Title: Hickman line and skin sensitivity
I forwarded this to the listserv because I think a lot of you would be interested in it.  I also want to thank everyone for their responses to my inquiry.  You've been very helpful.
 

Jerry Bartholomew RN BSN CRNI
Vascular Access Specialist
Veterans Affairs Medical Center
Spokane, Washington

 


From: Helen lazeration [mailto:[EMAIL PROTECTED]
Sent: Friday, December 23, 2005 7:18 PM
To: Bartholomew , Jerry A (SPO)
Subject: Re: Hickman line and skin sensitivity

Jerry,
 
A couple of things - After about 6 weeks we leave the dressings off most of our cuffed central lines.  We do secure the tubing with a small tubing holder.  Occassionally we leave the dressings on such as in our immune compromised patients.
Our infection control doc here once time had me try Azmacort Inhaler Spray on several patients that had irritated skin from dressings for one reason or another.  It is an approved use and it is great for two reasons - we used to have to go to gauze dressings because we used a hydrocortisone cream and the dressing were messy.  With the azmacort we leave the dressing prep off of the skin after we clean it and spray the azmacort spray on, let it dry - it leaves a white film - then apply whatever dressing we use (currently Tegaderm IV) and the rashes clear up easily, if not better than with the creams.  I couldn't believe the first few times we tried it - our WOCN nurse now uses it under some of her wound care appliances also.  It may help your patient if the doc is willing to try it
 
On occasion we have also gone to cleansing the skin of really sensitive patients with baby shampoo - doing a 2 minute scrub instead of the regular cleaners in the dressing kits etc.  I know that this sound not very aseptic, but it works and is the current accepted scrub used on a lot of serious burn patients by our plastic guys and it helps with any sensitivities to all of the products we would normally use on our patients.  Our line infection at our hospital is less than 1%.
 
Hope this helps.
 
Helen Lazeration, CRNI
Fairbanks Memorial Hospital
Fairbanks, Alaska
----- Original Message -----
Sent: Thursday, December 22, 2005 6:41 AM
Subject: Hickman line and skin sensitivity


        I have a young nurse as a patient who, after three PICC line placements, now has a Hickman line.  We had requested an implanted port, but they decided on the Hickman because she suffers from chronic folliculitis.  She is extremely sensitive to everything.  Every type of hypoallergenic dressing has been tried, including the IV3000, Sorbaview 2000, Duoderm, Hypafix tape, you name it.  We are currently using the IV3000, which did well for the first three weeks, but now the skin beneath it is becoming reddened, and burns when cleaned with alcohol. 

        Since this is a cuffed, tunneled line, I am wondering whether or not it might be better in her case to leave the site open to air.  She is an outpatient, so she's not around the constellation of killer pathogens that inpatients face.  Has anyone else done this?



Jerry Bartholomew RN BSN CRNI
Vascular Access Specialist
Veterans Affairs Medical Center
Spokane, Washington

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