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Patti Atteberry
Timeframe for dressing change post insertion

It has been our practice in Home Care to change the dressing 24 hours post insertion of a PICC or any central line.  Now most of the medical centers are placing a biopatch or algidex at the time of insertion, what would the best practice be?  I understand the disks are appropriate for 7 days, but I feel it is important to assess the site sooner than a week. 

Thank you in advance for any input anyone has!

Natalie F.
 We have struggled with the

 We have struggled with the same questions in our facility for some time and have used the products listed and also tegaderm CHG on insertion. Our conclusion is they all have their merits but show their weakness when they get wet (usually in the first few days) from bleeding or oozing.  Right now we are evaluating bioseal and that seems to be fixing the issue.  We seal the sites on insertion and don't change the dressing for 7 days.  We read about it in the new JAVA, check it out.

SusanBrown
We don't use Biopatch. We

We don't use Biopatch. We just place a gauze pad on the insertion site when the PICC is placed. We changed the dressing the day after placement and the every 7 days. This give us the opportuntity to assess the site of the PICC the next day.

[email protected]
Our practice in home infusion

Our practice in home infusion is to evaluate the site 24 hrs. post insertion.  If it's clean and dry then we leave it alone and change it in a week (or sooner if there is oozing).  Biopatch or not you can't leave bloody drainage under the dressing for an entire week.  Some PICC insertion kits are coming with the Biopatch in them so they are being placed an insertion.  We don't use Biopatch usually in our home infusion company so they are removed with the first dressing change any way.

RoseFeltner
We use Tegaderm CHG and, as I

We use Tegaderm CHG and, as I understand, it is made to absorb drainage at the site.  We do leave ours on for 7 days even with blood at site. 

Rose 

Natalie F.
 Just wanted to update this

 Just wanted to update this thread, we are almost a month into our Bioseal evaluation and I can count on one hand the number of unplanned dressing changes.  The ones we have done have been do to patients messing with dressing or getting them wet while showering.  We have been placing on insertion, hold for 2-3 minutes (no peeking says the rep) and then dress.  So long 24/48 dressing changes, yeah!

JCarrillo2
Dressings
Natalie F.
 I see the hemostat is

 I see the hemostat is oxidized cellulose, is it any different than surgicel? Chitosan?  Any data on use in low platelet or anti-coagulated patients?  Thanks.

JCarrillo2
GuardIVa for oozing

GuardIVa is an IV site dressing that is antimicrobial, hemostatic and absorbent.  GuardIVa does not work well on low platelet or anti-coagulated patients as the oxidized cellulose works with the clotting cascade and when the clotting factors are compromised by anti-coag's/low platelets, the hemostatic function is not as strong.  There is no data on use in low platelet or anti-coagulated ptaitents.

 GuardIVa contains CHG, Oxidized cellulose and Foam.  GuardIVa does not contain Chitosan.
 
 Oxidized Cellulose is used in various hospital products such as Surgicel. Surgicel is not designed as an IV dressing (no foam, no CHG, no slit, no indication from FDA).
 
  Judy Carrillo RN, BSN, WCC
Clinical Marketing Manager-west
Cardinal Health
 
Michelle Todd CRNI
 I find that if initially

 I find that if initially place a gauze dressing and then change the dressing to a biopatch after the CXR and charting are done about an hour later, I don't see the bleeding on the biopatch and I have the best of both worlds. When I place the biopatch initially, I usually get to change it the next day due to saturation. I tried the hemcon Guard IV and found it not to be helpful unless I did the same thing and placed it an hour later.

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