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Back to Basics:
IV Site CareSponsored by 3M™ Tegaderm™
Transparent Film Dressings
© 3M 2007. All Rights Reserved.
Today’s Topics
OVERVIEW
DRESSING CHOICES
GUIDELINES AND STANDARDS
HOW TO APPLY & REMOVE DRESSINGS
1
2
3
4
Today’s Topics
TIPS FOR SOLVING PROBLEMS
CATHETER SECUREMENT METHODS
SITE ASSESSMENT & COMLICATIONS
DOCUMENTATION
5
6
7
8
Vascular Access Devices
Frost and Sullivan, 2005
200 Million
Vascular Access
Devices Sold in
the U.S.100
200
Millions
Why be Concerned?
• Loss of an IV can cause:
– Delays in therapy
– Increased hospital stays
• Complications can:
– Increase morbidity and mortality
– Delay discharge
– Increase health care costs
Two Primary Goals of Infusion Therapy
Improve patient outcomes
Prevent complications
Clinician Responsibility
Choosing
Providing
Monitoring
Assessing
Documenting
Aspects
of
Infusion
Therapy
Do no harm
Today’s Topics
OVERVIEW
DRESSING CHOICES
GUIDELINES AND STANDARDS
HOW TO APPLY & REMOVE DRESSINGS
1
2
3
4
Types of Catheter Dressings
Tape and Gauze
Transparent
1
2
Tape and Gauze Dressings
• Positive Features
Absorbency
Minimizes exposure to adhesive
Limitations
• Poor adhesion
• Poor barrier to bacteria
• No barrier to fluids
• Must be removed to assess the site and changed every 48 hours (CDC & INS)
• Bulky and uncomfortable for patients
• Provide little stability for catheter securement
Types of Catheter Dressings
Tape and Gauze
2Transparent
Transparent Dressings
2
Transparent Semi-
permeable
Membrane (TSM)
Transparent
Adhesive Dressings
(TAD)
Transparent Film
Dressings
Transparent
Transparent Dressings
Positive Features• Breathable
• Semi-permeable barrier to external contaminants
• May also provide a barrier to bacteria and viruses
• Help secure and stabilize the catheter
LimitationsNot absorbent
May not be appropriate for sites with:
Excessive bleeding
Skin previously compromised
Transparent Dressings
• Transparent film dressings:
– Use pressure sensitive adhesives (PSA)
• PSAs are soft, allowing them to:
• Conform to the irregular surface of
the skin
• Stick well to the contours of the body.
Today’s Topics
OVERVIEW
DRESSING CHOICES
GUIDELINES AND STANDARDS
HOW TO APPLY & REMOVE DRESSINGS
1
2
3
4
Guidelines for PIV Dressings
According to CDC guidelines and
INS Standards of Practice, how
frequently should a transparent
adhesive dressing applied to a
peripheral IV be changed?
A. Every 2 hours
B. Every 10 days
C. Every 72-96 hrs or w/site rotation
D. Once per month
CDC
INS
Guidelines for CVC Dressings
CDC
According to CDC guidelines and
INS Standards of Practice, when
should CVC dressings be changed?
A. Every 48 hours for gauze, tape and
gauze, or island dressings
B. When the dressing is compromised
in any way
C. Every 7 days for transparent
dressings
D. With site rotation
INS
Today’s Topics
OVERVIEW
DRESSING CHOICE
GUIDELINES AND STANDARDS
HOW TO APPLY & REMOVE DRESSINGS
1
2
3
4
Applying Dressings
Three main steps
1. Remove the back liner
2. Press the dressing onto the site
3. Remove the frame as you smooth the edges
Remember to
• Use firm pressure
• Make sure extensions & IV tubing are secured
Application Tips for Transparent Adhesive Dressings
APPLICATION TIP True or False?
1. Make sure the skin is free of soaps, detergents,
and lotions. TRUE
2. Very gently press the dressing into place.
FALSE
Application Tips for Transparent Adhesive Dressings
APPLICATION TIP True or False?
3. STRETCH the tape or dressing during application.
FALSE
4. Place a small strip of sterile tape over the hub
without obscuring the site for added catheter
stability.
