We utilize Vaseline gauze , 2/2 and transparent dressing to an insertion site upon removal of a central line. ( utilizing full precautions to reduce the risk of air embolism; trendlenburg, Valsalva etc, lie flat for 1 hour). Typically most of these patients go home with the dressing and if so, we tell them keep dressing on for 3 days and then remove.
We are working on removing Central lines much sooner instead of upon discharge, as well as replacing MD inserted lines for PICC lines if line needed for long term and Md inserted line earlier in pt care. The question is; after the line is out and the proper above mentioned dressing is applied our protocol (HCA) wants us to assess the site every 24 hours. If we do this I would say we should be excercising caution again with all protocol in the event the tract isnt closed and there is some risk for air embolism . If that is the case then we would apply the same type of dressing not a simple transparent dressing , wouldnt you think? If our concern is keeping the site sealed until epitheliazed?
I dont think just the transparent dressing on the site is occlusive enough or similaar to that of a Vaseline gauze dressing . Staff say this way they can see it. I say, keep it covered properly Vaseline gauze and 2/2 and Opsite and re assess q 24 hours if we are expected to. I really think just keeping the dressing on 3 days in house is sufficient , and only change if needed but Corporate wants a re assessemnt q 24 hours.
So...... ? if changing /re assessing site daily what dressing to use?
? I thought I read the risk for air embolism is over 30 minutes after the line is removed, so.....is the dressing staying on for several days even needed.
Thank you again!
I would consider myself to be very familiar with the published evidence about venous air emboli primarily because of several lawsuits. I have never seen a report of a case of VAE occurring days after the catheter removal. It is possible, but the probability appears to be low. The occlusiive ointment based dressing should be left on until the site is epitheliazed. The question is how long will that take and it depends upon many factors - the size of the catheter and the corresponding hole left upon removal, the nutritional status of the patient and their ability to heal, the length of time the catheter was in the vein and the strength of the skin-to-vein tract. I wonder how this policy to reassess the site in 24 hours got started. I have never read anything about the risk of VAE being only over the 30 minutes following removal. There is one published case where the patient went out to smoke following CVC removal, and had a VAE about 30 minutes after removal. In that case, they documented air in an intact fibrin sheath connected to the skin to vein tract. But I do think healing time is different for each 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
I went to look into this deeper to see if I could get "the 24 hour post removal insertion site dressing " removed from our policy. I looked at the "aim for Zero" initiative packet that our company HCA put out for all to adhere wtih specific competencies on Air embolism prevention etc. and they referenced the the old INS standards 2006 which apparently stated; insertion site is re assessed every 24 hours until epitheliazed. I cant find that book , but I saw it did say that in the 2000 standards. The newer Standards do not have such a statement so.....i thought I could push it through for removal.
but.....then I found they also reference the I.N.S. Policy and Procedure manual from 2011 which does state the same action of re assessing the dressing every 24 hours until the site is epitheliazed.
So.......I guess I will leave it as it.
Gina Ward R.N., VA-BC