BIOPATCH

blondy2061h, MSN, RN · Nov 1, 2009

We continue to use Biopatchs and they seem effective. 7 days seems like way too infrequently to change dressings. Ours are q96h and that's longer than most of the literature suggests (q72h).

allnurses Guide · Nov 1, 2009

I work with lines that are implanted (sometimes permanently) but are not CVCs - we did not have luck with Biopatch, but have had luck with Medihoney (no AB resistance, easy to apply, antibacterial, helps healing). I rave about it now, so have to give the caveat that I do NOT have any financial relationship with the company/product!!

http://www.dermasciences.com/showpage.php?sid=48&id=1&pid=75&show=p

I also saw at a wound conference last week that Silverlon comes in the round disc for CVCs: http://www.silverlon.com/index.htm

Cindy-san · Nov 1, 2009

We're using these shiny new Tegaderms (clear, transparent dsg) with a blob of chlorhexidine on it that goes over the insertion site. Supposed to be better than the biopatch.

NurseStephRN · Nov 1, 2009

We're using these shiny new Tegaderms (clear, transparent dsg) with a blob of chlorhexidine on it that goes over the insertion site. Supposed to be better than the biopatch.

Yeah, that's what we're using too.

We were finding a lot of people using the Biopatch incorrectly (wrong side down), they weren't being changed on time, or even on a PRN basis (if the insertion site was oozing and saturated the Biopatch).

We've been using the Tegaderms with chlorhexidine for a while now.

diane227, LPN, RN · Nov 2, 2009

No but we have these new IV catheters from hell. I NEVER miss an IV and I can't get an IV started with one of these things no matter how much I try. I hate these things. I am going to have to figure out how to get some of the old ones back so I don't have to use these stupid things.

summerrose_10 · Nov 2, 2009

Interesting post.

lbbeauplan-what was the rational for d/c the biopatch? You said it wasn't effective? Who did the dressing changes? I'm curious. Our facility has a 0% infection rate for all PICC lines, but it is ONLY the PICC team that is allowed to do the dressing changes. Strict sterile procedure is always followed. The C.L.drsg change kits now come with the bio patch in them. I use to question why it was only the PICC team that could change these, until, I witnessed RN's not wearing masks and not paying attention to the sterile field while changing CL dressings.

For all infusaports that are accessed, any RN on duty is suppose to change them once weekly and PRN(policy at this institution), also using the biopatch. One thing I've observed, sometimes the RN does not realize she can not use the prefilled saline syringes with these huber needle kits that we have(they are not sterile-thus can not be put on the sterile field).

Cindy, I am wondering about your tegaderm drsg with blob of chlorhexidene. In our kits, there is chlorhexidene that we clean the site with, also a tegaderm that we put on after the biopatch. So, did you guys use biopatches before and are just leaving that out now? If so, what/where is the evidence base practice you all got your info from?

ghillbert-- We have used medihoney on some venous stasis ulcers and other various wounds with some yet minimal effectiveness. Your post peaks my curiousity. What/where are these catheters that you apply this to? Also, is there any dressing covering the site? How much do you have to apply and how far away from the site do you apply it? Have you done any research or seen any websites that talk about this?

We currently have 2pts that have gone septic on us. The only common thing they share is, their infusaport dressings have been changed by a RN that did not use (for whatever reason) the biopatch. Their drsg changes were done this way for several weeks. One had her port removed yesterday, awaiting lab results. The other is hospice, it is unlikely they will remove the only line he has, will never know if the disease process made him susceptible to infec. or if it was because of not using the biopatch/steril tech???

As for placing the patch upside down, which is easily done, it may help to remember the sky is blue and the blue side faces the sky. blue to blue.

diane227- curious about what new type of catheters you are using? If you've never missed a stick before, I would venture to say you have some excellent evidence to support getting the old ones back:yeah:Good luck.

