Biopatches can move from their original position with patient movement, line being at HUB, etc. even if they were placed correctly. There is a debate at my facility about changing the CVAD dressing when a biopatch moves from its intended position and is no longer providing 360 degrees of line coverage. I realize every patient is different, especially in regards to maintaining skin integrity with each dressing change. Of course, there is the infection risk to consider as well. I would appreciate any data supporting either leaving the dressing alone until the scheduled due date, or changing the dressing each time the patch is not fully covering the entry site. Thanks!
I have never seen any published data on this issue. I would ask what can be done to prevent this movement of the foam dressing in the first place. 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
The biopatch usually moves due to non-adherence of the dressing. Are the people who are changing the line allowing for complete drying of the CHG prior to placing the Tegaderm or transparent dressing? I also have seen where if a patient is third spacing all fluids and weeps from every puncture spont on his/her body that these biopatches get "squishy" and end up moving. We change the dressing then. We have worked very hard at educating our nurses to allow the CHG to dry before applying the biopatch and the transparent dressing and also possibly place some type of skin protectant allowing it to dry and then the dressings usually do not move.
In our facility we place a steri-strip over the Biopatch. This keeps in place AND when you remove the dressing, it does not adhere. (fold one end as a 'courtesy' tab!)
ReneMaslow, RN, VA-BC PICC/Proc RN Kaiser Permanente Santa Rosa, CA
Everytime a dressing is changed it increases the risk of infection too. If the dressing remains occlusive the CHG used to clean the site remains working for 5-7 days. The risk of the malpositioned biopatch needs to be weighed against the risk of exposing the site to air prematurely, assuming the dressing remains intact of course. I have never noted a biopatch changing position unless the dressing is compromised. If the dressing remains intact & presteen I would opt for leaving the dressing and changing it at the scheduled time.
Debbie Graham BSN, RN, CRNI, VA-BC
"It takes many people to make a team, but only one to break it" --A. R. R. Tripp