RE: 24 hour dressing after PICC insertion

[Janine Pritchett]

We are moving toward not using the gauze under the initial dressing.  We take a couple of extra minutes to hold pressure, then place a Biopatch and dress from there.  If we need a pressure dressing, we put several guaze and then tape over the top of the occlusive dressing, making sure that the tape does not cause problems with the occlusive dressing.  With the Biopatch, you have 7 days of coverage right at the site.  I believe that it still works even with the presence of blood.  Our J&J rep. was pretty clear on that when he did an in-service recently.  We have a very low infection rate as well.  We are doing this with outpatients, inpatients, adults and peds. Janine Clinical Supervisor, Mary Bridge IV Therapy, Pediatric Infusion clinic, Adult Infusion Suite Tacoma Wa.       From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Helen Lazeration Sent: Thursday, July 20, 2006 9:39 PM 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   "MMS <multicare.org>" made the following annotations. ------------------------------------------------------------------------------ NOTICE: This e-mail and the attachments hereto, if any, may contain privileged and/or confidential information. It is intended only for use by the named addressee(s). If you are not the intended recipient of this e-mail, you are hereby notified that any examination, distribution or copying of this e-mail and the attachments hereto, if any, is strictly prohibited. If you have received this transmission in error, please immediately notify the sender by email or telephone and permanently delete this e-mail and the attachments hereto, if any, and destroy any printout thereof. MultiCare Health System, Tacoma, WA 98415 (253) 403-1000. ==============================================================================