TRUE
Removing Dressings
Dressing Removal Techniques
Low and Slow
Stretch Release
Today’s Topics
TIPS FOR SOLVING PROBLEMS
CATHETER SECUREMENT METHODS
SITE ASSESSMENT & COMPLICATIONS
DOCUMENTATION
5
6
7
8
Tips for Solving Problems
Failure to apply the dressing with
pressure to the edges1
2Failure to allow prepping
agents to dry thoroughly
MOST COMMON CAUSES of ADHESION PROBLEMS
Can cause: Lifting
Rolling
Falling off
Rolling – Edge Lift
Failure to Apply Pressure
Review: Application
Failure to Allow Preps to Dry
Review: Skin Preparation
Make sure the skin is clean and dry
Allow preps to dry thoroughly
Clip (don’t shave) body hair as needed
Skin Injuries
Skin Injuries: Skin Stripping
Skin Stripping appears:
– As a reddened area…or…
– As shiny skin
Occurs more often:
• In patients with fragile skin
• Where an aggressive adhesive was used
Preventing Skin Stripping
Use an alcohol-free
film type skin
protectant
S.P.A.R.E.
• Select the right product
• Prepare the skin and position the body
• Apply using appropriate technique
• Remove using appropriate technique
• Evaluate skin site, Eliminate causative
factors, Educate others, Elect to report
skin problems to manufacturer
Today’s Topics
TIPS FOR SOLVING PROBLEMS
CATHETER SECUREMENT METHODS
SITE ASSESSMENT & COMPLICATIONS
DOCUMENTATION
5
6
7
8
Why Attend to Securement?
Visualizing the Site
Minimizing Movement
Preventing Contamination
Avoiding Removal
Problems Later
Types of Catheter Securement
• Tape
• Transparent adhesive dressings
• Island dressings
• Anchor securement devices
• Sutures or staples
• Adhesive skin closures
(e.g., 3M™ Steri-Strip™ Skin Closures)
Infusion Nursing Standards of Practice -2006
Modified
Transparent
Adhesive
Dressings
ConMed™
Veni-Gard®
3M™ Tegaderm™ Dressing
Tri-State
Centurion®
SorbaView® 2000
Window Dressing
Types of Catheter Securement
I.V. House
IV Site Protector ™
Modified
Tape
Tri-State Centurion®
HubGuard®
Tri-State Centurion®
WingGuard®
Anchor
Shield
I.V. House Ultra
Dressing™
Types of Catheter Securement
U Taping Technique
Chevron Taping Technique
Modified Dressings
What are the
challenges you
see here?
?
Modified Dressings
Modified Dressings
with borders & notch:
• Protection for the
insertion site
• Better stabilization
• Reduced mechanical
stress
NOTE: Modified dressings
DO NOT replace the need
for sutures in CVCs
• Clip Hair
• Turn patient’s
head away
• Extend the
neck fully
• Use additional
taping
techniques
Subclavian and Internal Jugular
non- tunneled Central Venous
Catheter Sites
Tips for Challenging Sites
Multi-lumen Catheters
Tips for Challenging Sites
Provide additional
securement or taping
Stabilize catheter
extensions
Position tape so
ports can be
accessed
Today’s Topics
TIPS FOR SOLVING PROBLEMS
CATHETER SECUREMENT METHODS
SITE ASSESSMENT & COMPLICATIONS
DOCUMENTATION
5
6
7
8
IV Site Assessment
• FREQUENCY
• INFUSATE
• ASSESSMENT
– Insertion site
– Patient’s condition
– Patient’s need for therapy
Look for signs
or symptoms
of
complications
Identify
problems
early
Phlebitis
What is it?
