PICC Line Dressings

[Anonymous]

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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[Tim Spencer]

Hi Phillipa,

a) PICC (and other CVAD) dressings, if a transparent semi-permeable
dressing is used, should be changed every 7 days or as required i.e
blood or moisture under dressing, poor skin adherence due to
diaphoresis, etc.

b) Antiseptic impregnated patch or sponge dressing should be
changed with the dressing or unless saturated with blood or fluid, based
on the manufacturers guidelines and evidence-based literature..

I would be looking at the current practice guidelines CDC, INS, AVA,
CNSA and ONS to support your practice, which should be evidence-based.

Here is the standards from INS (Infusion Nurses Society – USA 2011)
below.

Please feel free to contact me directly should you require further
information.

Tim..

46. VASCULAR ACCESS DEVICE SITE CARE AND DRESSING CHANGES

Standard

46.1 Vascular access device (VAD) site care and dressing

changes, including frequency of procedure and type

of antiseptic and dressing, shall be established in organizational

policies, procedures, and/or practice guidelines.

46.2 The nurse shall be competent in performing VAD

site care and dressing changes.

46.3 VAD site care and dressing changes shall be performed

at established intervals and immediately if the

dressing integrity becomes compromised, if moisture,

drainage, or blood is present, or if signs and symptoms

of site infection are present.

46.4 A sterile dressing shall be applied and maintained

on VADs.

Practice Criteria

A. Routine site care and dressing changes are not

performed on short peripheral catheters unless

the dressing is soiled or no longer intact.1 (V)

B. Central vascular access device (CVAD) site care

and dressing changes should include the following:

removal of the existing dressing, cleansing of

the catheter-skin junction with appropriate antiseptic

solution(s), replacement of the stabilization

device if used, and application of a sterile dressing

(see Standard 36, Vascular Access Device

Stabilization).2-4 (V)

C. Chlorhexidine solution is preferred for skin antisepsis

as part of VAD site care. One percent to two percent

tincture of iodine, iodophor (povidone-iodine),

and 70% alcohol may also be used. Chlorhexidine

is not recommended for infants under 2 months of

age.2,5-8 (I)

D. For infants under 2 months of age or pediatric

patients with compromised skin integrity, dried

povidone-iodine should be removed with normal

saline wipes or sterile water.9 (V)

E. CVAD site care frequency is based on the type of

dressing; transparent semipermeable (TSM) dressings

should be changed every 5-7 days, and gauze

dressings should be changed every 2 days. While

the evidence does not support one type of dressing

over another, gauze is preferable to TSM if the

patient is diaphoretic, or if the site is oozing or

bleeding. In the event of drainage, site tenderness,

other signs of infection, or loss of dressing integrity,

the dressing should be changed sooner, allowing

the opportunity to closely assess, cleanse, and

disinfect the site.2,3,8,10 (II)

F. Placement of a gauze dressing under a transparent

dressing should be considered a gauze dressing

and changed every 2 days. If gauze is used to

support the wings of a noncoring needle in an

implanted port and does not obscure the insertion

site, it is not considered a gauze dressing.3

(V)

G. The use of a chlorhexidine-impregnated dressing

with short-term CVADs should be considered in

patients older than 2 months of age as an additional

catheter-related bloodstream infection

(CR-BSI) prevention measure.2,11-13 (I)

H. With a well-healed tunneled CVAD, consideration

may be given to no dressing.14 (III)

I. The catheter-skin junction site should be visually

inspected or palpated daily for tenderness through

the intact dressing; for patients receiving outpatient

or home care, the patient should be instructed

to check the VAD site and dressing every day

for signs of infection and to report such changes or

dressing dislodgment immediately to the health

care provider.1,3 (V)

J. Gauze, bandages, or any dressing material that

may obstruct visualization of the catheter-skin

junction and/or constrict the extremity should not

be used (see Standard 38, Site Protection).1,4 (V)

K. The dressing should be labeled with the following

information: date, time, and initials of the nurse

performing the dressing change.1,3,4 (V)

L. Sterile gloves should be worn when performing

CVAD site care. The use of a mask during access

is often recommended; however, it remains an

unresolved issue due to lack of research.2,3,15,16

(IV)

REFERENCES

1. Perucca R. Peripheral venous access devices. In: Alexander M,

Corrigan A, Gorski L, Hankins J, Perucca R, eds. Infusion

Saunders/Elsevier; 2010:456-479.

