We are looking for ideas or how other facilities have managed patients with allergies to CHG, Betadine, and Tegaderm. We currently have a patient with these allergies and there is a PICC line in place. For the site care, we used alcohol prep and then applied a Covaderm dressing without a Biopatch. We have been doing site care every 48 hours. Has anyone dealt with this situation before or are there any other suggestions for site care for this patient?
Thank you,
Pam Weber, RN, BSN, VA-BC
Are these allergies actually confirmed by a dermatologist? Many times, various types of skin irritation are labeled as allergy, however it is really not a true IgE mediated allergic reaction causing the problem. This is especially true with TSM dressings. Adhesives are made with acrylic and some people are truly allergic to this substance. Are you using the 3M brand of Tegaderm or are you using some other brand? Have you tried changing to another brand of TSM while using only alcohol for skin antisepsis? Covaderm should be acceptable for the dressing but I woud be very careful removing the dressing so as not to dislodge the catheter. Does this patient have a long list of other allergies - drugs, food, etc? If so, this would tend to favor these being true allergies. There are antimicrobial dressings impregnated with silver from several companies. That might be a substitute for Biopatch, although there is no research providing outcome data. Good luck and let us know the outcome. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Hello Lynn,
Thank you for your response. I do not know if this patient has been tested, but there is a sibling with the same genetic diagnosis that has the same reactions. They have each had at least 20 lines placed over the years and have figured out their allergies by trial and error over the years. We do use 3M Tegaderm and are looking into samples of the silver dressings. We are seeing increasing reactions to CHG for those patients who have frequent exposure and even some who have the first time exposure with a preop prep. I am not sure if anyone else is experiencing this. I will let you know how the silver dressing works.
Thank you,
Pam
Hi Pam, I have been working with a group of patients that react to betadine, alcohol, CHG, and adhesive type transparent dressings. Luckily most of them are able to tolerate using alcohol to clean their needleless connectors and betadine on their skin. Sometime just the smell of alcohol causes a reaction. Their diagnosis is mastocytosis and/or mast cell activation syndrome. We have seen a familial tendency. Sometimes they will have used a product that was considered safe, then all of a sudden, they are reacting, and then they may again be able to tolerate the same product with time. I also have one patient with severe atopic dermatitis who has been challenging.
I have had amazing success with using IV Clear be Covalon (aka mepitel, just recently transitioned due to some type or licensing issue). I have no associations with this company. It is silicone impregnated with CHG and silver. No biopatch required, skin prep not recommended. It is gentle to remove. I don't know what I would have done without it.
The drawbacks: 1. the margins tend to roll. We have the patient use a sleeve ( with PICCs) over it to try to keep it in place longer. 2. it is not packaged with a securement device (that is another story). 3. The dressing often does not seem to stay occlusive for 7 days, although manufacture's IFU states it can be remain in place for 7 days.
4. It is more expensive than the average transparent dressing.
For patients that have betadine skin reactions we use a Dakin's solution, let it dry and remove with sterile NS wipes. I work in pediatrics but our adult ambulatory infusion also has had success with IV clear when their patients experience dermatitis with long term PICCs. I would be glad to speak with you (562-933-0614 pacific time)as well. I understand your frustration and concern. I am not familiar with covaderm. I will check it out.
Linda Tirabassi RN PhD
Long Beach CA
Linda Tirabassi PhD RN CNS CPNP