Inflammation in
the walls of the
vein
INS scale of 0 - 4
Image Courtesy and © Becton, Dickinson and Company
Signs and Symptoms – INS Scale of 0 - 4
– Redness - Erythema (1) (2) (3) (4)
– Pain or tenderness along the vein (2) (3) (4)
– Edema (2) (3) (4)
– Streak formation (3) (4)
– Palpable corded vein (3-beg) (4)
– Purulent drainage at insertion site (4)
Phlebitis: INS Scale
Phlebitis
Cause Mechanical Chemical Bacterial
Failure to scrub hub with alcohol
Infusion rate too rapid for vein
Solution too acidic or alkaline
Improper skin preparation
Traumatic insertion X
Medications into a small vein
Inadequate stabilization X
Phlebitis
Cause Mech Chem Bact
Failure to scrub hub with alcohol
Infusion rate too rapid for vein X
Solution too acidic or alkaline X
Improper skin preparation
Traumatic insertion
Medications into a small vein X
Inadequate stabilization
Phlebitis
Cause Mech Chem Bact
Failure to scrub hub with alcohol X
Infusion rate too rapid for vein
Solution too acidic or alkaline
Improper skin preparation X
Traumatic insertion
Medications into a small vein
Inadequate stabilization
Infiltration
Image Courtesy of N. Costa
What is it?
Inadvertent
administration of
an IV solution into
surrounding
tissues
Infiltration
Frequent complication
Often goes undetected
Signs
Swelling / Edema
Taut/stretched skin
Cool to the touch
Tenderness at the site
Infusion – sluggish or
stoppedImage Courtesy of N. Costa
InfiltrationCauses include:
– Improper selection of catheter or site
– Catheter gauge too large for the vein
– Traumatic insertion
– Inadequate securement
– Catheter inserted over a joint
Source: INS S59-60
Extravasation
Image Courtesy and © Becton, Dickinson and Company
What is it?
Inadvertent
administration of a
vesicant agent
MUST be identified
quickly
Extravasation
Signs and symptoms include:
– Severe pain or burning during infusion
– Blotchy redness surrounding the insertion site
– Edema at the insertion site
– A slowed or stopped infusion rate
Extravasation
Causes:– Same as for infiltration…
BUT occur when….– A peripheral route is selected
– When a central route SHOULD be used
Vesicants (irritating agents)
– Best administered through CVC
Catheter-Related Infection
Identification is
crucial
Early detection of
local infections can
prevent systemic
infections
PICC Infection Image Courtesy of N. Costa
Catheter-Related Infection
Signs and Symptoms include:
– Erythema or redness – warm to the touch
– Tenderness
– Swelling
– With or without drainage
– Changes in heart rate, BP
– Elevated temps
Signs and Symptoms Infiltr. CRI Phlebitis
Fever X X
Taut or stretched skin X
Redness at insertion site X X X
Tenderness at insertion site X X X
Coolness of the skin X
Drainage X X
Sluggish infusion X
Check Your Understanding5. Which signs and symptoms are true of
infiltration? Of catheter-related infection? Of
phlebitis?
Today’s Topics
TIPS FOR SOLVING PROBLEMS
CATHETER SECUREMENT METHODS
SITE ASSESSMENT & COMPLICATIONS
DOCUMENTATION
5
6
7
8
– Size length, and type of catheter
– Name of person who inserted it
– Date, time, and insertion site
– Complications, patient response, any nursing interventions
– Patient teaching and evidence of patient understanding
– Number of venipuncture attempts
– Medications used
Documentation-
for insertion of VAD
In the medical record include:
Dressing Label Documentation
Dressing Label Documentation
New PIV CVC Dressing Change
Date / time of insertion Date / time of change
Device
Gauge / size and length
Your Initials Your Initials
*Dressing change due date
* Always review and follow your facility’s policy and
procedure for dressing change documentation.
For Complications, document the:
Documentation
• Occurrence and severity of the complication
• Size of the catheter and location of insertion
• Estimated amount of drainage at the site or the
amount of fluid that was infused subcutaneously or
infiltrated
• Actions taken to treat the complication
• Communication with physicians
Two Primary Goals of Infusion Therapy
Together, well-informed
practitioners and correctly
performed IV site care form a
strong line of defense to
improve patient outcomes
and prevent complications.
For more information or to view other
educational programs sponsored by
3M™ Tegaderm™ Transparent Film
Dressings, visit:
www.3M.com/tegaderm
Or
www.3M.com/tegadermchg