Central Line dressings

[BeckyLRN]

I have a client in my home health that requires weekly dressing changes to her central line.

Initially the client had a couple of small red areas under the dressing that looked like she perhaps had scratched herself.

However as time has passed this reddened area has progressed and is now a full blown rash ..isolated only to the area under the dressing.

Initially we were using tegaderm and she went to her doctor who prescribed medipore dressings to see if that would improve the rash. It has worsened. Most recently we applied another tegaderm type dressing designed to be applied by "one hand" I do not recall the specific name on it. We are waiting now to see if the rash improves. However meantime I am TRYING to find something that is suitable for a sterile central dressing that is more breathable as I believe the heat and humidity may be contributing to the rash development under the dressings. She has never had a sensitivity to any tape in the past. We also omitted the skin prep adhesive on the most recent dressing change.

Thus far...despite the rash the site itself looks very good and the skin..although it has this rash is not at this point in time "open". I have instructed her to monitor the area for any signs of drainage or other infection. She is to see her MD on thursday of this week.

If any of you know of any dressing that might help her I would appreciate your input. Additionally is there any sort of skin cleanser out there with hydrocortisone or benadryl infused in that could be used to clean the site. Obviously this would have to be a "sterile" applicator.

Thank you so much for your help.

Concerned nurse:nurse:

[highlandlass1592, BSN, RN]

I have a client in my home health that requires weekly dressing changes to her central line.

Initially the client had a couple of small red areas under the dressing that looked like she perhaps had scratched herself.

However as time has passed this reddened area has progressed and is now a full blown rash ..isolated only to the area under the dressing.

Initially we were using tegaderm and she went to her doctor who prescribed medipore dressings to see if that would improve the rash. It has worsened. Most recently we applied another tegaderm type dressing designed to be applied by "one hand" I do not recall the specific name on it. We are waiting now to see if the rash improves. However meantime I am TRYING to find something that is suitable for a sterile central dressing that is more breathable as I believe the heat and humidity may be contributing to the rash development under the dressings. She has never had a sensitivity to any tape in the past. We also omitted the skin prep adhesive on the most recent dressing change.

Thus far...despite the rash the site itself looks very good and the skin..although it has this rash is not at this point in time "open". I have instructed her to monitor the area for any signs of drainage or other infection. She is to see her MD on thursday of this week.

If any of you know of any dressing that might help her I would appreciate your input. Additionally is there any sort of skin cleanser out there with hydrocortisone or benadryl infused in that could be used to clean the site. Obviously this would have to be a "sterile" applicator.

Thank you so much for your help.

Concerned nurse:nurse:

While I don't know of a type of dressing you are looking for, may I recommend contacting the nurse's infusion society? They may be able to point you in the direction of an alternative dressing as they set the standards for such things as when this type of dressing needs to be changed. Also, you may be able to contact a local 3M representative who may be able to help you with determining an alternative as well. I just got an email today for my local rep (I spoke with someone at a nursing convention recently and they just got back to me.) I know they've helped me in the past. Good luck.

[PAERRN20]

Is this a PICC line that is near her elbow? If so, when she bends that could contribute to moisture under the dressing and cause a rash.

[BeckyLRN]

No its a subclavian tunneled catheter

[LouisVRN, RN]

If patients can not tolerate the clear plastic tegaderm dressing we are permitted to place steile gauze over the site under the tegaderm, but these dressings must be changed q48 hours

[BeckyLRN]

Yes I had thought of that, but not sure how her insurance company will feel about this as the medication and dressings will be lifelong.

and every 48 hours will get mighty costly

[netglow, ASN, RN]

allergy to chlorhexidine?

[Asystole RN]

How long has she had the TAC?

How does the wound site itself look?

What type of cleanser are you using?

Is the pt A+O and capable of self care?

[BeckyLRN]

chlorhexidine allergy is a possibility..however initially there was no rash under the area that was covered by the biopatch and certainly i was cleaning the entire site with both alcohol and chlorhexidine. it is only this past week that the skin that is under the biopatch has been affected.

Other than the rash, the insertion site looks great.

She is A & O, and probably COULD do the dressing herself, however she is elderly and very intimidated. Our thought on my last visit was for her to do the drsg and if she did ok then from here forth let her do it herself..however this rash is so ugly I am hesitant to not have it assessed weekly by a RN

Thanks for all your comments/suggestions..keep them coming:D

[BeckyLRN]

almost forgot..one of you asked about the catheter age..roughly two months.

[P_RN, ADN, RN]

What about something like a Comfeel dressing with the hole enlarged so you can see the insertion site?

[netglow, ASN, RN]

I'm sensing your worry. My intuition off of your worry tells me to say, maybe she needs to see an MD? Ugly rashes can turn into infection as you know, a bad area for that.