Concerning BioPatch. I have seen this "potential" problem a couple of times now.
Look at pic. This is 2 days post PICC insertion (1 stick, no insertion 
There is a hematoma"ring" around the BioPatch edge but not, over the area, where the patch initially was placed.
Why? Good or bad?
The exudate on the catheter base supports some sorta drainage. Could be the biopatch acted like a mini pressure dressing and blanched any SQ bleeding giving it that ring appearance. CHG reaction?
Well. The patient did not complain at all. No itch, pain or other discomfort. Maybe its from extensive pressure.
I believe its some kind of reaction. Better watch out!!!
Nurse specialist ICU/ANE/PICC.
Dep. of Neurosurgery
Umea University Hospital/SWEDEN
I also think this looks like pressure from a tight dressing pushing downward in the shape of the Biopatch. I can't tell if the ring is petechiae or if the skin is actually broken as in some other form of irritation, maybe contact dermatitis from the CHG? 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
I have seen a hematoma at the insertion site then 24 hr later the hematoma is gone, the biopatch is bloody, the dressing needs changing due to exudate. When the dressing was changed, there never was any evidence of a hematoma and never happened again.
All that to say, I think the hematoma leaked through the insertion site into the biopatch. I could see a few tiny bloody spots at the edge of the biopatch. I would emagine that is what happened here.
I agree with Lyn...looks more like pressure related vs rxn
On the subject of biopatches. I have seen this in my practice. It is caused from some leakage during insertion and the application of the biopatch with an occlusive dressing. It is benign and usually is gone within 48 hours.
Biggest question I have under "Best Practices" and the use of a antimicrobial patch at iv insertion sites. What literature or research supports the use and necessity of use. My pharmacy is not convinced they should be standard in the dressing change kits, yet almost all the nurses think that it should. If I can support their decision with the knowledge base, perhaps policy could then change. Any help would be appreciated.
Probably some kind of reaction between blood and Chrolhexidin. Can not explain why the "hematoma" is around the edge only. The patient had the symtom 4-5 days after removal and survived. Funny, there is a lot of stuff one can not explain. We are not using the Biopatch on all patients because we do not have any problems with infection at all (1 in 225 catheters). This was only a test "free sample"
Well, thanx anyway
Nurse specialist ICU/ANE/PICC.
Dep. of Neurosurgery
Umea University Hospital/SWEDEN
ONE infection is ONE too many. End of story.
You are SO right!
Nurse specialist ICU/ANE/PICC.
Dep. of Neurosurgery
Umea University Hospital/SWEDEN
I think it is pressure related as I have only seen it after insertion then its less at ea weekly site change
Cheryl Ferraro RN, CRNI
I have sometimes seen a little ecchymosis underneath the BioPatch when I change it. Is that really a hematoma? or just a ring of ecchymosis? A hematoma would be firm and raised. Was the pt on enoxaparin or heparin for DVT prophylaxis? ASA or plavix? Something similar? There are several of new alternatives to warfarin out there now that do not require monitoring and my experience is that they bleed more than even warfarin patients with high INRs. I sometimes see a little delayed ecchymosis related to arm movement with those sorts of drugs. Looks like the dressing put enough pressure on the Bio Patch to push the blood to the edges. I would really doubt this is a reaction to CHG, especially if you had used it multiple times for skin cleansing. This does not look like rash especially with a little blood on the catheter, a shade of blue beyond the red ring and if the patient had no c/o of itching. No insertion complications does not mean that a small amount of leakage may not occur around the catheter at the vessel entry site or from capillaries if lidocaine was used. My patients on "blood thinners" will sometimes bruise immediately when I give the lidocaine. I have stopped and held pressure for a couple minutes before I procede. It just goes with the territory.
I get a bruise with every subqutaneous injection I get. Every year with my TB test with that tiny bleb when it separates the intradermal tissue. I take antiinflammatory medications for arthritis which also increases bleeding. Make sure you are looking at your patients med lists so you know what to expect.
I tell my patients that this is not unusual, depending on their medication list. If I see it happening quickly, with a uneventful stick, I get them an ice pack to minimize the ecchymosis and have the staff monitor for a hour or so and have the patient keep their arm still for a couple of hours. I am also very careful with my skin nick and make it as small as possible.
We see this sometimes (not in a ring) with patients with very frail skin just from IV sticks. I will do a very clean stick and later it will have a small area of ecchymosis at the insertion site. Catheter still has positive blood return and easy flush so its not a catheter problem but a fragile skin problem. I mark the spot for observation and they rarely get bigger since I secure them so well.
Mary Penn RN VA-BC