This question is a bit out of my comfort zone but it has been asked and I've agreed to poll the experts.
We have a surgeon who applied dermabond around a tri-fusion (triple lumen tunneled cuffed) catheter at the skin surface post placement of line. The surgeon says the site does not require a dressing in the immediate post-placement period because dermabond provides a barrier. Our interventional rads generally place these lines and they dress them afterward like any other central line......but this was done by a surgeon.
Patient is immunocompromised (prep for stem-cell transplant) and our protocol requires placement of a dressing.
Concerns are:
*Would the dermabond seal disallow any drainage which may follow line placement?
*If we place a tegaderm dressing (we use tegaderm CHG) over the site and it is removed for a dressing change is there a chance the chg may adhere to the dermabond and compromise the insertion site?
Our gut instinct is to place at least a gauze dressing but preference is for tegaderm CHG.
Thanks......
Alma Kooistra CRNI
If you look at the DermaBond website it is hard to find any reference where using this product for anything other than skin closure is acceptable. I have used this product as a surgical assist many times and it does not work well with blood exposure, you need a clean surgical line with the skin well approximated and then use this product for closure. As all catheters piston in and out of the skin in some fashion you could even make an arguement that this could lead to more risk of infection as the wound track from the catheter could be made more ridgid and be easier for bacteria to ingress into the channel. Perhaps this surgeon has some research or data supporting this use, if so it would be great to see!
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
I agree with Stephen that if the surgeon has supportive evidence for use of Dermabond with CVC insertion site then he/she should present it and have the use of the product incorporated into hospital approved protocols. I would be concerned with the solvent attacking the plastic of the CVC and potentially causing failure. I know that the solvent is very similar if not the same as what is used to bond the components of IV tubings, ext sets, etc. Without good evidence I would advocate strongly that this practice not continue. I venture to guess that your CVC manufacturer does not qualify the use of Dermabond in conjuction with its product.
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Tom Billings, RN
~no affiliation with Dermabond or CVC manufacturers~
I think there are 2 issues here - risk of infection and catheter stabilization. I do not think there is any evidence for Dermabond to be used for CVCs in relationship to either of these issues. I am not certain but I think this product wears away with time and mechanical cleaning. So your normal cleaning procedures will remove this stuff leaving nothing there. I also think if you put any type of transparent dressing on top of it, removal of the dressing will also pull off the Dermabond. So I would go to this doc and discuss, give him/her the opportunity to provide studies to support this practice - do not allow them to force you to find this evidence! If he/she is resistance, refuses, etc. then take this up the chain of command all the way to risk management and administration, medical QI/QA, etc. You can not allow individual preferences such as this without evidence to support it. The whole movement in healthcare now to away from physician-based differences and to standardized care the same way for every patient. 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