Course Access
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
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Mary Willimann
Sent: Thursday, 18 April 2013 12:45 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: PICC Line Dressings
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
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
>>> “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
Email: pparsons@cabrini.com.au
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