Chlorhexidine patch on central lines

[andiekae2]

Our Infection Control Practitioner has approached us regarding changing the brand of chlorhexidine patch we use on all central lines. We have routinely used the Ethicon BioPatch while keeping a few Bard GuardIVa on hand for those lines that ooze. However, she has found that with our purchasing program the GuardIVa are much cheaper and wants to switch. My concerns with this are:

• exposing every patient to Bard's "propriatary hemostatic agent"
  
• the notable difference in the amout of Chlorhexine (I believe it is 24mg vs 92mg)
  
• lastly, the lack of research on Bard's part showing their patch "was not clinically tested for its activity to reduce local infections, CRBSI, or skin colonization of microorganisms commonly related to CRBSI" (on GuardIVa box).
  

Any information would be greatly appreciated, especially published studies (hard to find) before we make a decisions.

[la_chica_suerte85, BSN, RN]

I'm curious what your concerns are regarding the hemostat properties in the Bard patch.

[andiekae2]

I've tried to find out exactly what it is that makes it hemostatic. Is it thrombin? Bard is very vague and therefore how can we assess for allergies or potential coagulopathies they may cause? In the good old days, we exposed everyone to heparin (through hep-locks) and now we know the consequences.

[la_chica_suerte85, BSN, RN]

Yeah, I only ask because they started using StatSeal powder at my facility to minimize the need for dressing changes immediately after line placement and it's actually pretty nifty. Here's a link detailing how that works: The Technology | statseal.

Bard was a bit more vague on their proprietary formula for the hemostatic component of the GuardIVa but their white paper does explain the rationale for less chlorhexidine and I guess I buy it: http://www.bardaccess.com/assets/literature/MC-1129-00_guardiva_white_paper_web.pdf. Essentially they feel they are using the minimum amount that is effective against clinically significant pathogens. They do have their own StatSeal-like product called Arista AH that is a plant-based method of hemostasis which is intended to basically reinforce/enhance the body's natural clotting process. I would conjecture that this is somehow integrated into their patch. I mean, that's cool, I guess but I don't really see how effective that would be on a patch -- eventually there should be a nice scab that shouldn't need much reinforcing. Where I work, the StatSeal is an immediate post-procedure phase tool that is intended to last for 7 days and the BioPatches are still used with subsequent dressing changes. I'm sure you've seen all the info I cited above but I guess, if they want to take a leap of faith and see how well the lower chlorhexidine GuardIVa patches compare to infection rates prior to their use, it might be worth it in the financial gain if rates stay the same (or, maybe even improve?).

By the way, I've kind of noticed a trend where there is becoming a kind of hesitance to be so heavy-handed with chlorhexidine because people are either starting to develop sensitivities to it while in the hospital or more people are found to be sensitive to it because it is being so widely used. That's the only reason I would maybe offer a 'yes' vote to changing to the Bard patches.

[zacarias, ASN, RN]

I'm not aware of people being sensitive to chlorhexidine. I do know that I don't like it much for an open wound!

Z

[TeenyTinyBabyRN, BSN, RN]

I work in a NICU and we commonly see patients with Chlorhexidine sensitivity/allergies. We typically see it on our older babies (6+ months old) that have had a central line their entire lives.