What you have described could be an exit site infection which
does require catheter removal according to the IDSA guidelines or it
could be many other types of skin irritation, This irritation could be
due to the adhesives on the dressing, the CHG use, or the simple fact
that the solutions are not totally dry when the dressing is applied.
There can also be skin irritation if the dressing is stretched when
placed on the skin and finally, but the least frequently seen is an
actual allergy to the adhesives or antiseptics. Also the use of a skin
protectant solution from the very first dressing must be part of all
IV dressing protocols to prevent skin irritation, Don't even think
about cutting cost to eliminate this step and it will come back to
haunt you with problems such as you described.
Have you obtained any cultures of the sites to determine if you
have an exit site infection? Lynn
At 10:45 AM -0400 10/20/06, Ward Gina wrote:
What about when the site looks bad? You dont see any signs of CRBSI but worried about the potential because the site looks poor. Do you follow that same protocol.
We have had several patients from home ( outpatients for daily antibiotics ) who we struggle with keeping the dressing clean and dry ( we wrap around them with kling and fluff) ( have done more frequent dressing changes to maintain a good clean site) they get really red under the opsite and have even had white patches under the biopatch? ( you would think it would be beyond the biopatch) we have also tried using chlora prep to clean instead of alcohlo and betadine )
Anyway........ When we ultimately remove this picc should we do cultures on the tip? Blood cultures peripheral as well as picc line??
I dont see that in any of the CDC guidelines? It all starts with a suspected CRBSI.
Thanks in advance! Gina Ward R.N., C.P. A.N.
From: [EMAIL PROTECTED] on behalf of Kokotis, Kathy
Sent: Mon 8/14/2006 12:35 PM
To: Elizabeth Harmon; [EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: RE: culture protocols/guidelines for suspected CRBSI
The protocols are right in the CDC guidelines on an algorithm or in Mermel's article that Hadaway sent out
www.cdc.gov
Intravascular guidelines in 2002
kathy
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From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Elizabeth Harmon
Sent: Saturday, August 12, 2006 9:29 PM
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: culture protocols/guidelines for suspected CRBSI
Does anyone out there have anyestablished protocols/procedures or guidelines their facility uses when Central Lines are removed for suspected CRBSI? Would you be willing to share? If so please e-mail me privately. We are working on a set protocol for all Physicians to follow for any suspected CRBSI. It would be done anytime a central line is changed or pulled and another one is placed. Previously lines would get pulled, no cultures, nothing and meds changed, and the lines blamed for the problem. We are looking to have set protocols.
Thanks in advance.
Betsy Harmon RN CRNI
Vascular Access Team
Critical Care Unit
Alaska Native Medical Center
Anchorage, Alaska
[EMAIL PROTECTED]
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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
