We have had issues with pressure ulcers from PIV's at one of our system facilities. It is a pediatric facility. We have Statlock in stock, but not everyone uses it. Generally, we see problems if PIV's are placed and then the transparent dressing is placed over the entire conncetion without the securement device or padding under the catheter hub/extension connection (we use Insyte Autogard). Can others share with me whether you see this, what you are doing to combat this, what if any securement device you use? We certainly don't want to cause further injuries, rather prevent them from occuring. We have done education, which has lowered the incident but not completely prevented occurance.
While I don't want to pick on anyone, all of these lines have come from the OR. By the time the pt. reaches the floor, they can have a problem with pressure areas already, or people have covered everything up with tape 'so it doesn't come out', so it is harder to evaluate without doing a complete dressing change. That can be a challenge with peds. We try to get them changed right away, but there are times when that just doesn't happen.
Thank you in advance for your input!
This has been an issue at our pediatric facility as well. We devised an IV start kit that has a securement piece that is shaped like a bone that is placed over the hub area but before placing that piece there is another tape that is similar to the OR foam tape that goes under the hub. It pads this junction, allowing for secure taping with the clear dressing and preventing any pressure in that area.
Theresa Reed
Have you tried any of the PIVs that look like the old butterfly needles? There are several brands on the market. They are flat - so more comfortable for the patient and I have seldom seen any skin issues. I have used Safe-T-Intima brand. They are not appropriate for preasure injections, but other brands are. There is a learning curve to placing them, so be sure your ER and OR are included in any trials and training.
Gail Mccarter
Gail McCarter, BSN,CRNI
Franklin, NH
What does HAPU stand for? Skin integrity at any VAD insertion site is already compromised due to the puncture. So adequate nursing care requires that the surrounding skin remain intact and healthy as possible. Tightly taping a PIV hub can produce additional skin breaks and can easily be prevented by use of proper taking technique. As you mentioned some are not using your stabilization device. Without standardization, you will never learn what is best for your patients. Long before stabilization devices, numeorus IV teams folded a 2x2 gauze, placed a piece of 1 inch tape over the gauze, and placed this under the catheter hub. Then the extension set is curled to the side with another 1 inch wide piece of tape placed directly on top of the piece holding the gauze under the hub. This works to prevent skin breakdown. Do not omit the piece of tape covering the gauze because you will have great difficulty in getting the top tape off of the gauze with the catheter in the middle. Use of a stabilzation device required for all PIVs brings the standardization that is required to measure consistent outcomes. 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
We have not experienced any issues with Hospital acquired pressure ulcers with our piccs. We utilize the statlock device that assists with keeping the flange portion from being indented into the skin and it works well. Occasionally we get folks who have issues with the adhesive which leads us to looking at ways to minimize that.
smahoney