what are you doing for your patients who have a severe skin reaction/allergy to the occlusive tegaderm dressing that is standard for all placements? I initially thought this reaction was due to improper use of the skin prep (not letting it dry completely), but in doing these dressing changes myself, I have found that this is not always the case. Any suggestions, advice, comments, material suggestions would be greatly appreciated. Thanks in advance
It is possible that you are dealing with an allergy but this is very unlikely. This could be a contact dermatitis. I would work on prevention by ALWAYS using a skin protection solution on every patient with every dressing change. These solutions protect the skin while encouraging the dressing to have better adherence to the skin. Prevention is always better than treatment and I have found these skin protection solutions to be great. 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
thank you Lynn, I agree completely. some of the issues were when the skin protectant is used, but not allowed to dry prior to placement of the tegaderm. I have done the dressing changes myself on some of these patients and have used the skin protectant, allowed for thorough drying and the patients still develops blisters, redness, dry and flaky, itchy skin and skin breakdown. I don't know if there may be a better tegaderm or occlusive dressing to use in these particular situations.
Tegaderm is a brand name and there are many different versions of it. There are many other transparent membrane dressings (the generic term) available so you could try others. My question is do you know which patients will react before you actually see a change in skin integrity? So how could you choose the patients to use a different TSM on? 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
Lynn,
sometimes I don't know who is going to react. But for the most part, many patients will tell me of their skin sensitivites, especially if they have had PICC lines before and had to deal with this. I would say about 80% of them that have issues already know they are at risk.
Is the reaction over the entire area that touches the skin or just a portion. If the dressing is placed with a slight tension, it will cause a shearing effect and only a portion will appear red.
From a 3M flyer
Skin reactions seen with transparent film dressings can often be prevented by appropriate application of skin antiseptics and skin protectants, as well as correct application and removal of the dressing.
Skin irritations can include:
thank you, good information. I have heard about being careful not to stretch the tegaderm, had forgotten about it until you mentioned it. Could be a possibility. the area of concern is the same size as the tegaderm dressing, rarely outside of the edges. when you remove the dressing, the area involved is exactly where the tegaderm had touched the skin
I have found patients who have skin irritation or breakdown under transparent dressings do better with a dressing that is more permiable such as OPsite 3000. Tegederm HP is another one but I don't have any experience with it. I have seen skin actually heal, however, with the Opsite 3000.
A number of years ago, we switched to IV3000 on all our CVL dressings. Noticed a huge decrease in skin irritations, and it seems to remain secure longer (which is important esp in the summer with home patients!)
Ann Williams RN CRNI
Infusion Specialist
Deaconess Home Infusion
Deaconess Hospital
Evansville, IN
I have found patients who have skin irritation or breakdown under transparent dressings do better with a dressing that is more permiable such as OPsite 3000. Tegederm HP is another one but I don't have any experience with it. I have seen skin actually heal, however, with the Opsite 3000.
Whenever I have a patient with skin irritation from Tegaderm, I use Covaderm or Primapore dressings. They are more breathable, and the adhesive tends to be less irritating to most patients. The Primapore has a low allergy acrylic adhesive.
Ann Armstrong, RN
Ann Armstrong, RN
PICC Lines
MidMichigan Medical Center, Midland
I have had great success with Covalon's IV Clear. It's a silicone based dressing that is impregnated with silver and clorhexidine. I use this dressing on patients that cannot tolerate traditional transparent dressings. I have even used it on patients that react to chlorhexidine. I asked the company why these patients can tolerate this dressing, but react to other forms of chlorhexadine (Chloraprep and Biopatch). The explaination I got was due to the dilution of the chlorhexadine in the silicone. This is an amazing product for the fragile skin patients as well. I have found that once a patient has used this product, they won't allow another dressing. BTW - I am not on their payroll, but I do love the product.
Happy Holidays
Judy
I have also started using IV Clear for our challenging skin irritated patients in home infusion. Have only used it on a few patients so far but the patients that I have used it on love the dressing and have not had any future skin irritations. I also have no financial affiliate with the product or manufacturing company.
Carole Rumsey, RN, CRNI
Home Infusion Program Manager
Sutter Infusion and Pharmacy Services
Sutter Care at Home
Northern CA
[email protected]
thank you all so much for this great information. I am going to look up these dressings and see if we may possibly have some of these already in use here at our facility. I will also forward these suggestions on to our wound care manager as she is interested in this information as well.
Karen