Can you all tell that I have some much-needed administration time?? Â :o)
What is everyone's opinion on skin prep? Â Do you use it? Â How big of an area do you apply it to - just around the edges or as much of the area surrounding the insertion site as possible?
We use Chlorapreps for the Skin prep of PICC insertion.
Using Chorapreps, we prep about 6-8 inches around the intending insertion site for 30 seconds and wait for another 30 seconds to dry the prep area completely. If the skin surface is wet, then it takes for 2 minutes to apply. I believe this is the manufacture guideline.
It is very important to prep the skin properly to get rid of normal skin flora as much as possible to decrease chances of catheter related bloodtream infections. Many patients who have acquied infections in hospitals might get them from their own skin flora.
I think she was asking about "skin prep" as in the barrier film, not the skin cleansing step.
I use the skin prep that comes with the STATLOCK PICC-plus device. I put it all around where the dressing will be once the Chloroprep has dried. Depending on the dressing and the patient, I have at times also applied the skin prep around the edges of the tegaderm-type dressing once it has been applied. I started doing this in when I worked in home health as the other more experienced nurses told me it helped to hold the edges down better. Being this was in home care, i did not see the patient again for a week, the dressing did usually stay intact with some loosening around the edges.
Susan Schuetrumpf, RN, CRNI, VA-BC
It must be an area larger than the transparent dressing for dressing changes, in my opinion.
It must be an area much larger than the fenestrated drape opening for PICC insertions. We probably do an area about 6x6 for insertions.
When preparing the skin,you should always apply the cleansing agent larger then the dressing being applied. If you are using a 4x4 tegaderm, clean an area 6x6.
It is critical to allow the cleansing agent to completely dry. If not, the chemicals in the tegaderm will leach into the skin when it comes in contact with the wet cleansing agent. This places the patient at risk for a skin reaction, such as a contact dermatitis.
Kathleen Hartman, RN BSN
Susan was right - I am asking about the actual "Skin Prep" - the barrier film, not cleansing the site.
Since that has been clarified, could I get answers to my original questions? They come in our dressing change kits, however we have found that many do not use them, even when a patient has a reaction. For more tender skin, some use Primapore - but, it's not transparent and I have found that this dressing is even more painful to remove when the skin prep is not used.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
We use the skin barrie swab sticks that come in our dressing change kit - applying to the area coverd by the dressing but avoiding the catheter itsself. If needed we use the NO STING barrier by 3 M -for really sensitive or problem skin areas
Ann Marie Parry, RN, CRNI, VA-BC
Great, that's the kind of information I'm looking for. Thank you Lynn and Ann. Now, my next question for you is where can I find data or information to back this up? I recently discovered that a few of my coworkers did not use this and didn't agree with my rationale to use it. I did get some info on the product from a website, but I wondered if anyone had a policy regarding it. Thanks! Kelly