Is there a true 'air occlusive' dressing on the market besides Vaseline gauze? I use petroleum gel, folded gauze, and Tegaderm. When a patient has a central venous catheter removed and is discharged in an hour are hospitals sending home air occlusive dressing supplies? If the patient going home is told to keep the dressing on for 24 hours until healed, what if it isn't healed in 24 hours, what is the patient instructed to do?
As peripheral IVs are left inserted until clinically needing to be changed, is there more of a risk for the skin-to-vein tract with a potential for air embolism? PIVs are being inserted into deeper veins using ultrasound and left dwelling for a longer time. The extended dwell catheter can be inserted as a Midline or inserted in the forearm. Does this pose risk in the forearm/deeper larger veins, for air embolism when the catheter is removed and has the skin-to-vein tract up to 72 hours after removal. Wouldn't this occur in these situations? Thank you
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C. Olson
As you can imagine, there are no clinical studies on humans on your dressing question for CVAD removal. Studies on VAE are limited to animals and none have looked at your question that I can recall. Some anecdotal published information suggests that the dressing should remain intact for 24 hours or until it heals but the question - is 24 hours a sufficient time for it to heal - has not been addressed, much less answered. The only answer I can think of is that there is not any reports of VAE attributed to CVAD removal that is occuring hours after the removal, therefore this does not appear to be an issue. I have never known of any policy to send dressings home with a patient for them to change at a later date.
RE your question about peripheral catheters - this is not an issue. VAE is ONLY going to occur because of a pressure gradient. The venous pressure must be lower than atmospheric pressure, and there is an open conduit for the air to enter. Venous pressure in the peripheral veins is about 35 mm Hg in the hand and forearm Venous pressure DECREASAES as veins get larger. In the SVC, venous pressure is at or near 0. To have a VAE associated with any peripheral vein, there would have to be some air inside an infusion system being forced in by pressure. This could be a syringe filled with air or an infusion pump with air in the set below the air detector. The only venous air reported from peripheral veins is associated with power injection in CT or from infusions on pumps associated with scalp veins in infants. Those studies involved finding small amount of air on brain CT and there was not clinically significant problems reported. Once the peripheral catheter is removed, there is no negative pressure gradient and nothing to force air into the venous system. Theorhetically, VAE can occur with a PICC due to a skin to vein tract AND an intact fibrin sheath extending to the intrathoracic vessels. But this is not the case with a peripheral catheter with the tip loocated in peripheral veins. 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