Neonatal PICC dressings- What brand do you use in your unit?

[rowena222]

I work in a newly formed PICC team for the NICU in our hospital. We are looking for new PICC dressing options and would really like to know what other hospitals are using. Currently we use 3M Tegaderm, but find that it doesn't always hold up very well (especially in larger babies). Also, I think it's a little rough on the skin, especially for the micro-preemies. We trialed one that had a gauze border, but found that the edges start lifting up, especially in the bigger, sweatier infants. We do our dressing changes PRN. Also, do you use a skin protectant barrier on the skin surrounding the site? We were using Cavilon, but recently switched to AllKare (but I'm unsure if this product is sterile-- I plan on calling the company to find out). Thanks in advance.

[Asystole RN]

Tegaderm dressings all use a pressure sensitive adhesive that requires you to massage the dressing onto the skin. Edge lift is a cardinal sign that the dressing was not pressed into place, especially when removing the paper border.

What issues were you having that you feel as thought the dressing was rough? Do you routinely use a barrier film on all of your PICC dressings for the kiddos?

The new IV Advanced Tegaderm dressings, which still require the dressing to be pressed into place, do a far better job at reducing edge lift due to the type and way the adhesive is applied on the borders.

I use a barrier film on all of my patients (adult) regardless if they have issues or not. Mostly because it is easy to apply and regardless if they have a skin issue or not, it is a small thing to prevent potential issues.

[iluvivt, BSN, RN]

I use a barrier film/skin protectant on every PICC line dressing I do as well. You also need to make sure that whatever skin prep you are using to allow it to completely air dry before apply the skin protectant.

[fifiroo]

We use tegaderm to cover the whole site and a duoderm just beneath the hub to protect from pressure sores. We don't use any skin prep, just cleanse with betadine or clorhexidine and clean that off with a sterile saline wipe, then completely dry before placing the tegaderm. We secure the edge where the line comes out of the tegaderm with steristrips. For the sweaty kids... Well, we just change dressings pretty frequently and occasionally will secure the lifted edge of the tegaderm with another tegaderm, as long as the dressing is still occlusive over the insertion site. :). Interesting about the skin prep/barrier. Does that help protect the skin when the dressing comes off for changes??

[Asystole RN]

We use tegaderm to cover the whole site and a duoderm just beneath the hub to protect from pressure sores. We don't use any skin prep, just cleanse with betadine or clorhexidine and clean that off with a sterile saline wipe, then completely dry before placing the tegaderm. We secure the edge where the line comes out of the tegaderm with steristrips. For the sweaty kids... Well, we just change dressings pretty frequently and occasionally will secure the lifted edge of the tegaderm with another tegaderm, as long as the dressing is still occlusive over the insertion site. :). Interesting about the skin prep/barrier. Does that help protect the skin when the dressing comes off for changes??

Why do you use a saline wipe? If the idea is to remove the CHG then why use a CHG scrub at all? When scrubbing the skin with a CHG prep the vast majority of the initial killing is actually due to the alcohol. The CHG really comes into play later on to continue killing bacteria/provide a bacteriostatic effect. If you don't like the CHG then why not just use an alcohol scrub and not risk contaminating the site with a sterile saline wipe and a hell of a lot cheaper.

The barrier film lays down a thin sheet of polymers that lightly bond to the skin. When an adhesive is applied the bond between the barrier film and the adhesive is stronger so when you remove the dressing it pulls off the barrier film and not the skin. A little experiment is to wipe the back of your hand in Cavilon, allow it to dry, and then place a single piece of tape in the middle and then remove the tape. You can actually see where it pulled the Cavilon off.

The only bag thing about reinforcing is that it reduces the MVTR for the dressing significantly, almost to nothing, for the entire dressing. The best intervention is to apply the dressing using a firm massaging motion to pressure activate the adhesive which will get rid of that edge lift in the first place. Pressure aside, using tape to reinforce lifting edges is a better alternative to reinforcing than with another dressing. You wouldn't want to use a harsh adhesive tape but something like a silicon adhesive tape works magic with the kiddos.