Forum topic

also not a fan.  for my little confused folks I want to try SecuraCath, which stays for the entire dwell time of the line.  I haven't found securement/dressing nirvana yet either, but things do seem to be improving.

we are using Sorbaview and it seems to be working fine.

we are using Sorbaview and it seems to be working fine.

Our health system has a history with Statlock, which was not well-liked as well, and changed to the SecurAcath.  It has been received very positively from most, and it has been pointed out that it is a lot better than having to change a Statlock every 7 days.  They like the fact that you can thoroughly clean the site without worrying about any movement of the line.  The most important thing is to make sure that everyone has been trained well on the removal. 

We have just converted from Statlok to the 3M 1685 securement dressing. Wondering if anyone has any comments on newly inserted PICCs (our protocol for the first 24 hours is to have a pressure dressing covering the insertion site and previously with the Statlok we changed this dressing at 24 hours and replaced everything). The PICC inserters are having troule with the process for using the 1685 and a pressure dressing.

Would a 2x2 gauze provide enough coverage for the first 24 hours or do they need to use 4x4?

Melanie Cates RN

Professional Practice Leader

Thunder Bay Regional Health Sciences Centre

 Melanie, why do you need a pressure dressing and why do you change the dressing in 24 hours?  

 I am wondering the same as Jill. Change of PICC dressings at 24 hours is an old practice frim the very early days of insertion. Those percutaeous introducers were larger than the PICC, leaving a larger hole in the vein. This caused bleeding in many patients for a few hours, thus the need to change the dressing. With MST now, this change is probably not necessary unless there is blood under the dressing. Pressure is not needed unless there is active bleeding which is not the case for most PICCs. Lynn

 It is my understanding the scrubbing with chlorhexadine in 24 hours with a dressing change impairs healing of the tissue surrounding the insertion site.  The sterile dressing with catheter placement should be left for 7 days (or per policy) unless compromised.  Like Lynn pointed out, when we placed lines with Excaliber it was a bloody affair sometimes.  Thank God those days are over.

Back to the intent of the thread, is anyone in love with their securements and dressings?

 I don't think I have seen the evidence you are talking about with CHG scrubbing causing delayed healing of the site. Can you give us the reference? Lynn

For the last couple of years we have been using the 3M 1685 Securement Dressing with relatively good success.  Initially we did have some migrating out PICC lines, but we had a learning curve ono proper application the extra securement tape that is provided by 3M.  We do at times use the Statlock securement device if the patient is having difficulty keeping the dressing secure.  We do also for extra security put a Statlock and securement dressing on all our Inotropic, Chemo and TPN patients since we don't want to take the risk of the CVAD migrating out even 1 - 2 cm.  We have only seen the Securacath a few times and although I like the concept I am not a big fan the way you have to remove the PICC line first, cut the Securacath and remove it.....very hard to maintain an occlusive seal post removal of PICC with this procedure.  I am a believer that the occlusive dressing (for us vaseline gauze) needs to be applied as soon as PICC removed and that is hard to do when the Securacath has to be cut in half.  There can also be some tenderness and pain with removal of the Securacath.....of course we have PICCs that are in for months to years and can develop granulation tissue around the catheter and Securacath. 

I am not affliated with any of the products mentioned.

 I'll have to dig for the reference on the CHG thing.  It was mixed in with some wound care information, the jist of it was allowing for the new layer of cells to establish.  I'll go hunting for it.

that was a challenge!  The information I was remembering discussed cell migration to close the wound.  Some of the same discussions are in here:

Mechanisms of Delayed Wound Healing by Commonly Used Antiseptics

Gregory W. Thomas, BS, Leonard T. Rael, MS, Raphael Bar-Or, BS, Richard Shimonkevitz, PhD, Charles W. Mains, MD, Denetta Sue Slone, MD, Michael L. Craun, MD, and David Bar-Or, MD

J Trauma. 2009;66:82–91.

Which would take forever to read, but here's the part that stuck in my head: 

"Chlorhexidine may have a role if a wound is infected with or colonized with staphylococcus aureus but not much beyond that as doses required to be cytotoxically once again completely inhibit fibroblast proliferation and migration."

We have been using the SecurAcath for almost 3 years now and are quite happy with it.   No migration problems anymore!  However, since our central line dressing change kits already have a Statlock included, I use it in tandem with the securAcath.  I mean, why throw it away if it's there already?  I change the statlock with every dressing change and cleanse the securAcath with the CHG sponge as usual.  The PICC's hubs can be really heavy, so the statlock is just an extra help.  If the statlock wasn't included, I would not seek one out because the securAcath does the job fine on it's own.  But the two together have been a real success story for us. 

Leah Crement RN CRN VA-BC