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bnosal
Tegaderm CHG
Anyone with any thoughts/experience with theTegaderm CHG dressing.
We did a small trial w tegaderm CHG and had difficulty with bleed through.  The biopatch is more absorptive.  We are thinking we should trial gauze dressing with regular tegaderm for 24 hours then tegaderm with CHG.  Are people having trouble removing the biopatch?  Also trouble with removing the tegaderm w CHG?
fizerjk
We  trialed them at our
We  trialed them at our facility. I liked them, finding them easier to work with and remove during dressing changes. Hopefully we will be using them soom on a routine basis.

Jeffery Fizer RN, BSN

Hermione Montgomery
Hi there we use Tagaderm

Hi there we use Tagaderm which has been modified for our patients (Birmingham Children's Hospital, Birmingham, England) but I am unfamiliar with Tagadern CHG. Could someone enlighten me.

What dressing do you use for newly formed Central Venous Lines? 

mary ann ferrannini
 It a Tegaderm with a clear
 It a Tegaderm with a clear light tan-colored Chlorhexidine impregnated patch that is an intregal part of the dressing. The patch is centered in the middle and the nurse must make certain the CHG patch is placed over the catheter skin  junction. I tried a sample but I could see where uneducated nurses would not center it properly not knowing what it was. Yes I know that will be happening. At least they would not have to grab a second product as it is all in one piece.
DonnaS
The rep came to our
The rep came to our institution and stated that sometimes the CHG sticks to the catheter.  When that happens you are to use alcohol to seperate the dressing from the catheter.  This really alarmed us because of the increased risk of catheter dislodgment as well as using alcohol on the line to clean of the sticky residue.
tamster
Donna I agree with you.

Donna I agree with you. Although I have not personally tried them, I stopped at the booth at INS to see how they worked. The rep had one on his arm and I requested that he let me try to take it off. He was very reluctant but finally said I could take it off. I did notice first hand that the CHG did stick to the catheter. He said it is best to use alcohol swabs instead of the alcohol pads to get rid of the sticky residue.

I really like the concept of the CHG tegaderm but I have the same concerns as you do about catheter dislodgment.

fizerjk
I have never had that
I have never had that experience with the Tegaderm HCG. I find it easier to work with and less likely to disloge the catheter than trying to remove the biopatch.

Jeffery Fizer RN, BSN

RoseFeltner
I am getting some to

I am getting some to trial.  How bad is the gel pad sticking to the catheter?  I have had problems with regular Tegaderms sticking (actually tearing apart) the stat locks. Is this the same or worse?

 

Rose

Rose Feltner RN, BSN, CRNI
Speciality Practice Nurse
Vascular Access Team
Indiana University Hospital Bloomington
[email protected]

fizerjk
You should hold the catheter

You should hold the catheter down with a sterile gloved finger when removing the dressing this will prevent the catheter from being disloged. An I believe the Statlock devices have a coating on them that prevents them from being pulled up when removing the dressing (only once). The Statlock should be changed every time dressing is removed or the next time it will be very difficult to remove intact, increasing the risk of disloging the catheter.

Jeffery Fizer RN, BSN

lynncrni
You are correct - the

You are correct - the Statlocks have a coating on the top that makes it easier to have the TSM dressing release from the Statlock. This does get removed with the first dressing change. For this reason, and for good skin antisepsis, the Statlock should be changed with each dressing change. 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

asherwood
Our IV Therapy team tried

Our IV Therapy team tried these dressings and they were VERY difficult to take off without pulling the line out. Unless these dressings GREATLY reduce risk of infection our team may not use them. Also they are very costly.

ebalinsat
We are now using Tegaderm

We are now using Tegaderm CHG in our hospital. There are more disadvangtages  and unhappy nurses using this product.We are a hospital without an IV team so our staff RN's are responsible of care & maintenance of their lines. The main problem is the removal of the dressing, the gel "molds" into the catheter & to the suture which it makes it very difficult to remove. It takes more time to remove! and nursing time is very "precious". So between the cost of nursing time and dislodgement .. this product cost a lot! The site will also become so "ugly& dirty" if blood sets in the gel, moisture(i.e sweat) absorpton is good but blood absorption is very poor.

fizerjk
I have a similar problem

I have a similar problem with the biopatch. If the biopatch abosorbs sweat, blood, or serous fluid,  I have found that it can cause the skin, in patients with thin or sensitive skin, to become red and exoriated. We did not find this to be a problem with the Tegaderm CHG. I am curious why you suture PICC lines(assuming) in?  There are very good non invasive securement devices available. 

