From being involved with PICCs from the very early stages in
1981, I am sure this 24 hour dressing change came about from the fact
that there is bleeding from the site and this dressing should be
changed. This practice has nothing to do with the CHG or biofilm
because we were not thinking about either when it started. If there is
no bleeding, the dressing does not require changing at 24 hours.
Lynn
At 9:21 AM -0400 7/21/06, Schwaner, Sandra L *HS 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
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--
Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
