3M™ Tegaderm™ Dressings IV Site Care

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

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4

Today’s Topics

TIPS FOR SOLVING PROBLEMS

CATHETER SECUREMENT METHODS

SITE ASSESSMENT & COMLICATIONS

DOCUMENTATION

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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



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2

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4

Types of Catheter Dressings

Tape and Gauze

Transparent

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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


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 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



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2

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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



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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



SITE ASSESSMENT & COMPLICATIONS

DOCUMENTATION

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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




DOCUMENTATION

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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


I.V. House

IV Site Protector ™

Modified

Tape

Tri-State Centurion®

HubGuard®

Tri-State Centurion®

WingGuard®

Anchor

Shield

I.V. House Ultra

Dressing™


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




DOCUMENTATION

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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




DOCUMENTATION

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– 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

http://www.3m.com/tegaderm

http://www.3m.com/tegadermchg

Health & Medicine

3M™ Tegaderm™ Dressings IV Site Care