2. Marschall J, Mermel LA, Classen D, et al; Society for Hospital

Epidemiology. Strategies to Prevent CLABSI. Strategies to prevent

central line-associated bloodstream infections in acute care

hospitals. Infect Control Hosp Epidemiol. 2008;29 (suppl 1):

S22-S30.

3. Gorski L, Hunter M. Central venous access devices: care, maintenance

and potential complications. In: Alexander M, Corrigan A,

Gorski L, Hankins J, Perucca, R. eds. Infusion Nursing: An

Evidence-Based Approach. 3rd ed. St Louis, MO: Saunders/Elsevier;

2010:496-498.

4. Phillips, LD. Techniques for initiation and maintenance of

peripheral infusion therapy. In: Manual of I.V. Therapeutics:

Evidence-Based Practice for Infusion Therapy. 5th ed. Philadelphia,

5. Chaiyakunapruk N, Veenstra DL, Lipsky BA, Saint S. Chlorhexidine

compared with povidone-iodine solution for vascular catheter-site

care: meta-analysis. Ann Intern Med. 2002;136(11):792-801.

6. Hibbard JJ. Analysis comparing the antimicrobial activity and safety

of current antiseptic agents. J Infus Nurs. 2005;28(3):194-207.

7. National Kidney Foundation/Dialysis Outcomes Quality

Initiative. Clinical practice guidelines for vascular access: update

2000. Am J Kidney Dis. 2001;37(suppl 1):S137-S181.

8. Safdar N, Kluger DM, Maki DG. A review of risk factors for

catheter-related bloodstream infection caused by percutaneously

inserted, noncuffed central venous catheters: implications for
preventive

strategies. Medicine (Baltimore). 2002;81(6):466-479.

9. Doellman D, Pettit J, Catudal P, Buckner J, Burns D, Frey AM;

Association for Vascular Access. Best practice guidelines in the

care and maintenance of pediatric central venous catheters. 2010;

PEDIVAN.

10. Gilles D, O’Riordan L, Carr D, et al. Gauze and tape and transparent

polyurethane dressings for central venous catheters.

Cochrane Review. In: The Cochrane Library, Chichester, UK:

John Wiley & Sons; 2004.

11. Yong-Gang L, Hong-Lin D, Wang L. Chlorhexidine-impregnated

sponges and prevention of catheter-related infections. JAMA.

2009;302(4):379.

12. Ho KM, Litton E. Use of chlorhexidine-impregnated dressing to

prevent vascular and epidural catheter colonization and infection:

a meta-analysis. J Antimicrob Chemother. 2006;58:281-287.

13. Garland JS, Alex CP, Mueller CD, et al. A randomized trial comparing

povidone-iodine to a chlorhexidine gluconate-impregnated

dressing for prevention of central venous catheter infections in

neonates. Pediatrics. 2001;107(6):1431-1436.

14. Olson K, Rennie RP, Hanson J, et al. Evaluation of a no-dressing

intervention for tunneled central catheter exit sites. J Infus Nurs.

2004;27(1):37-44.

15. Phillips, LD. Techniques for initiation and maintenance of central

venous access. In: Manual of I.V. Therapeutics: Evidence-Based

Practice for Infusion Therapy. 5th ed. Philadelphia, PA: FA Davis;

2010:458-545.

16. Oncology Nursing Society (ONS). Access Device Guidelines:

Recommendations for Nursing Practice and Education. 2nd ed.

Pittsburgh, PA: ONS; 2004.

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 Parsons, Phillipa

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

Please consider the environment before you print this e-mail.
————————————————————————
—————————————
This email and any attachments may be confidential, and are intended
solely for the use of the individual(s) or entity to whom they are
addressed. If you are not the intended recipient of this communication,
please notify the sender immediately and delete the email and any
attachments.
Cabrini does not guarantee that this email is virus or error free.
______________________________________________________________________
This email has been scanned by the Symantec Email Security.cloud
service.
For more information please visit http://www.symanteccloud.com
______________________________________________________________________

_____________________________________________________________________
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Health Districts by the MessageLabs Email Security System.
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Health’s Electronic Messaging Policy.

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do not represent the opinion of ACIPC.

