We have had these same reactions, most also among our home infusion
patients. We also got the 'contact dermatitis' diagnosis that just didn't
seem to me was a good fit. I addressed the issue with the staff caring for
these lines and they insisted that they were not stretching the tegaderm and
that they were allowing the skin to completely dry.
One of out patients completed his cycle of abx and later when he needed a
new PICC he had the same skin reaction.
Which prompts the question......what alternative cleanser/dressing do you
use in a case like this? With our patient, we eliminated the StatLock,
switched to alcohol/betadine cleansing, and went to a gauze dressing.
Things got some better, but the line was removed due to completion of tx
before everything completely cleared up. Any other/better ideas?????
Alma Kooistra RN, CRNI
----Original Message Follows----
From: "Gwen Irwin" <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED]
Subject: Re: site rash
Date: Tue, 11 Apr 2006 21:31:39 -0500
Since your description leads me to believe the size of this reaction is
exactly the size of the dressing, I probably would also think of contact
dermatitis. We have responded to these type of situations in our network
and had resolution of the occurrence by allowing the prep to dry.
Our experience with this kind of "reaction" has been the prep isn't dry or
the transparent dressing has been "stretched" over the insertion site when
placed over the site. I will be interested in what others have to say they
have experienced, since I haven't seen anyone react to the CHG alone. Not
to say that it couldn't happen.
Gwen Irwin
Austin, Texas
----- Original Message ----- From: "Maria Kostylo" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Tuesday, April 11, 2006 8:09 PM
Subject: site rash
Hi All,
We're seeing patients in our SNF unit that develop rashes under their PICC
site dressings weeks and/or months after it's been inserted. Our ID nurse
is sure it's contact dermatitis. We do weekly (and prn) dressing changes
using Chloraprep, Biopatch and TSM. It is the IV therapists doing the
dressing changes, and they assure me the prep is completely dry before they
apply the dressings. Do you think the patients just develop a cumulative
sensitivity to CHG? I know some of my nurses have had to switch to a
different soap because they're developing skin irritations r/t frequent
handwashing with CHG.
Thanks, Maria
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