Re: PICC Line Dressings

18/04/2013 at 2:13 pm #69950 Quote

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Hi Tim
Thanks so much for your reply. I am probably just not looking in the
right spot but have been struggling to find some evidence specifically
around PICC lines. Most of the evidence seems to be around short term
CVCs. We have been collecting oncology and haematology CLABSI data for
nearly a year now and although our rates are not high, we are seeing
PICC line related infections in this group which is why we would like to
see the use of CHG dressings. Are the RCTs that you mention the
following ones?
Ruschulte H, Franke M, Gastmeier P, et al. Prevention of central venous
catheter related infections with chlorhexidine gluconate impregnated
wound dressings: a randomized controlled trial. Ann Hematol 2009;
88:26772.
Timsit JF, Schwebel C, Bouadma L, et al. Chlorhexidine-impregnated
sponges and less frequent dressing changes for prevention of
catheter-related infections in critically ill adults: a randomized
controlled trial. JAMA 2009; 301:123141.

Kind regards
Mary

Mary Willimann I Clinical Nurse Consultant – Infection Prevention &
Control I St John of God Subiaco Hospital
Level 3, 12 Salvado Road SUBIACO WA 6008
P: 08 9382 6220 F: 08 9382 6785 E: mary.willimann@sjog.org.au

>>> Tim Spencer 18/04/2013 11:20 AM
>>>

Hi Mary,
This is a wise move gauze square under dressing and change to CHG
sponge at 24hrs post insertion. Quite widely practised within the USA
also.
It saves wastage costs in changing CHG sponge dressing twice in 24hrs
if its contaminated with blood post insertion, etc.
We have just implemented hospital-wide use of a CHG sponge dressing
after using in ICU and Haem/Onc for the last 4 years.
CLAB rates are quite low already, but we standardised its use to give
every patient the benefit, rather than just using it on specific
groups/types of patients and devices.
This also allows for greater compliance with using the device in the
care and maintenance when the patient goes to the ward.
There is much supportive literature that supports the use of a CHG
impregnated sponge on an insertion site, including 2 good RCTs.
Using the literature to support your case will be imperative. J
Getting past the covered exit site is hard, but there needs to be faith
in the product that it is doing its job correctly this will show in an
infection rate reduction generally.
PICC lines are well documented to have LOWER infection rates than your
standard chest CVCs (IJ/Subclavian/Axillary Vein), so I would consider
its use based on your overall infection rates for both CVC and PICCs.
Do you happen to use impregnated CVCs at all?
Tim..

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral
Nutrition Service
Conjoint Lecturer, South West Sydney Clinical School | Faculty of
Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital,
Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428
| Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au

Behalf Of Mary Willimann

Hi Phillipa

I was just about to put something on the AICA list myself as we are
having similar issues particularly around the use of
chlorhexidine-impregnated sponges or dressings. Whilst we are using them
routinely in ICU for CVCs, we are meeting with resistance from our
oncology staff about using them routinely for all PICC line dressings in
our oncology and haematology patients. In ICU we have the option of both
the sponges and the transparent dressings depending on clinician
preference – as you have stated some people like to able to view the
exit site. Also we are wondering if it might be more sensible to dress
PICC lines with a gauze dressing when they are inserted but changing to
a chlorhexidine-impregnated sponges or dressings when changing the
dressing 24 hours later? All advice would be gratefully received!!

Kind regards

Mary

>>> “Parsons, Phillipa” 18/04/2013 9:18 AM
>>>

Dear All,
Could people please advise on the management of PICC line dressings
when an antiseptic impregnated patch is used in regards to
a) frequency of PICC line dressings
b) antiseptic impregnated patches
We have two streams guiding our discussion and management of PICC lines
at the moment.
I am receiving arguments that the exist site cannot be observed
properly with the patch insitu and the patch always requires changing
next day as blood soaked. The patch product use recommends changing if
blood stained.
Is anyone dealing with a similar issue and how have they managed this?
Regards
Phillipa Parsons
Infection Prevention and Control Clinical Coordinator
Cabrini Health
183 Wattletree Rd
Malvern Vic 3144
03 9508 1577
0400 369 741

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