Surgeons are insisting the sheath {larger part of the catheter}is included under the tegaderm..Not easy with ExLBW infants and it lifts the dressing so the dressing is changed more often.  Â
Can not find literature to support this practice of including the sheath under the tegaderm..nor does the manufacturer.
Concerns include:Â re-opening access to the central line, trauma to skin in so doing for a .97 kg baby, and the challenge of keeping the sheath under the dressing when there is not much baby area to work with and so much catheter for looping in order to include the sheath, regularly see the loops over the catheter as well as over the tunnel site, Â issues with maintaining a sterile field in manipulating the catheter to get the dressing done appropriately.
under consideration is also the stress intolerance level, sleep disturbance, thermoregulation, undue stimulation and discomfort which accompany dressing changes. Additionally, most of the < 1 kg babies tend to do better in the prone position, which does place more potential for pressure sites along the catheter. Avoiding the need to redress a site due to technique is imperative.
What are others doing to maintain these lines?
 All suggestions greatly appreciated,
Deb McPhersonm MSN, RN
Maine Medical Center
The surgeons are probably trying to have the sheath [thicker part???] of the tunneled cuffed line under the dressing to keep the line from pulling out. But you are correct in that this practice can cause skin pressure, etc. We currently change our dressings on these lines weekly or more often if loose, soiled, etc. There isn't any great securement system that would apply to all size kids and lines.... for our double lumens, we have had a lot of success using a Stat Lock Dialysis Catheter securement device to keep the weight of IV tubings from pulling. For the single lumen tunneled lines, we find that the Sorba View works quite well...the small Sorba View has a slit that you can open and secure under the catheter where it exits the dressing, the larger has a separate piece that slides under the catheter to and over the big dressing to keep it secure. I have also seen steri strips used to secure these lines by sandwiching the catheter between two half inch steris with the bottom half secured to the skin, then another steri strip over the line as it falls naturally, or a dressing on top. This was presented years ago at the APIC convention and was studies at St. Christopher's Hospital in Philadelphia when I was an IV nurse there....I don't think there is evidence regarding looping the line under the dressing, but I think there are some articles on line securement regarding type of dressing. You would have to do a search.
Anne Marie Frey RN, BSN, CRNI
Clinical Nurse Level Four
Vascular Access Service: I.V. Team
The Children's Hospital of Philadelphia
Anne Marie Frey RN, BSN, CRNI, VA-BC Clinical Expert Vascular Access Service: I.V. Team The Children's Hospital of Philadelphia [email protected]