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Nancy Safranek
sensitivity to transparent dressings and tape
Have a pt needing a PICC (can't find a peripheral site even w an U/S).  Has had 2 prior PICCs with transparent dressings and both times ended up with serve skin breakdown and staph infections.  Any well thought out suggestions would be appreciated.  Thanks, Nancy
We have run into this type
We have run into this type of problem a few times and have done two things that have worked. On a patient were the reaction is not known until the skin is already a mess (or a patient with such thin skin any dressing causes skin tears) we used a skin care product called Flexan. It comes in several sizes (we use 4X4) is soft and thin and made to go over an open area for 7 days before needing changing. Using sterile technique we cut a small circle out of the center of the Flexan and put the PICC through the hole. We then secured the PICC with stat-loc and transparent dressing on top of the flexan so as not to touch the skin. It is challenging to remove but worked really well to heal the skin around the PICC. When we have a patient with a known issue with most dressings we revert back to the old gauze and paper tape and do a every 48 hr dressing change. Hope that helps.
I also like Sorbaview and
I also like Sorbaview and Coverderm dressing for sensitive skin patients.
try mepilex with border, MD

try mepilex with border, MD Anderson uses this and we have used successfully on patients that have sensitive skin issues.

Good Luck

Beth Ferguson, RN, CRNI

Indiana University

elizabeth ferguson

Our first step with any

Our first step with any adhesive reaction is always Cavilon No Sting Barrier Film (NDC 8333-3345-01).  This will solve the problem most of the time (~90%).  If still a problem we change to a different TSD brand, usually the Smith and Nephew IV3000.  Regarding the barrier film, make sure you apply it heavily, and allow to completely dry before covering.



Chris Cavanaugh
Are you sure it is a

Are you sure it is a reaction to the dressing?  I have seen terrible rashes under dressings due to wet Chloroprep.  The dermatitis occurs when the dressing is applied without letting the chloroprep dry completely first.

If it is the dressing, the No-Sting Barrier film works very well, and there is no reason the PICC cannot be dressed with Gauze and tape.  It would just mean that the dressing needs to be changed daily.  This is within the CDC guidelines.

Chris Cavanaugh, CRNI

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

Chris is correct about the
Chris is correct about the CHG...allow the CHG to completly dry before you apply your dressing.  Vapors from wet CHG can also cause skin issues!
Gail McCarter,

Gail McCarter, BSN,CRNI

Franklin, NH

We have switched to the TegadermCHG, and I have found that most of the patients that we have been using special order dressings (sorbaview or  Smith & Nephew) tolerate these well.

Gail McCarter, BSN,CRNI

Franklin, NH

Nancy Safranek
Thanks for the responses. In

Thanks for the responses. In this case, I carefully reviewed the patient's record and found no indication for the PICC except her desire for IV pain meds when she could take PO.  Her Doc agreed.

I'll get some different products because she will be back and they may be useful for others. 

Nancy S.

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