Considering that your nurses are performing the dressing technique appropriately and allowing the skin antiseptic to dry before applying the dressing, I would suggest that the patient may have developed a cumulative sensitivity to the adhesive on the dressing. Some patients who are sensitive to Tegaderm are not to Opsite or Sorbaview, or vice versa. After settling the site down with change of skin antiseptic and a significant period with gauze dressings, I would trial another occlusive dressing. In our experience the Sorbaview dressing seems to be the least irritating. Also make sure the nurses are using a skin protectant. Good Luck. Regards, Dianne Sim IV Assist, Inc
-----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Alma Kooistra Sent: Wednesday, April 12, 2006 4:12 AM To: [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: Re: site rash 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 > > > >Confidentiality Notice: This e-mail message, including any attachments, is >for the sole use of the intended recipient(s) and may contain confidential >and privileged information. Any unauthorized review, use, disclosure or >distribution is prohibited. If you are not the intended recipient, please >contact the sender by reply e-mail and destroy all copies of the original >message. >
