PICC dressings and Grip-lok secure net devices

[Lynstat1]

Hi There, I'm a Paeds nurse in Australia and was hoping to hear some strategies involving PICC dressing changes on children focussing on the following;1. Removal of the Tegaderm/IV 3000 semipermeable dressing. We currently use a product called Convacare which is an orange oil impregnated swab that we rub around the dressing site as we peel it off. I also use the manufacturers directions for removing the IV 3000( stretching the dressing first before removing it from the skin). I find this can be a time consuming and anxiety provoking ordeal for some children, and although we use distraction techniques and all forms of "nurse whispering" with the kids, it would be FANTASTIC if anyone new of a product that would safely remove this dressing as quickly and as painlessly as possible.2. Once the top dressing is removed, the Grip-lok (see link below for more info on these) needs to be removed. Now if anyone has a technique for safely removing these contraptions while remaining sterile on a 3-year old who is not happy about having this done, with the insertion point at the brachial vein (ie under the upper arm), while trying not to dislodge the line, I would be so happy to hear from you! We are finding that the anaesthetists are placing the grip-lok about 0.5 cm away from the insertion site on PICC lines. The INS (2011) states that securement devices need to be changed on a weekly basis, and that is the policy at my hospital as well. However these devices are difficult to work with, especially when they are place so close to the insertion site.....I find the risk of dislodging the line and maintaining sterility is quite a challenge. Consequently, we don't change the secure meant devices as often as stated in our clinical practice guidelines if the risk of dislodging the line is too high. An issue for me is if the grip-lock has old ooze/blood on it and the insertion point can't be visualized, but there is a very real risk of losing the line, would you change it?Some nurses I've spoken with have said that because the grip-lok is under the sterile dressing then it is sterile and doesn't need to be changed even if the grip-lok has significant old blood on it. Also some of these kids are on continouos antibiotic infusions, so I have also heard nurses rationalise that the IVAB's will "protect" against the risk of a line infection. What are your thoughts? Does anyone know of any evidence/literature specifically addressing old blood under a sterile dressing and the risk of infection? Where I have worked previously we had to do a dressing change on a PICC line 24 hours post insertion, however the securement device were stat-loks and they placed about 3 cm away from the insertion point, so dislodging the line was not a huge issue.Please remember that I'm addressing the paediatric population with these questions. For adults I would not hesitate to do a dressing change if there was blood present etc on the dressing. Also we have quite advanced distraction techniques used for children ( actually we have a whole department dedicated to this) so don't need any advice in this area:)Griplok info;http://www.zefon.com/medical/GRIP-LOK-CS-Securement-Device-for-Arrow-CVC-and-PICC-Hubs-p-1006.htmlPlease not that this product info shows a cooperative adult patient and/or application of the griplok under anaesthetic conditions. My issue is taking the griplok OFF and putting on a new one on a wriggling, upset child with the griplok placed less than 0.5 cm from insertion point. Thanks in advance for your help

[Asystole RN]

I heard the beer was bigger in Australia, I guess the paragraphs are too.

To remove dressings effortlessly I use a skin protectant pad. There are various brands of this product but it usually is dispensed in a 1x1 pad (looks exactly like an alcohol pad) that is applied to the skin where any dressing is expected to adhere. The skin protectant will leave behind a clear, water-resistant, glue-like residue on the skin that allow greater adherence for most dressings. To remove the dressing you simply apply alcohol which immediately denatures the skin protectant and then the dressing simply lifts away. Skin protectant is very inexpensive and easy to use.

As far as securement devices, personally I like to use Statlocks for PICCs and I use the Griplocks for holding IV tubing or the extension tubing. I find that since the Griplocks use an adhesive to hold the tubing it can be difficult to disengage the lock without pulling on the catheter. This is where Statlock's simple plastic clasp is superior, you can disengage the catheter from the lock easily then work on removing the lock without pulling on the catheter. If you are unable to obtain Statlocks then see if you can obtain a skin protectant, you can smear it on the catheter itself and use alcohol to remove it from the lock.

I will see if I can locate those studies but yes, blood and fluid are a bad thing to keep around an open wound. There is already an open wound for entry but why would you leave food for the bacteria to consume and grow?

There is no current recommendation stating that you must change the dressing 24 hours post insertion, this practice comes from the assumption that there will some blood or fluid around the insertion site immediately post insertion.

[Lynstat1]

Thanks Asystole, and sorry about the paragraphing, I'm new to online forums! Anyway, I too prefer the stat locks, however it's the anaesthetic team who decide what securement device is used. We are actually liaising with the anaesthetic team about this issue (Griploks placed within close proximity to the insertion site), however it takes time, I guess.