Skin condition

[sueinga]

Hi,

I have a patient who develops extremely irritated, scally skin around her access- it has happened around a catheter dite and also over an AV access in both arms. The CVC area responded to a bactroban on gauze debridement ( of the scales) and vaseline gauze for a dressing. It took 2-3 weeks to get it to heal up- now the same skin condition exists overlaying her forearm graft. I suspect an allergic reaction to Chloraprep and alcohol- but what can I use to de- germ the skin prior to cannulation that is both antibacterial and hypoallergenic without drying? Anyone else seen this and and any advice appreciated

Susan

[Lacie, BSN, RN]

Have you tried just simple Hibiclens? I use it frequently on my allergic pts without issue. We used it routinely in debridement during the whirlpool in the Burn ICU without ever having an issue and I have never had an issue with it in dialysis either. I use it for the cvc port soaks also.

[sueinga]

Do you apply and let dry prior to cannulation? Or have them wash their arm before they sit down? Either way I wil try it- thanks for the input!

[Lacie, BSN, RN]

I use 2x2's to apply to access site and allow it to sit for 2-3 min. I then wipe it off with another 2x2 then apply an alcohol prep. I'm sure to cannulate with the site wet though. Once alcohol dries it's ineffective. I would suspect alcohol not to be the issue but the other chemicals in use. It may have a drying effect but allergy to the alcohol is unlikely (not saying it's impossible). If you cant use alcohol after the hibiclens just be sure you wipe it off very well with a sterile 2x2 then cannulate. I also put the cvc ports to soak with 2x2's satuated with the hibiclens and once pt is on then I wrap the ports and tape the 2x2 packet with the hibiclens around it leaving it intact throughout treatment. We just recieved an award for having absolutely NO access or cvc infections for the entire year since I started using this protocol. Also we went to cloth cvc dressings rather then the transderm and unless they are dislodged from the skin we only change them weekly now. So far obviously it's working for us. Our company is now doing the same at other units and getting the same results. Pretty much anytime they are allergic to betadine I just grab the Hibiclens.