Jeffery Fizer RN, BSN

ebalinsat
we are using the CHG drsg
we are using the CHG drsg with all our lines except ports. the jugular, femoral and subclavian are inserted & sutured by MD. and these are the challenge lines for these dressing....
Leigh Ann Bowegeddes
Did anyone see the 1st

Did anyone see the 1st place winning poster at AVA? It was by a scientist at J&J who did porcine skin research comparing Tegaderm CHG and Biopatch, and looking at where the CHG actually contacts the skin. You need to look at this research and the pictures that go with it. CHG does not migrate onto any area it does not touch. When used according to manufacturer directions, the Tegaderm CHG does not allow any CHG contact over nearly half the area surrounding the catheter. Remember that this product's insert says that it is not indicated for prevention of CRBSI. Research to support the use of this product is not available at this time.

3M is also marketing this product as a securement device, as well as dressing, suggesting that it be used instead of StatLock or suture. The securement part of it is a piece of tape that is to go across the catheter hub, which blocks CHG from reaching the skin surface at that point. For those who have used it, I wonder if any have deleted the suture or StatLock, and if so, how well the Tegaderm works at securing the catheter. Feedback?

I do consult for Biopatch, but the data I am stating is not my own. Check it out.

Leigh Ann Bowe-Geddes, BS, RN, CRNI

Vascular Access Specialist

University of Louisville Hospital

momdogz
Yes, it's important to

Yes, it's important to review manufacturer data, and the manner in which it's presented, carefully.  Both companies (Biopatch, Tegaderm CHG) will emphasize the studies or parts of studies, for eg, that state that most CLABSI have extraluminal sources.  

Its not that there isn't some compelling literature about this issue, but be aware of how companies might skew toward extraluminal, showing these skin treatments to be that much more necessary.

When I brought this up at an AVA vendor sponsored talk, Dr. Ash supported my question/doubt that there was adequate consensus about the extraluminal/intraluminal question, and time frames that might indicate one or the other - i.e.: "the evidence re: source of infection intraluminal/extraluminal – is all inferential" - not clear.

While at AVA I also asked the Tegaderm CHG manufacturer rep for data to support the statement that CHG migrates under the catheter.  I believe he said they had some in-vitro tests, but it didn't sound very convincing. 

Again, I'm not saying there is no compelling literature, and I'm not saying that these devices won't help prevent CLABSI - just seconding Leigh Ann's investigative efforts.

In the vendor talk I did find the information about bacterial colonization of the layers of the skin (5-8 layers deep) useful, including how rapidly skin sloughs off, and that there is 20% bacterial colonization remaining on skin after disinfection.

Also had some helpful references from Hadaway, Ryder, Richardson, Safdar, Maki and Kluger.

 

 

 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

Sheila
Sheila's picture
Sheila Fiscus, RN, CRNI,

Sheila Fiscus, RN, CRNI, Seton Family of Hospitals, Austin, TX

I have a question.  When removing CHG residue from catheter/site, are we not cleaning the area with Chloraprep?  Might have to use extra Chloraprep.  We are thinking of trialing the CHG Tegaderm d/t improper use of Biopatch.  I'm not sure how effective the Biopatch is when it is placed upside down:-) and how much more the catheter is manipulated with removal and replacement of Biopatch. 

My other question is, did anyone see the poster presentation at AVA: Antimicrobial Activity of a CHG-impregnated Gel Pad for IV Site Protection by Debra Schwab and Linda K Olson, 3M Medical Division and the also the one by Dennis Maki, MD, Julie Stahl BS, Cassie Jacobson, MS, and Janine Pyrek, MS?  I realize the one is done by 3M, but the other one has no financial interest in the CHG dressings and received no compensation (Dr. Maki) for his participation in the study.  I also realize the Maki study was on healthy individuals, but it bears more research. 

Sheila Hale, BSN, RN, CRNI, VA-BC, Austin, TX

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