In an area where IV Consultants place lines and leave the facility (LTC mostly)- the facility nurses then care for the lines - - I fully advocate that the dressings must be changed in 24 hours to be sure 1. any gauze is removed (prompting compliance for a 7 day TSM dressing change) 2. have the staff nurses be familiar with the site/condition and focus to monitor for any complications 3. remove any drainage, yes there may be - even with the modified seldinger approach. 4. keep one standard approach - it has been safer to do this rather than have an individual patient approach - many nurses say well = change it in 7 days and then never look closely at the site. 5. Remember - while experts are placing the lines, general nurses may be caring for them. AZ -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Cindy Schrum Sent: Friday, July 21, 2006 7:41 AM To: Schwaner, Sandra L *HS Cc: [EMAIL PROTECTED] Subject: Re: RE: 24 hour dressing after PICC insertion
I believe the standard was once necessary because of post insertion bleeding at the site. The nurses on our team rarely nick when using MST and with the tapered piccs the site is usually clean. We use a second Chloraprep post insertion, add gauze only if the site is bleeding and don't do the 24 hour drsg change. We do daily site checks, haven't seen a site infection in a very long time. I don't believe the rationale is there anymore for doing the 24 hr drsg change. Not 100% of the time. When practice and methods change we sometimes have to look at other aspects of care and evaluate the necessity. I believe it's better not to take a dressing down that's clean, and uncompromised. On 7/21/06, Schwaner, Sandra L *HS <[EMAIL PROTECTED]> wrote: > > > > I also remember hearing Marcia Ryder speak at AVA a few years ago about > biofilm. That combined with my understanding of how bacteria multiply, and > how chlorhexadine works, leads me to believe that that 24 hour dressing > change can reduce by a significant amount the number of residual bacteria > and total colony count at the site. Therefore, I see the 24 hour dressing > change as an added infection control measure. > > Sandy Schwaner RN, MSN > Angio/Interventional Radiology > University of Virginia > Charlottesville > > ________________________________ > From: [EMAIL PROTECTED] on behalf of Helen Lazeration > Sent: Fri 7/21/2006 12:39 AM > To: [EMAIL PROTECTED] > Subject: Re: 24 hour dressing after PICC insertion > > > > > > Gwen, > > I think that I do the 24 hour dressing because there is usually bleeding at > the site some more than others and I don't like leaving that moisture on > there. Studies, I don't know about. I think that the moisture of the blood > against the skin and acting as a culture medium for bacteria growth seems to > be an adequate reason for me to change the dressing. I don't know about > others but the first 24 hours we kind of bulk up the 2x2's over the > insertion site as part of the pressure dressing and it is more comfortable > for the patient if we can remove that at 24 hours. We occasionally leave one > that looks dry and intact for 48 hours or the next routine dressing change > if everything looks fine. We do ours every 4 days because that what works > for us with our central lines and we have an extremely low infection rate. > We also use biopatches on 100 % of our lines and I'm not sure that we don't > loose some of the effectiveness if they are saturated with debris and > moisture. > > Hope this helps. > > Helen Lazeration, CRNI > Fairbanks Memorial Hospital > Fairbanks, Alaska > > -------Original Message------- > > > From: Gwen Irwin > Date: 7/20/2006 6:15:59 PM > To: [EMAIL PROTECTED] > Subject: 24 hour dressing after PICC insertion > > I have had a question posed to me about why a 24 hour dressing change after > a PICC insertion is required. The CDC's Guidelines to the Prevention of > Intravascular Catheter Related Infections address gauze dressing used on > CVCs (includes PICCs, right?) need to be changed every 48 hours. > > So, why do we require a 24 hour dressing change? Every PICC course that I > have attended states this, but why do we do this? I had to laugh when asked > this question, because I almost said "That is what we have always done." > This kind of response is what I battle often for many other CVC practices > (sound familiar?). Is there evidence that the 24 hour dressing change for > PICCs is necessary? Is there any evidence that a 48 hour dressing change > after insertion would change the patient's outcomes? > > I value your perspectives and would enjoy hearing what you think. > > Gwen Irwin > Austin, Texas > > > ************************************************************* The information contained in this E-mail transmission is intended only for the use of the individual or entity to whom it is addressed. It may contain privileged, confidential, and protected health information. If you received it in error, you are on notice of its status. Please notify us immediately by reply e-mail and then please delete this message from your system. Please do not copy it or use it for any purposes, or disclose its contents to any other person. To do so could violate state and Federal privacy laws. Thank you for your cooperation. Please contact the sender if you need assistance.
