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G.G. Northington
picc insertion with blisters
I have been consulted for a PICC to be inserted on a patient that has a terrible skin disorder (not sure of the name), but he has blisters and peeling from head to toe.  It looks as if he has been burned.  He is in terrible pain.  What type of line do you all recommend for him?  It is very difficult to keep any dressing on due to the blisters and weeping.  I am concerned about the PICC insertion with the integrety of his skin, and not being able to keep an occlusive dressing intact.  And the surgeon is concerned about a subclavian line being kept intact as well.  Thanks
Sounds like pemphigus,and

Sounds like pemphigus,and they are a major skin-care challenge. Years ago I had a lady with this condition. We kept her PICC line and insertion site covered with gauze and snugly wrapped in Kling to keep the dressing in place. Sterile gauze and a Biopatch should keep the site clean enough. The other challenge will be to keep the line from migrating in or out,as a Statlock or similar device may be difficult to keep on as well. This may be the rare instance where a stitch would benefit more than not. With the daily dressing changes you would at least be able to cleanse the suture site well and keep an eye on it.

Good luck. 

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