Dressing Changes for home infusion

kids · Jul 20, 2010

The HH agency I work for contracts overflow or distance clients from hospital based HH and other home infusion agencies. We follow the contracting entities policy and it's consistant across the board and they don't differ significantly from the facility P&P I've encountered over the years.

Weekly for all occlusive dressings using a prepackaged kit that usually includes a biopatch. 3x a week is too often for an uncomplicated access with an occlusive dressing, every time you change the dressing you're exposing the site to potential infection.

Non occlusive (gauze) dressings are changed daily.

Asystole RN · Jul 20, 2010

q7 days using CHG cleanser, bio patch and transparent dressing. Found the more often we changed dressings the more infections there were. Once a week seems to keep the infections down.

x3 a week would also be super expensive. Bio patches are $20 a piece, not to mention the kits, dressing, Stat Lock/Grip Lok and caps. Most manufacturers recommend q7 days anyways.

iluvivt, BSN, RN · Jul 22, 2010

When you make these types of decisions and are evaluating current practice you want to look at nursing organizations and other government agencies that recommend standards of care. Over the past 27 yrs in which I have practiced this as my specialty there have always been some controversy regarding the most optimal frequency that will keep all complications low especially infection and bear in mind that that have been a lot of research on infection prevention from many of these. There has been a lot of new research about biofilm and how it affects infection risk. Here are a few key concepts that most agree upon and that have different levels of evidence to support those recommendations.

1 a Non occlusive dressing of tape gauze should not stay in place for more than 48 hrs or a dsg with gauze at the site and a TSM dressing over it. Bacteria counts increase dramatically after 48 hrs.

2.The use of a CHG patch ,such as a biopatch has shown to reduce CRBSI's as much as up to 60 %.CHG impregnated dsg does not have as many clinical studies behind it has does the biopatch but may also be highly effective..have not seen many current studies..may be some out there

3 With he use of CHG patch or integrated patch and then a TSM dressing over that...you can leave that dsg on for 7 days...both those manufacturers state the product will release the CHG up to 7 days...The Biopatch is only about 5 bucks and we have it in a CVC kit that only cost us about 10 dollars . The dsg must not be compromised in any way or it must be changes before the 7 days.

4 the Use of CHG for routine catheter site care is recommended by the CDC...INS also recommends it as well as .......alcohol....povidone iodine..should you have any patient allergies. It is essential that at least a 30 second scrub with the CHG take place and it MUST be allowed to air dry

5. You can of course, change them more frequently but you do not want to change the caps more frequently then every 72 hrs or leave greater than a week ( in a few situations this does not apply) as you need to decrease the breaks into the system

6 My PD job is at a big home infusion company and we change our caps and all CVC dressing every 7 days unless compromised or if there is a specific problem. This also decreases supply costs.nursing time..pt compliance increase , The pt and or caregiver really need to be instructed on a successful technique to cover the CVC during bathing.including the caps. Water can sometimes sneak in there and that is why you see more gram positive infections and different bacteria for home care pts than in hospitals

karenaa · Jul 26, 2010

Thanks!!!

What about just using a transparent dressing - without Biopatch? Will i have to change the dsg more frequently or once a week is ok?

Asystole RN · Jul 26, 2010

Thanks!!!
What about just using a transparent dressing - without Biopatch? Will i have to change the dsg more frequently or once a week is ok?

Once a week is ok. The Biopatch is 100% optional.

At my facility the Biopatch is only applied for brand new (sub 1 week) central lines and those leaking.

iluvivt, BSN, RN · Jul 30, 2010

If you opt out of the Biopatch and just want to use the TSM dressing...yes it can stay on for one week as long as clean,dry and intact.