Dressing post Central line removal

MunoRN, RN · Oct 16, 2016

Tegaderm is an occlusive dressing that allows for osmotic transfer of moisture and gasses through the dressing. It is "breathable", but does not actually allow for the free flow of air through the dressing, so for the purpose of preventing air embolism through an intact tract and open insertion site it is occlusive.

There is little true evidence on the subject, recommendations are based on 'expert' opinion which varies widely on this subject. The INS recommends using a petrolatum based ointment on/in the insertion site to prevent air embolism, opposing opinions point out that all petrolatum products carry an FDA warning that they should never be placed over an open wound or tract to a vein or artery, there have been reports of petrolatum emboli that have entered the vascular system through a central line insertion site, with at least on case resulting in death, so the balance of the evidence would appear to oppose putting ointment directly on, and therefore into, an insertion site.

AJJKRN · Oct 16, 2016

My hospital just changed the protocol to place petroleum gauze over the insertion site, regular gauze, then cover with tape occlusively. I haven't read exact EBP yet on the change but we utilize Lippincott for most of our procedures to make it more cost effective for our entity so I would assume Lippincott would have done the EBP to back up the change...but it is my assumption since I'm not at work today with work access.

nu16843 · Oct 17, 2016

Thanks for the info guys. Would also like to clarify. Is primapore also considered occlusive? What about the tegaderm with pad?

IVRUS, BSN, RN · Oct 18, 2016

ONLY 1 VERY old report, that in reality is an abstract report, not a complete study. Also, it occurred when the line was placed. But that is neither here nor there imo, as this has not been duplicated. A Petroleum based gauze is an important piece that can prevent this never event.