Bio Patch with PICC line dressing changes?

[nervousnurse]

Hi, I did a search for this topic before posting and the most recent one was 2009----it was interesting that someone posted it was found they weren't effective, whereas others said it is......What's the policy where you work?

Where I'm working, we don't deal with PICCs often, so that's another reason I want to ask. At my previous, we ALWAYS used the biopatch, but now, we're only using the regular dressing kit, which contains the spongy chlorhexadine thingee to cleanse the insertion site.

I was reading on a PICC Nursing site about the biopatch, and it seems as though it is still used a lot. I suggested it to my boss and am awaiting her response.

[NurseDirtyBird]

Our facility policy is actually different. We are not to use a biopatch unless there are s/s infection because of visualization issues. Sounds too late to me, but that's our policy.

[SoldierNurse22, BSN, RN]

Our facility policy is actually different. We are not to use a biopatch unless there are s/s infection because of visualization issues. Sounds too late to me, but that's our policy.

Yeah, that is an issue. By the time you have an infection, most of the time, we have to pull the line anyway. A biopatch is WAY too late by then.

I don't mean to knock anyone on this board, but I really don't understand the hospitals with policies that don't require biopatches due to visibility. Biopatches aren't that big and if you're doing a good assessment, you'll catch an infection even with a biopatch in place. If you're that curious about the insertion site due to redness/exudate/pain, do a dressing change and check the insertion site as you would anyway with a patient who is presenting with those s/s. Too easy.

[decembergrad2011, BSN, RN]

It is policy to use the biopatch with central lines. We change 1x a week or sooner if soiled, patch saturated, or the tape loses its sticky. We also use a stat lock for the PICC lines specific. I enjoy making the dressings pretty.

[iluvivt, BSN, RN]

You are correct it that it is not a big deal to see the insertion site. I just meaured one from the radial slit (the portion of the insertion site you will not see) and its 1 cm. You can use your other assessment parameters such as palpation of the site and along the course of the vein,visualize what you can see,ask the patient if they are having any pain or tenderness at the site,look for s/sx of systemic infection as well. As with any thing in nursing and medicine you need to evaluate the evidence and weigh the risk vs the benefit. The benefit is so great here with almost non-existant risk. The only risk I can see would be if the patient stated they were allergic to it!

[FlyingScot, RN]

We switched from Bio-Patches to the CHG gel dressings. My biggest beef with the Bio-Patches is that nobody seemed to be able to manage to put them on correctly which made dressing changes a challenge.

[iluvivt, BSN, RN]

Yes! I can see that happening but see how you like the CHG pad that is incorporated into the TSM dressing. I would say education is needed or have a dedicated team to perform all CVC dressing changes. The CDC does recommend a dedicated team to perform this function but with everyone having concerns about the changes coming next year with the ACA I can see that may not be happening at some places. I did not like that dressing. It tends to get gummy and we had to pick it off and you can still not center it properly and you lose the benefit of the design of the biopatch that encircles the entire catheter skin junction. Again it is wise to look at all nursing interventions that aid in keeping the infection rate low and possibly to even zero.

[SoldierNurse22, BSN, RN]

We had the same issue with the gel patch being stubborn when trying to remove it. The **** patch will pull at the catheter, the skin, the dressing--it's a mess.

I'll be darned if a (sterile, of course) NS flush dripped over the gel while gently removing from the site doesn't work like a charm.

[FlyingScot, RN]

Normal saline is what the manufacturer reccommends for dressing removal. Our PICC dressing change kits come with a saline syringe in it. So far I like the gel dressings and have had no problem removing them even without saline. They are much easier to remove than an incorrectly positioned Bio-Patch.

[iluvivt, BSN, RN]

I still disliked them.If you open up the radial slit and then line the exposed catheter with that slit and then secure it with steri strips one can easy peel the whole thing off.If the slit is not lined up with the catheter and you are not extremely careful you can pull out valuable catheter length and this can compromise an optimal tip position.When this happens I just get the edge of the biotech I am having and tear or rip it along the the catheter before I try to peel it off.

[FlyingScot, RN]

I still disliked them.If you open up the radial slit and then line the exposed catheter with that slit and then secure it with steri strips one can easy peel the whole thing off.If the slit is not lined up with the catheter and you are not extremely careful you can pull out valuable catheter length and this can compromise an optimal tip position.When this happens I just get the edge of the biotech I am having and tear or rip it along the the catheter before I try to peel it off.

I know how to use them properly. And I'm aware of the issue with losing catheter length as I deal with PICCs all day long. The problem I have is with other nurses who rotate the radial slit so it is OPPOSITE to the catheter making dressing removal very difficult. Our tegaderms do not tear so I have to cut them or slowly pick them off the Bio-Patch with a blunt needle all the while maintaining sterility and not compromising the catheter. It's a huge pain.

[AMR21, BSN, RN]

We use biopatches on all central lines for kiddos who qualify based on wt and allergies.

We stopped threading the bio patch all the way around the line though. We just set it on top of the insertion site. This helps with the removal/ dislodging the line issue.

We have been bsi free for >2 years.

[Brooke Schmidt, BSN, RN]

I work in home health, our standard is to use a biopatch on all PICC/central line sites. The supplier we get our kits from sends the biopatch separate as the pre made kit does not contain the patch.