Our system wide skills days are coming up and I'm teaching about changing gauze dressings in 2 days, as the CDC recommends. The following question is from our infection control nurse who has been working on our nursing policy for central lines:
"I just want to make sure that since this is a systems policy--that the statement about changing out the gauze after 2 days will also apply to home care and CR Infusion Center. In other words...you will be instructing them that they have to see their patients every 2 days? I am not sure that CMS will reimburse for that--and they may question. I agree that it is best practice to use a transparent dressing if there's no need for absorbancy, but hesitate in making a general statement for everyone based on a type 2 recommendation."
Does anyone have any thoughts regarding this issue?
THANK YOU!
Ann Armstrong, RN
PICC Nurse
Midland, MI
I am actually surprised that this is coming from an infection control/prevention nurse. Both the CDC and INS state now and have for many years that all VAD dressings with tape and gauze be changed every 48 hours. This dressing obscures much more of the site and prohibits anyone, the patient or nurse, from looking at the area. There is no evidence that this type of dressing is safe to extend beyond 48 hours. If there is a question about absorbency, then gauze is not the answer. If the gauze is absorbing fluid, this would require a complete assessment to determine what this fluid actually is and what to do about it. Is it infusing fluid leaking from a damaged catheter or sweat or infusing fluid leaking due to retrograde infusion from a complete fibrin sheath or vein thrombosis? You can't just keep changing the dressing at any frequency and allow it to continue leaking. If this is bleeding, there are other products that are used to stop this bleeding including Bioseal or GuardiVA. The CDC guidelines are written for acute care but is applied in all settings. The INS standards are written for all nurses performing infusion therapy in all healthcare settings. So regardless of who is paying or not, if gauze dressings are used, they must be changed every 48 hours. Obviously this is a major reason not to allow a gauze dressing in these alternative situations. Both of these documents emphasize changing the dressing immediately when it is wet, dirty or nonocclusive. So a catheter with fluid leaking from it would require changing immediately even if it is less than 48 hours regardless of the type of dressing. So you can not allow the use of gauze dressings in alternative sites but you have to follow this 48 hours change if it is used. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
My question, what is the standard dressing change protocal if a small 2x2 folded over qauze dressing is applied to the insertion site post PICC placement due blood oozing from the site which is then covered by a transparent dressing.....can this dressing be changed at the 24hour interval if bleeding has stopped so a Biopatch can then be placed appropriatley followed by placement of a transparent dressing? I read over the INS 2011 Standards of Practice and was unable to find any mention of this particular type of situation.
I would appreciate feedback on this!
Thank You!
Check out Standard #46 Practice Criteria E & F
Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.
Thank you, Lynn! Your thoroughness and expertise is very appreciated. I will pass along this information.
Ann :-)
Ann Armstrong, RN
PICC Lines
MidMichigan Medical Center, Midland
Hi Ann,
I have been in Home Care and Home Infusion for 23 years and I have always instructed and have policies that state if the patient has a gauze dressing on their CVAD then it must be changed every 48 hours (every 2 days). We are a Medicare certified Home Care agency and have never had CMS, insurance or State question this or refuse to pay for nurse visits. Of course when possible we will change to Semi-permiable transparent dressing and use Bioseal or GuardIVa (we have both) if the reason for gauze dressing is related to bleeding.
Carole
Carole Rumsey, RN, CRNI
Home Infusion Program Manager
Sutter Infusion and Pharmacy Services
Sutter Care at Home
Northern CA
[email protected]
Thank you, Carole! This is very helpful! I will pass it along...
Ann :-)
Ann Armstrong, RN
PICC Lines
MidMichigan Medical Center, Midland
Our PICCs are tapered at the port end. Are all that way? I think it really helps for ooze. thoughts?
thanks
David
It is called a reverse taper and all PICCs do not have this feature. There is no published clinical evidence on outcomes with this and many think that placing the largest diameter in the smallest part of the vein can increase the risk of thrombosis. Also the length and size of these tapers vary greatly between brands that have them and we do not now if there is a length and size that produces the best benefit without increasing the risk
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861