I seal my dressing by lifting up on the line as
I apply the TSM, making a little "tent" with the TSM, then pinching it together
around the catheter. This "pinched TSM" is around the built on extension,
not the catheter itself. It provides additional stability this way, and
prevents "gaposis", which is what I call the gap that is created by the TSM
lifting from the skin. If you lie the catheter on the skin and apply your
TSM, it is almost inevitable that over time when the catheter is lifted up to
use, that the TSM becomes separated from the skin and there goes
your occlusive dressing. This way you don't get "gaposis". I
try to leave as little catheter outside as possible. If needed, I use an
extra TSM. I always found this troublesome with the Groshong PICC because
they had the (removeable) suture wing, which I statlok'd as close to exit site
as possible, and then the other anchoring device (also a suture wing really....)
that was an integral part of the catheter. TOO much stuff outside in my
opinion. I haven't used the Groshong in a while so I don't know if this is
still how it comes. Also, it required using 2 statloks, which was not cost
effective either. Nurses don't suture in Colorado, and even if we could, I
never liked sutures. They hurt, get pustules around them, and frequently
pulled out over time. I know Nadine uses one successfully in California,
but in my practice I have never liked them. Besides, in Colorado, nurses
don't suture....
Halle Utter, RN, BSN
Intravenous Care, INC
----- Original Message -----
From: "Kelly Murphy" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Wednesday, October 11, 2006 6:53
AM
Subject: Occlusive Dressing
> dressing? We have two issues that make us question if
> you can ever get a truly occlusive dressing. . .
> the first is one that will be eliminated when we
> finally convert to inserting Power PICCs only. Right
> now, we use Groshongs and when there is extra
> catheter, what is the proper way to ensure
> occlusiveness (is that a word?). I try to make sure
> that all extra catheter remains under the dressing.
> Others have used 2 statlocks and left some of the
> catheter and the second statlock hanging out of the
> dressing. I don't like this practice for fear of the
> patient pulling it (which they will), but was
> wondering if there was a protocol.
> Secondly, when I use a statlock, I try to put it as
> close to the insertion site as possible, hoping to
> anchor it more securely. Others will put it a little
> further away and then the edge of the dressing goes
> over part of the statlock, but the entire statlock
> isn't covered. In fact, half of the clip is exposed.
> This makes for a dressing that is not "air-tight" and
> hence could let bacteria in.
> I know the answers to these questions already, but
> just wanted a little back-up for when I present it to
> my coworkers.
> Thanks!
> Kelly
>
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