Help Solve OR Burn Mystery!!

[a.smithrn]

I have been circulating CT for 10 years and have never encountered this issue:

In the past 2 months my OR has had 6 open heart patients that present with partial thickness burns 1-4 days post op. Most of the burns have been in the right or left axilla. At first we thought it was a chemical burn from prep pooling, but we have since changed the way that we prep to ensure there is no pooling and we are still getting burns.

It has happened in 3 different ORs, 3 different surgeons, some use chloroprep, some use duraprep. We have had multiple meetings with every department involved in our patients' care and have not been able to find the cause.

Any thoughts?

[a.smithrn]

That's a really interesting new perspective! But, all the burned areas are completely covered by towels and drapes. None of the exposed skin has been burned. Maybe, though, the heat of the lights is making heat pockets under the drapes?

[guest974915]

Two thoughts; This area is sometimes near where the bovie (electrocautery) holster is placed for surgery (not actually in the axilla, but close to)-maybe the surgeon or the assistant is leaning in and inadvertently activating the pencil when not holstered?. Another idea-could these injuries not actually be true 'burns' but instead skin tears (shearing) from the draw sheets used to tuck the patient's arms?

[Mergirlc, MSN, APRN, NP]

Hello,

I know somebody who was a dialysis patient. She had a temporary catheter placement in the chest (she always did peritoneal dialysis, but had to have an operation, thus the temporary switch to hemodialysis). Anyway, she went in for placement, they put chloraprep on there and after they were done, Tegaderm was placed. Lo' and behold, her skin starting to lift up and peel off like a burn within the next few days. She said it hurt like hell too. I don't think it was to the degree you're talking about, but I saw it and it did look like a burn.

She now has it listed that she is allergic to Tegaderm on the chest area. She's actually okay w/ Tegaderm anywhere else, but for some reason the chest area was ultra sensitive.

Who knows, it could've been the combination of chloraprep and tegaderm, or just one or the other. Either way, she had a bad reaction and those were the the things used.

[DowntheRiver]

Hello,

I know somebody who was a dialysis patient. She had a temporary catheter placement in the chest (she always did peritoneal dialysis, but had to have an operation, thus the temporary switch to hemodialysis). Anyway, she went in for placement, they put chloraprep on there and after they were done, Tegaderm was placed. Lo' and behold, her skin starting to lift up and peel off like a burn within the next few days. She said it hurt like hell too. I don't think it was to the degree you're talking about, but I saw it and it did look like a burn.

She now has it listed that she is allergic to Tegaderm on the chest area. She's actually okay w/ Tegaderm anywhere else, but for some reason the chest area was ultra sensitive.

Who knows, it could've been the combination of chloraprep and tegaderm, or just one or the other. Either way, she had a bad reaction and those were the the things used.

I work in Oncology where we use a lot of Chloraprep + Tegaderm for port access. Most people have a reaction when Chloraprep is used and then not allowed to dry as the Tegaderm is immediately applied. The area under the Tegaderm remains moist and can cause rash, redness, and blistering. Since we started making sure the skin is very dry before accessing we've severely cut down on Tegaderm allergies.

Also, I've noticed that a lot more people react to Chloraprep than Tegaderm.

[offlabel]

It's your OR lights.

Same thing was happening in Oregon three years ago.

Patients Get 'Burned' During Surgery at Oregon Hospital - ABC News

Lights aren't directed at the axillae during cardiac surgery. What about BP cuffs? Re-useable? Processed with something?

[Hoosier_RN, MSN]

I work in Oncology where we use a lot of Chloraprep + Tegaderm for port access. Most people have a reaction when Chloraprep is used and then not allowed to dry as the Tegaderm is immediately applied. The area under the Tegaderm remains moist and can cause rash, redness, and blistering. Since we started making sure the skin is very dry before accessing we've severely cut down on Tegaderm allergies.

Also, I've noticed that a lot more people react to Chloraprep than Tegaderm.

I work in dialysis and was going to say the same thing.

[Argo]

I have seen the same thing with chloraprep and duraprep with the addition of a dressing placed immediately after without it drying prior to adhesion. Tegaderm, hypafix tape, medipore...... we wipe off what we can after surgery, dry it and then put dressings.