Looking forward to your replies and also to other peoples opinions and feedback. Thanks for this post.:redpinkhe

Cindy-san · Nov 2, 2009

cindy, i am wondering about your tegaderm drsg with blob of chlorhexidene. in our kits, there is chlorhexidene that we clean the site with, also a tegaderm that we put on after the biopatch. so, did you guys use biopatches before and are just leaving that out now? if so, what/where is the evidence base practice you all got your info from?

we used to clean with chlorhexidine, then place the biopatch andd then tegaderm it.

we do still use chlorhexidine to clean the site, we just don't place the biopatch or the regular tegaderms anymore. these dsgs also have a square blob of chlorhex that covers the insertion site. i'm probably not explaining this very well. i think a pic might help. this one is good.

inservice was a long time ago, i don't remember where they got their info from exactly. but here's the official site with all their self-promoting research.

the problem on my unit was, they had (& probably still do) a very high clabsi rate which they were desperate to reduce. we didn't have a problem with applying our biopatches the right way. the problem was they tended to be in short-supply. >90% of our pt population at any given time has a huge cordis in their neck (takes forever [>1 month] to get a picc in the chronics. we rarely see tlc's). in the super sick and septic pts, site oozing and weeping was problematic and led to numerous dsg changes daily, further limiting our patch supply. (and probably also contaminating the insertion sites.) we went more than a month without seeing a single box of biopatches at one point.

they were happy to hear that you can have a bit of oozing with these chlorhex tegs and not have to change the dsg immediately (doesn't need to be changed unless the chlorhex patch is saturated with blood).

how much this has helped the clabsi rate, well, i'm in school and haven't been to work in a while, so i don't know the latest number crunching. i'd like to think it's improved, but i think other things need to happen in terms of pt management before we really get a solid reduction in clabsis. like less of those big-ol' cordises (cordii?).

allnurses Guide · Nov 3, 2009

ghillbert-- We have used medihoney on some venous stasis ulcers and other various wounds with some yet minimal effectiveness. Your post peaks my curiousity. What/where are these catheters that you apply this to? Also, is there any dressing covering the site? How much do you have to apply and how far away from the site do you apply it? Have you done any research or seen any websites that talk about this?

I work with patients with implanted left ventricular assist devices (artificial hearts, basically). They have a power lead exiting the left/right upper abdominal quadrant. I am originally from Australia and had a lot of experience with Medihoney there, and have brought it in to my hospital here in the US. I recently presented at a wound conference about our first cases of infected LVAD sites and Medihoney. I prefer the impregnated calcium alginate, split and placed around the driveline, then covered with a secondary dressing that is occlusive, like Telfa Island dressing.

There is a lot of research out there about Leptospermum species (Manuka) type honey and its effectiveness. One particularly large study comparing medihoney to mupirocin for dialysis catheters. Research is of varying quality - lots of case studies.

I particularly like it because it is fairly innocuous (little to no adverse effects, no resistance etc). One thing to note is that it can require longterm treatment for things like venous ulcers. The most important thing is to put and keep enough honey in contact with the wound. I use the alginate because our wounds are highly exudating at the start and it soaks up the drainage and keeps the honey gel in contact with the wound.

Tons of info here: http://bio.waikato.ac.nz/honey/

ebeehm · Nov 13, 2009

If you place the biopatch correctly, it prevents infection. If you don't place the biopatch correctly, well, all bets are off. Hard to believe that people would bail out on a product that is clinically proven because "people aren't using it right". None of the other products mentioned in this discussion are proven to prevent catheter infections or are researched in how they perform. Their comparison to biopatch has no clinical or relevant basis. Just read the literature these sales reps give you, don't just listen to their sales pitches.

Since the manufacturer added the word UP to the blue side of the biopatch (duh) I haven't seen any upside down ones on our unit.

CoffeeGeekRN · Nov 13, 2009

If you place the biopatch correctly, it prevents infection. If you don't place the biopatch correctly, well, all bets are off. Hard to believe that people would bail out on a product that is clinically proven because "people aren't using it right".

What do you believe is the correct placment?

ebeehm · Nov 13, 2009

What do you believe is the correct placment?

The blue side facing upwards with the slit completely closed, underneath the catheter tubing.

(does quick google search...)

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