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[Anonymous]

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

Please consider the environment before you print this e-mail.
—————————————————————————————————————
This email and any attachments may be confidential, and are intended
solely for the use of the individual(s) or entity to whom they are
addressed. If you are not the intended recipient of this communication,

please notify the sender immediately and delete the email and any
attachments.
Cabrini does not guarantee that this email is virus or error free.
______________________________________________________________________
This email has been scanned by the Symantec Email Security.cloud
service.
For more information please visit http://www.symanteccloud.com
______________________________________________________________________
Messages posted to this list are solely the opinion of the authors, and
do not represent the opinion of ACIPC.
Archive of all messages are available at
http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a
new message send an email to aicalist@aicalist.org.au
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intended recipient. They may contain confidential or privileged
information. This information may not necessarily be the view of St John
of God Health Care Inc (SJGHC). SJGHC does not warrant, represent or
guarantee the accuracy or completeness of the information. SJGHC does
not accept liability for any loss or damage in connection with the
information. If you are not the intended recipient then any use,
reliance, interference with, disclosure, distribution or copying of this
information by you is unauthorised and prohibited. If you have received
this email in error then please notify the sender by return email and
delete all copies. SJGHC does not waive any privilege.

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[Tim Spencer]

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

Please consider the environment before you print this e-mail.
—————————————————————————————————————
This email and any attachments may be confidential, and are intended
solely for the use of the individual(s) or entity to whom they are
addressed. If you are not the intended recipient of this communication,
please notify the sender immediately and delete the email and any
attachments.
Cabrini does not guarantee that this email is virus or error free.
______________________________________________________________________
This email has been scanned by the Symantec Email Security.cloud service.
For more information please visit http://www.symanteccloud.com
______________________________________________________________________
Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.

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IMPORTANT: This email and any attachments are for the sole use of the intended recipient. They may contain confidential or privileged information. This information may not necessarily be the view of St John of God Health Care Inc (SJGHC). SJGHC does not warrant, represent or guarantee the accuracy or completeness of the information. SJGHC does not accept liability for any loss or damage in connection with the information. If you are not the intended recipient then any use, reliance, interference with, disclosure, distribution or copying of this information by you is unauthorised and prohibited. If you have received this email in error then please notify the sender by return email and delete all copies. SJGHC does not waive any privilege.

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Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.

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Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

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_____________________________________________________________________
This email has been scanned for the Sydney & South Western Sydney Local Health Districts by the MessageLabs Email Security System.
Sydney & South Western Sydney Local Health Districts regularly monitor email and attachments to ensure compliance with the NSW Ministry of Health’s Electronic Messaging Policy.

Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.

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[HIP Consultancy]

The CDC Environmental Infection Control in Healthcare Facilities warns of the generation of aerosols from cleaning chemical, especially if the cleaning chemical happen to be contaminated. The CDC recommends;

Application of contaminated cleaning solutions, particularly from small quantity aerosol spray bottles or with equipment that might generate aerosols during operation, should be avoided, especially in high-risk patient areas.992, 993 Making sufficient fresh cleaning solution for daily cleaning, discarding any remaining solution, and drying out the container will help to minimize the degree of bacterial contamination. Containers that dispense liquid as opposed to spray-nozzle dispensers (e.g., quart-sized dishwashing liquid bottles) can be used to apply detergent/disinfectants to surfaces and then to cleaning cloths with minimal aerosol generation.

Dispensed diluted chemicals are unstable as they do not contain any preservatives etc like ready to use chemicals do and grow bacteria very easily, which is why they must be dispensed every day / prior to use and then discarded at the end of each day / end of shift / after use as per manufacturers instructions. Best Practice is to use pour caps or pre-impregnated cleaning wipes.

Cheers

Cath Wade

Director

Healthcare & Infection Prevention

Hi All,

Would anyone know if there are any reasons for not using Trigger Bottles in healthcare housekeeping settings, please? Some of our bottles tips over easily and cause spills and stains. We are looking at color coded containers which will transfer the liquid to the trigger bottles.

Does anyone have any suggestions or experience please?

Kind Regards

Franciska Ferreira

INFECTION PREVENTION & CONTROL /WOUND MANAGEMENT CONSULTANT

Burnside War Memorial Hospital

120 Kensington Road, Toorak Gardens, SA 5056

t: 08 8202 7222 f: 08 8407 8573 e: fferreira@burnsidehospital.asn.au

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