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Colombyana2
Cvc dressing changes in child with skin sensitivity and skin gvhd

my son has sensitive skin and skin gvhd from transplant.  He scratches all around at night in his sleep and during the day.  He has a central line that needs frequent dressing changes.  I‘m trying to use the least irritating dressings.  I am cleaning with iodine-povidine.  Currently I used an ultra thin duoderm over the biopatch with Sorbaview dressing to secure the catheter on Top of that. I’m avoiding the use of the stat-lock to secure it because I think that’s irritating him as well.  A wound care nurse gave me a large Mepilex AG foam dressing to try.  I’m going to try this next, making a larger dressing to cover all the irritated skin surrounding his central line where he scratches.  Please see the picture attached.  I next a dressing that will last longer, heal the small abrasions from scratching and that will withstand his scratching.  Does anyone have experience with the Mepilex AG fosm dressing?  Please give me advice for his sensitive skin!  I am at my whits end!

lynncrni
You are probably dealing with

You are probably dealing with medical adhesive related skin injury or MARSI. Your post did not provide a nursing description of what the appearance or size of the irritated site. Did you ever use any brand of skin protectant solution around where the adhesive would be placed? This is recommended to prevent this irritation from forming in the beginning but it does not heal an irritated site. You may need to use a type of dressing like Duoderm to prevent any adhesive from touching this irritated area until it is healed. I think you need to find a wound care nurse that can thoroughly assess the site, create a plan of care and work with you on an ongoing basis until it is healed. Then create a plan to prevent it from occuring again. It sounds like you are using a simple trial and error method and it is not working for you. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Colombyana2
I always use Cavalon skin

I always use Cavalon skin prep after cleansing with betadine. I let the betadine dry, wipe it with sterile saline, dry it with sterile 2x2, then put the Cavalon and let it dry.

Linda_Tirabassi
cvc dressing in a child with skin sensitivity and skin gvhd

I  just had this very same question come up last week with a 4 year old in our infusion center. This child has gvhd and has a Broviac. The mom had been treating other skin lesion areas with hydrocortisone, then suddenly the childs skin under her transparent dressing became irritated, primariy along the margins of the dressing & itchy. She has had this Broviac for 2 years. Recomended switching to betadine and sterile NS for skin care, emphasizing to make sure skin was very dry, and changing to IV Clear dressing. Now 5 days later, her mom reports that her skin is way better, less itching and erythema. Our plan was to reduce the irritation and hoped for resolution with the anticmicrobial properties  in IV clear. If she did not respond then we would have considered tape and gauze and hydrocorticone. Hope this helps. 

Linda Tirabassi RN CNS

lynncrni
Important to remember -

Important to remember - povidone iodine (Betadine, and many other generic names) requires 2 full minutes to dry for it to be effective. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

campriishe
We have a patient with

We have a patient with bulbous pemphoid-amonsgst her numerous medical conditions-and her skin is a mess. We change her R femoral TLC  every 2 days. We use CHG right on the insertion site and use NSS soaked sterile 4x4's on the inrritated skin (because of course she has an allergy to betadine) around the insertion site and catheter. She has had sutures just tear through her skin twice so now we attach the statlock to a smaller Aquacel foam, place Aquacel AG strips on the open areas around the catheter and placed a large Aquacel foam on top all that.  Going on 3 months now and knock on wood have kept her infection free! 

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