PICC dressing removal w/ biopatches

IVRUS, BSN, RN · Feb 21, 2008

Has anyone experienced difficulty when changing a PICC dressing that has a Biopatch @ the insertion site. Last evening, I spent 15 minutes just trying to remove the tegaderm transparent dressing from the biopatch which is also adhered to the PICC cannula & Hub- without dislodging the PICC catheter. Am I doing something wrong? or have I completely missed the boat? Also, what are the guidlines for flushing Power PICCS with heparin. I have 2 patients currently with these PICC's - one is ordered to flush with heparin & the other is not. (Neither patients have anticoagulation issues contraindicating the use of heparin)

It can be difficult to remove a TSM (transparent sterile membrane) and seperate it from the Biopatch, however, it does become easier if one tapes the Biopatch down after placing it at the site then places the TSM. This way, the TSM is removed without much trouble.

Power PICC"S are open-ended IV catheters and "normally" are flushed with Saline and Heparin Flush solutions, however, if that Power PICC has a positive displacement injection cap on its end (like the CLC2000 or Flolink) it changes the open-ended IV catheter to one that needs flushing with Normal Saline only. In my practice, the PICC's that tend to occlude with the greatest frequency are the power PICC's and I encourage my students to Heparinize them because of this. But in theory, the above may work especially if the nurse using the positive pressure injection cap appropriately. The CLC 2000 and the Flolink can't be used using "normal" positive pressure flushing techniques.

These new caps are excellent in helping to prevent HIT in certain populi who are prone to its development. The longer we continue to expose even small amounts of Heparin to our pt's, the greater incidence of HIT.

Hope this helps

DD:typing

LeighAnnCRNI · Feb 24, 2008

We have found the Biopatch to be very effective in reducing our CRBSI rates, and have had some time to perfect our processes in using it. The manufacturer does not recommend taping it down under the dressing. They recommend positioning it so that it stays attached to the transparent dressing, and lifts off with the transparent dressing. In order to do this so that the PICC isn't inadvertently dislodged in the process, the key is to position the Biopatch correctly when placing it on the skin. Turn the slit of the Biopatch so that it makes 360 degrees of skin contact around the catheter, but make sure that the slit is in a position to lift open and pull away with the dressing. Think of the Biopatch as the face of a clock, and the catheter as pointing to 6 o'clock. The slit of the Biopatch needs to sit at either 7 o'clock or 5 o'clock position to lift easily off with the dressing.

Leigh Ann, Vascular Access Specialist

IVRUS, BSN, RN · Feb 25, 2008

We have found the Biopatch to be very effective in reducing our CRBSI rates, and have had some time to perfect our processes in using it. The manufacturer does not recommend taping it down under the dressing. They recommend positioning it so that it stays attached to the transparent dressing, and lifts off with the transparent dressing. In order to do this so that the PICC isn't inadvertently dislodged in the process, the key is to position the Biopatch correctly when placing it on the skin. Turn the slit of the Biopatch so that it makes 360 degrees of skin contact around the catheter, but make sure that the slit is in a position to lift open and pull away with the dressing. Think of the Biopatch as the face of a clock, and the catheter as pointing to 6 o'clock. The slit of the Biopatch needs to sit at either 7 o'clock or 5 o'clock position to lift easily off with the dressing.
Leigh Ann, Vascular Access Specialist

While in theory this may work for some, J&J's website denotes a PICC catheter with a Biopatch, but it has a hubguard holding the PICC and a portion of the Biopatch in place before the TSM is placed. Hubguard (centurian product) is a foam tape.

By having that tape, you decrease the incidence of accidental pullouts with TSM removal. This is a substantially better alternative than taking the chance of catheter dislodgement if the biopatch shifts during dressing application.

DJ-Adia, find out what works best for your patient population. You may find a virtual plethera of information here, and differences of opinion, but what is best for YOUR patient? Try it and see.

DD

iluvivt, BSN, RN · Mar 20, 2008

I tape them down as well with steri-strips and then open up the radial slit and lini the opening of the biopatch with the catheter and then approximate or pull back the biopatch so edges meet. I have no problem with pulling any off. If someone else puts it on and you cannot get it off...apply some sterile salin and it will puff right up and then you can easily remove it. hope it helps

ccny · Mar 20, 2008

yes that often happens the top layer melts to the dressing. we just lay the biopatch on top not wrap it around the picc. that seems to work good

iluvivt, BSN, RN · Mar 20, 2008

johnson and johnson recommends that you open the radial slit apply smooth side toward skin ( I remember this by S to S) and wrap it around catheter re -approximate slit . there picture actually shows the catheter layiny on top the biopatch. To get good results as in lower infection rates i would follow their advice and not just set it on top of the catheter. Also 3M has a new product with a chlorhexadine impregnated patch already incorporated into the tegaderm dressing and you can see through it as a bonus...it looks good but we have not tried it yet but we will..