judy Carrillo RN, BSN, WCC
Clinical marketing manager
We are going to start a trial using BioSeal. Could someone who is currently using this product clarify the removal. We will apply at the time of catheter insertion and leave on until the first dressing change in 7 days. Will the BioSeal come off easily at this point with the dressing or is there a technique to the removal that you have found effective? We plan at this point to then apply BioPatch. I am trying to perform education for the staff and would appreciate current users experiences.
We have been using BioSeal on all PICC insertions for about 6 months now. It works great if you use sutures to secure the catheter because it absorbs the bleeding from that even if you don't have any site bleeding. It does eliminate the need for a 24 hour dressing, we go and assess and change the dressing only if there is excessive bleeding. Since I work at a pediatric facility, it has decreased the stress to the children with a dressing due when the line is still new.
I had a patient this past week that was on lovanox that wasn't stopped before the PICC placed. There was significant amount of bleeding. The rep was really helpful in giving instruction on how to handle this issue. I removed the blody dressing and after cleaning placed a dose of BioSeal at the site and around the sutures and help gentle pressure for about 20 minutes. I applied another dose and put a pressure dressing on. The interventional radiologist was worried we would have to pull the line due to the bleeding. I went back three hours later and had to place another dose as one suture continued to bleed. After that dose the bleeding stopped and the line did not have to be pulled.
You clean as you normally do with each dressing. The BioSeal is a sort of mechanical scab and will come off eventually but you should not try to scrub it all off with the first dressing. It is used to seal the site and help prevent bleeding but should not be used in place of the biopatch. With the first dressing after a week, we place the biopatch at the site. The BioSeal sometimes takes many dressing to be completed removed.
Theresa Reed, RN, BSN
Manager, Vascular Access Team
Texas Children's Hospital
We finished our evaluation last month and have now incorporated it into our bundle. We apply on every insertion, leave dressing in place for 7 days, at day 7 removed loose powder BUT leave seal in place. You can go over it with a chloraprep and it usually will stay in place. We then cover with our typical dressing. Since using the product we have had basically no unplanned dressing changes even on patients with low platelets and anticoagulation, this stuff works regardless. Really neat product, hope I helped.
Question about the BioSeal's securement properties.........
Does it keep the PICC or any non-sutured CVC from pistoning during dressing change procedure?
Robbin George RN Vascular Access Resource Dept Alexandria Hospital Virginia
Robbin George RN VA-BC
While not a securement device, it does have some flex to it and helps limit the pistoning, kinda like a gasket. We've been using it now for about 2 months and love it. Initially the brown color was a turn off but the elimination of dressing changes, planned and unplanned, quickly changed our perception. Also eliminated the trauma to our pediatric patients who really didn't like the dressing changes.
If one is looking for a device that is both an antimicrobial and a securement device, they need to be looking at Tegaderm CHG instead of Guardiva. Guardiva imho has less chg in it and is some one try to balance hemostatic properties and antimicrobial properties. Lets wait to see what clinical publications come out over the next year or so about the device.
Although I am sure the Tegaderm CHG works well in some environments in our clinical practice we continue to see a lot of inadvertent line withdrawals with the Tegaderm CHG. We are using the GuardIVa with great results, so far no infections and some impressive hemostatic performance. If you are comfortable waiting for papers that's great but we had a need in the field immediately and so far this product has been helping our patients. I have no affiliation with any of these products at this time!
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
My IV team at our small community hospital uses Bioseal for those pts who really continue to ooze post-PICC insertion and find that it works well. It's easier to apply and more effective than the gauze dressings, such as Surgicel and Surgifoam.