We are looking at new central line dressing kits. Some have skin prep, some do not, they have a mask for the nurse. Should skin prep be used routinely on dressings for central lines/piccs etc? Is it a standard for the patient to wear the mask as well as the nurse or is it ok to just have them to look the other way? We are a small rural facility that has just started placing PICC lines ourselves. The rep for those said to use the skin prep for the statlocks. Any input is greatly appreciated.
Kim Dockery
By skin prep, I am assuming you are referring to a skin protectant solution and not the skin antiseptic solution. Skin antiseptic solution should always be chlorhexidine gluconate. I strongly believe that all dressings and stabilization devices, anything with an adhesive, requires the use of skin protectant solutions. Skin integrity is often disrupted by adhesives and these protectant solutions promote skin integrity and prevent skin breakdown with frequent dressing changes. Will you also be using an antiseptic impregnated dressing such as Biopatch or the Tegaderm with the CHG gel pad? If so, the skin protectant solution should not be applied to the skin where these dressings will be placed. The skin protectant solution creates a barrier and would prohibit these antiseptic agents from reaching the skin. Apply the skin protectant solution around these antiseptic dressings but where the adhesive products will be in contact with the skin.
The use of masks for the patient and all caregivers present during a dressing change is controversial. There are no studies to confirm that this will reduce bloodstream or local site infections, however it makes common sense to me for their use. While doing the dressing changes, the nurse and patient are talking, causing oral microorganisms to become airborne. These organisms can land on the area near the puncture site and possibly increase the risk for infection. During all CVC insertions, we should be using maximum barriers - full body drape, sterile gown, gloves, masks, etc. It only makes sense to me to use the masks during dressing changes for the nurse and the patient. 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
Be sure the skin protectant is compatable with CHG.
wwwn.cdc.gov/publiccomments/comments/guidelines-for-the-prevention-of-intravascular-catheter-related-infections/2025.ashx
"Many surfactants and emollients deactivate certain antiseptic agents. Forexample, CHG is deactivated by anionic surfactants and must be formulated only with cationic or ionically neutral ingredients." 31
Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.