[Robbilin]

Our current policy for drsg changes is to change them weekly, cleanse with betadine and then H2O2, apply a Bio-patch, and then a Tegaderm dressing. We will possibly be changing to using just a dry guaze and a piece of tape and doing that at each HD tx. What advice, cautions do you have? What are you all doing for your drsg changes? Thanks in advance.

[kdhnursern]

Originally Posted by Robbilin

Our current policy for drsg changes is to change them weekly, cleanse with betadine and then H2O2, apply a Bio-patch, and then a Tegaderm dressing. We will possibly be changing to using just a dry guaze and a piece of tape and doing that at each HD tx. What advice, cautions do you have? What are you all doing for your drsg changes? Thanks in advance.

At our facility, we have been changing IJ dressings every tx and using ExCept to cleanse the site, TAO on guaze, then Tegaderm over all. But we are starting to do away with the Tegaderm and just use paper tape over the guaze. This has worked so far as long as they don't get it wet in a shower.

[gwenith]

It really depends on the wound and the amount and type of exudate.

[babyboomerRN]

we change our cvc site drsgs every treatment. we usually use betadine swabs to clean the site,apply abx.oint and dress w/sterile 2x2 and tegaderm. we modify this as needed per pt. hope this helps!

[Robbilin]

Originally Posted by kdhnursern

At our facility, we have been changing IJ dressings every tx and using ExCept to cleanse the site, TAO on guaze, then Tegaderm over all. But we are starting to do away with the Tegaderm and just use paper tape over the guaze. This has worked so far as long as they don't get it wet in a shower.

Do you use antibiotic in single dose packets? I am trying to do this cost effectively, but still best for the patient.
I know the KDOQI recommendations are not to use an occlusive dressing, which is why we are switching to paper tape also. Thanks

[kdhnursern]

Originally Posted by Robbilin

Do you use antibiotic in single dose packets? I am trying to do this cost effectively, but still best for the patient.
I know the KDOQI recommendations are not to use an occlusive dressing, which is why we are switching to paper tape also. Thanks

Yes, the little single dose packets do real well, just the right amount.
We actually had some irritations showing up under the Tegaderm but those are history now.

[babs_rn]

We used the gauze and tape for awhile but found it just didn't work well at all. What DOES work and is applied just like Tegaderm is the Island dressing...it's got the non-stick telfa like surface about the size of a 2x2 implanted in the center of a 4x4 piece of Mefix. Adheres well and breathes and qualifies as a nonocclusive dressing (for you Davita people who can't use occlusives) and all around just seemed the best way to go for patient and nurse satisfaction, as well as its ability to stay ON, thus cutting down on exposure to pathogens> We've always changed the dressing every treatment, as we are bound by P&P to assess the site prior to beginning treatment. Obviously if you have purulent drainage from the access site the MD would need to decide if the patient can go on or has to be hospitalized. Davita has also been trying to get away from the betadine/alcohol (depending on the make of the catheter) and go to Exsept for site cleaning. The antibiotic ointment is optional but losing favor as the oils can break down the catheter and it really isnt necessary if the dressing change is performed correctly and the patient is compliant with what they're supposed to do (or not do) with that catheter.

[Mel RN]

Originally Posted by Robbilin

Our current policy for drsg changes is to change them weekly, cleanse with betadine and then H2O2, apply a Bio-patch, and then a Tegaderm dressing. We will possibly be changing to using just a dry guaze and a piece of tape and doing that at each HD tx. What advice, cautions do you have? What are you all doing for your drsg changes? Thanks in advance.

Frequency of dressing changes will depend upon the type of catheter. A temporary subclavian cath should be changed more frequently with sterile supplies. An IJ cath that is at least 3-4 weeks old can be left open to air. You can get specific guidelines by the surgeon that places your catheters. You will probably get many different responses to your question. We use betadine swabs, sterile 2x2 and a tegaderm for our sterile dressings which are changed every treatment!

[gfrn02]

We use dynahex to clean our sites and a sterile 2x2 and tegaderm. Our P/P also states that we observe the site before the treatment is initiated. i know that in the hospital settings you only change the cvc every 7 days but this is different than the dialysis catheter.

[jnette]

Again.. so many varied responses !

At our HD facility we have been advised to change the dressing only once a week, as the more it is exposed to air, the greater the chance of contamination. Thoise who have had their cath for a month or more, need no dressing at all.

We use the breatheable dressings.. not occlusive. They stick quite well, and cover nicely. Use betadine to cleanse the area first unless otherwise stated by the brand of cath.

We USED to just use gauze and paper tape, but no more.

Then again, this could change.. seems like every time we turn around, they are changing the P&Ps on us !