Broviac Allergy

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Hi there

I wasn't sure if this was the appropriate group to pose this post to but figured I would give it a try.

I have a pediatric patient who is on a continuous medication infusion for his disease process. He previously received this medication via a continuous SC infusion but was reacting significantly to the medication as well as various dressings and cleaning products. The decision was made to insert a central line. We have had to play around with different dressings/methods of cleaning but he is now reacting to the Broviac itself with blistering when it touches the skin and some blistering at the exit site. Has anyone experienced this and any recommendations for what to do. This line is a lifeline for him.

These are the products he has previously reacted to:

Mepilex, Tegaderm, IV 3000, Mepitec tape, Duo Derm, Meopore, Chloraprep, Coloplast, 3m clear tape, regular bandaids, Opsite flexigrid, chlorhexidine, alcohol. We have used gauze with a blue tape and his skin is okay but it does not stick well. Currently we are trying Biatain and no reaction so far to the dressing. Cleaning with NS.

Any help would be greatly appreciated.

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Specializes in Vascular Access.

Since he has a tunneled IV catheter which I presume has been in long enough to allow the cuff to have good tissue ingrowth, is a dressing mandatory? It sounds like he is sensitive to so many things, I would use a gauze and blue tape to fold under the Broviac so as not to have the catheter actually touching the skin, but leave the site OTA. You see, once the skin has grown around the cuff, and the tunnel track well established and epithelized, then microorganisms are not going to get up through the exit site, only through the hub/needleless connector. Just a thought.

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Thanks for your suggestion. I have suggested wrapping with gauze and tape to mom. His line has not gotten to the point where the site is completely secure with the cuff. He still occasionally has a small amount of serous drainage from time to time. He is also a very active 6 year old boy on the autism spectrum so not sure most people would be very comfortable with him going without a dressing both for decreasing risk of infection and helping to keep the line secure.

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Poor little guy!!! I'm a new RN so I have no advice. Good luck in finding a fix for him!

I learn so much from this site! Here is what I'm confused about: So when a patient needs a tunneled catheter for long-term/permanent meds, we want skin to grow around it? Is that for stability and infection control? If it needs to come out, isn't it a surgical process? Ouch!!

Thanks!!

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Specializes in Nsg. Ed, Infusion, Pediatrics, LTC.

A few of my central line pts. Who have had reactions in the past to conventional tapes generally do well with either hypafix or hy- tape. Good luck to you.

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Sounds like you've already found a solution. If the pt isn't reacting to the Biatain dressing, you can put gauze between the catheter and the skin and just clean with NS, that sounds fine.

As has already been mentioned, because it is a tunnelled catheter with a cuff, the risk of infection is decreased, and many people do just fine without dressings. The only real indication I can tell for a dressing is to keep the catheter secured, and if the current dressing you're using is doing that without causing a skin reaction, then you're a-okay!

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Specializes in Infusion Nursing, Home Health Infusion.

Plus if he is very active you don't want the Broviac to come flying out if it get caught on something. You must make sure that there is no moisture collection at the insertion site due to bathing and sweating and things like that and that there is not tension on the catheter. it sound more like his skin is very sensitive to tape and dressing products rather than an allergic type reaction to the silicone that the catheter is made up.It is true once the cuff is seated you can eliminate the dressing but not the cap changes, but it can be problematic in the pediatric patient population. You can however be creative and make it have a small footprint while securing the tails so it does not catch on anything. My favorite option to use is a silicone dressing if TSM dressing such as Tegaderm and Op Site 3000 and others are not working. I believe that the Biatain is silicone but I know they have other type of dressing as well.

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Specializes in med-surg, mother-baby, teaching, peds.

Sounds challenging but you have found something that works. Thank you for sharing with the rest of us.

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