Our Infusion Therapy Dept. recently started using the CHG sponge on all our CVC's ,either at time of placement or routine dressing change. Our big question is use on Pedi patients. The manufacturers IFU states safety and effectiveness not established under age 16. The sales rep is telling us Pediatric hospitals do use the product and sent us a link to the Pedivan Guidelines. We are enlisting the help of our Pedi Hospitalist to find out what our big "partner" pediatric hospital in Boston does.Also, I always appreciate the expertise and knowledge of the users of this forum ! I do see the INS standard saying" use should be considered in patients older than 2 months of age". Patti Wholley
The IFU statement is the manufacturer's way of saying they have not conducted any studies in patients less than 16 years old. You should check all of the published studies to see what ages have been listed in those studies. I can't recall exactly what the Pedivan guidelines state but that is written by pediatric VAD experts, so their statements would be a part of establishing the standard of care. The INS Standards statement about 2 months of age comes from the IFU for the CHG solution used to prep the skin. But the IFU for Chloraprep has recently changed. CHG use in less than 2 months is not longer prohibited but the statement now says to use with caution. This change occurred within the past couple of months. 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
Our institution has been using the bipatch on any pediatric patient greater than 1 week of age along with chlorohexadine scrub for line insertions with the exception in the NICU. I have seen only 2 kids react to chlorohexadine and both of the were cystic fibrosis patients who had multiple exposures in the past 7 years. These kids we change to the traditional betadine for prep and maintenance.
Staff complaint and have had issues with line dislodgement due to the small size of the biopatch used with the 3 Fr. PICC lines and small extremity with dressing changes.
You should look into the GuardiVa. GuardIVa Hemostatic Antimicrobial IV Dressing is a complete IV site care solution that combines the powerful antimicrobial protection of chlorhexidine gluconate (CHG), a well-known antiseptic agent with broad spectrum antimicrobial and antifungal activity, with the unique properties of HemCon’s proprietary hemostatic oxidized cellulose in a sponge dressing. It uses less CHG but just as effective as Biopatch.
Daniel Izzo, RN
Director of Clinical Support
Integrated Medical Systems, Inc.
I work at a children's hospital and we use biopatch for patients > 2mo of age without problems. We have used this product since it first emgerged on the market. Education for correct placement is critical to avoid accidental displacement of the PICC with dressing changes, particularly with 3 FR catheters or smaller. I still see the biopatch occasionally placed incorrectly. We are also planning to evaluate GuardIVa for the hemostatic properties in the near future.
Linda Tirabassi PhD RN CNS CPNP
I work at Children's in OKC, and we use Biopatch on all our Peds PICC insertions beginning with initial placement. The ChloraPrep packaging now states "use with care in premature infants or infants under 2 months of age These products may cause irritation or chemical burns". We have only ever seen 1 or 2 whose skin was irritated in the past, and I believe was probably due to someone placing the disc while skin was still wet from cleansing with CHG. We love our Biopatches!
At our Children's hospital, we use it on all patients from the time of insertion. Even in our NICU, we use it on patients who are >1200 grams and > 28 weeks gestation. Even in our smallest patients, it is tolerated very well.