We have a young paraplegic with a new PICC who states his skin is sensitive to tape/Tegaderm . Asking me to change the very occlusive drsg ( we have on a SorbaView now ) because he says it is itchy under the white edges of the drsg that is not visible. No obvious rash or inflammation.The MD increased his dose of Benadryl to Q4 hours, he says he is willing to try to see if that helps. 24 hour dressing was done yesterday by IV CRNI. He says last year he had a PICC at another facility and skin got so irritated it was " weeping " and no tape would stick. " Took PICC out & put it in other arm" I explained every time drsg is removed we have to wash with Chloraprep-peeling occlusive drsg off will irritate more. He says Nurse Manager of the floor told him maybe we could" cover with gauze and wrap with Kerlex" .But then staff couldn"t visualize site for assessment ?? And if it was gauze we would have to change daily and CLEANSE correct ??? Been doing this over 20 years but I'm stumped. What can we do to keep the pt happy, skin in good shape, and prevent CRBSI ?? Thank You Patti W.
I have seen patients actually allergic to the acrylic in the glue on many TSMs and they had to be switched to gauze and the roller bandages. When we started placing PICCs in 1980, that was our routine dressing - gauze held on with a Kling or Kerlix. The insertion site is usually not the site of the beginning of any signs of early stage mechanical phlebitis. Have you tried to use a skin protection solution under the dressing to protect the skin? Is this patient possibly having a reaction to the CHG rather than the dressing? That is certainly possible. If that is the case, you have a valid reason for using PVP-I instead of CHG. If that is not the case, I would not have a problem with using gauze and roller bandage with documentation of why this is necessary. What type of stabilization is being used? Is he having a reaction to the adhesive on this device also? 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, The pt. said it was tape that causes the irritation, NOT chloraprepHe had on a Stat-Lock which he also felt was going to irritate. He seemed to know his body pretty well, but I certainly was concerned about "too frequent" cleansing causing further irritation. He was actually discharged on my day off with the line. As far as a sterile gauze drsg and a roller bandage- would you "change" this every 24 or 48 hours and cleanse per protocol ??? PW
I have seen patients with a sensitivity to Tegaderm/OpSite in the days we used alcohol and Betadine to clean sites. We discovered it was not the dressing so much. It was the Betadine remaining on the skin. I have had to use gauze dressings on central lines before. You have to consider the tape you are using as well. Some people do well silk tape.
Thanks,
Sherry Cline RN, CRNI
Clinical Educator
Sherry Cline Martin RN, CRNI
I had a difficult situation like this as well. I started using Meplex with Border for those with sensitivies and it worked like a charm. It's a non adhesive dressing but you can get them 4x4 and they can stay on for 7 days. You can't see the insertion site but the Biodisk is under it as well.
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We have had several of these patients lately and found the mepilex to be very successful. We switched to povidone iodine instead of chlorhexidine. Steri-strips for extra securement, biopatch and then the mepilex dressing. If they cannot tolerate the statlock I just use extra silicone tape on the extensions. I hear they are coming out with a VAD dressing that is clear. The stuff is silicone based and does not irrritate the skin. It is also wonderful for those people who have tissue paper skin.
Darilyn
I have used Mepilex with excellent results.
Lois Long Rajcan, MSN, RN, CRNI
I have found when the irritation on a dressing is demonstrated on one edge of the tegaderm that it was probably placed with a "Z" track tension on the dressing. I personally tested this with my arm and found a reference to it on the 3M site.
When sorbaview fails we use Tegraderm HP. When HP fails, it's a 48 hour gauze dressing. Drying time is really important! Isopropyl alcohol is a transdermal agent, IMO it can carry the adhesive into the skin. Allowing a full minute (or more if necessary) for chg to completely dry is imperative also allow the skin prep to completely dry a minute. Proper removal of the dressing with adhesive remover will help keep the skin intact and less likely to irritate and excoriate. Apply it to the top of the dressing and allow to soak in a minute or two. Then start to peel the dressing off using a fresh adhesive remover pad and wipe and peel at the same time. Basically allowing the adhesive remover to wipe off the dressing. While the other hand just holds the dressing, not really peeling it off. Only be careful not to apply adhesive remover to the top of sorbaview boarders or paper tape. It has a tendency to increase adhesion before it dissolves the adhesive and then turns it into a gooey sticky mess. Ask me how I know ;~) It does work if the sorbaview is peeled back a bit and the adhesive remover is used to wipe off the dressing between the skin and the bottom of the dressing. I usually wipe the top of the clear window then start peeling and wiping off. It's difficult to explain in writing.
I also agree that dressing should just lie on top of the skin and not be stretched on.
Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.
We have had success with Cavalon skin protectant swabs. I can drop them on my field, as the swabs are sterile, for dressing changes. Just swab the skin that will be in contact with your dressing and this will hopefully decrease irritation.
For a nice tape that doesn't affect skin as much, we use a blue silicon tape from 3M. The patients love it, as does our NICU and Wound Care.
I do like your suggestion to use Mepilex when this doesn't help! Thanks for that!
I have a concern with the post regarding Mepilex dressing and leaving it on for 7 days. The manufacturer states that it can be left on for 7 days however it truly is a gauze dressing and the insertion site it completely covered. According to the standards that requires changing it every 48 hrs. We have used it in the past with good results also but our policy is to change every 48 and it is a very expensive dressing so we usually will go to a gauze and tape. Curious as to what others think.... Thanks
I completely agree with you Debbie. 7 days without seeing the insertion site would cause concern for me too. Also, the Mepilex is easily peeled back then repositioned, which works well for observing wounds. For vascular access, the sterility of the site could be compromised without observable evidence such as a non-occlusive tsm dressing. Perhaps Mepilex is a good solution for dressing access on some patients as long as the Mepilex remains occlusive at all times and is changed according to the guidelines for a gauze dressing. This is a conversation we should have with the manufacturer of Mepilex.
When our daughter had her PICC in (age 11 months old at the time) we had to use IV 3000's for sensitive skin. We used the same for the central line. Maybe it will help. ?
Mike Fitzgerald
CareAline Products, LLC
Functional Line Care for PICC and Central Lines
www.carealine.com