Sunday, April 30, 2017

Tolerated Central Line Dressings + Antiseptics For The Allergic

Itch. Scratch. Burn. Adjusting to life on IV therapy has its challenges. Between administering medications and learning proper line care, irritated and allergic skin should not have to be one of them.


If you have a line, chances are you are aware that part of care entails changing the sterile dressing. On a weekly basis, the home health company delivers a shipment of supplies related to the weekly dressing changes required for a central line. They consist of antiseptics, dressing kits, a Stat-Lock kit, and other miscellaneous supplies. Sometimes, especially in the case of Mast Cell Diseases and related conditions, the supplies is not tolerated. It becomes an arduous process of trials to identify safe dressing supplies.

Dressing: 

Central lines are covered with sterile dressings to prevent infection. One to three times a week the old dressing is removed, the skin is cleaned, and a new dressing is applied in a sterile manner using the dressing kit provided by the home health care company. With adhesives continually in the same location, those with allergies and sensitives might suffer from skin irritation, itching, and breakdown. Thankfully, there are other options than the generic Tegaderm or transparent dressing in the kits.

  • Tegaderm IV Advanced 1685
Tegaderm is infamous for causing localized skin reactions for those who are sensitive. They are the first resort to use for IVs, wounds, and central lines. The brand Tegaderm manufactures multiple variations of dressing products. Although the others are problematic, the Tegaderm IV Advanced 1685 is my favorite and I tolerate it better than IV3000!!!! It is my number one dressing suggestions. Ironically, others with major sensitivities claim they do well with it too after failing the dressings that are generally deemed "safer" or "hypoallergenic."

Aside from tolerating Tegaderm IV Advanced 1685, an aspect of the dressing that I am fond of is that it has the translucent window to view the line site. The border of the dressing surrounding the window is supportive. The border stays put and does not annoying collect lint and dirt like the dressings that are entirely translucent without a border.  

Tegaderm IV Advanced 1685 can be purchased online, as the exact type is not always in stock with home health companies and at hospitals. 

  • IV 3000 
Once the typical dressings fail, IV 3000 is the next to be trialled. It is universally well-tolerated amongst the allergic community.


  • Opsite
Another tolerated dressing is Opsite. It is nice to add into a rotation to prevent the body from developing a sensitivity to any one dressing.

It sticks very well, becoming a hassle to get off without excessive rubbing with alcohol. It also left its sticky residue on my line. The stickiness is both a blessing and a downfall. Opsite is not my dressing of choice, but my skin does not reject it with pain, redness, or itching if used sparingly. 

                                      

  • Sorbaview is the name of a dressing that is good for allergies. The design is wonderful! Unfortunately, I did not tolerate it. 


Antiseptic: Wipes

Various antiseptics are required in central line care. The main purpose of antiseptic WIPES are to sanitize the end of the claves for 30 seconds before connecting to an IV therapy. If preferred, they can also be used to clean the skin prior to changing the dressing.

  • Alcohol Wipes
Alcohol wipes are the most common antiseptic wipes for the actual end of the line. They are often provided by home health care companies and contain minimal ingredients, usually JUST 70% isopropyl alcohol and water.

Covidien Alcohol Wipes are my preference.
While not optimal for a quick 15 to 30 second clean for connections, very large alcohol wipes can come in handy when needing to sterilize surfaces in preparation for a dressing change, the drawing up of IV medications, or other purposes. They are similar in size to a Clorox wipe. Unfortunately, home health companies do not provide them because they are not necessary for line care, but I purchase Pharma-C-Wipes in bulk because I like them so much! 



  • Povidone-Iodine (Betadine) Wipes
Less common are small betadine wipes. In some cases of Mast Cell Disease, alcohol causes mast cell degranulation. Reactions then result from wiping the end of the line. Betadine is a safer option for those patients.

I personally do not use betaine wipes, but Dynarex Povidone-Iodine Prep Pad is a good example.



Antiseptic: Swabsticks

Swabsticks are prevalent in dressing kits. They are easy and convenient to scrub the skin during a sterile dressing change procedure. In the package of the dressing kit, a cleaner of some sort is included. They are then placed on the sterile field to eventually be used on the patient.

  • Chlorhexidine 
Chlorhexidine is the go-to for the purpose of dressing changes. It is extremely effective at ridding of unwanted bacteria. Hospitals even give patients a chlorhexidine bath in ICU admissions.

The stick below is the form frequently included in the dressing kits. Loads of people, with or without a Mast Cell Disease, do not tolerate chlorhexadine though. I am unable to wipe my skin with it, as it causes chemical burns. 


  • Povidone-Iodine (Betadine) Swabstick 
Another common antiseptic is the use of Betadine. Its trademark is the unappealing orange and brown residue left behind after surgeries or other occasions it is used. 

Betadine is a common allergy. However, before writing it off, consider the additional ingredients. 
For example, the Aplicare povidone-iodine sticks depicted below cause reactions for me. The Medline does not cause me to react. The Aplicare has many ingredients, like nonoxynol 9, whereas the Medline sticks do not. Since it can be difficult to find sticks without potentially harmful ingredients, the Medline Povidone Iodine Swabsticks can be purchased online. 


Along with the skin, the actual lumens of a tunneled central or PICC line are scrubbed during a dressing change. Alcohol is known to degrade the materials forming the particular line I use, which is the Bard Power Hickman. Betadine is a way around that issue. When doing my dressing changes, I wipe the lumens and skin with betadine. Afterwards, I clean up as much of the betadine residue as possible with an alcohol wipe, carefully avoiding the actual line.

  • Alcohol Swabsticks 
Alcohol sticks come in dressing kits also. They are typically safe because the majority of them do not contain inactive ingredients. 



Other Dressing Change Supplies: 

Besides the dressing kit and infusion supplies for IV therapies, miscellaneous supplies are sent weekly. Included in "miscellaneous" supplies are skin protectants, patches of antiseptics, and line stability devices. Like anything else, patients can be sensitive to them. 

  • Stat-Lock
A stat lock is a sterile device that is meant to hold a line in place for additional support. It sticks to the skin with an adhesive and has clamps where the "wings" of the central line are clipped into. 

The Stat-Lock kit is likely separate from the dressing kit. Below is an example of what is included in an adult Stat-Lock kit (i.e. Stat-Lock device, secondary adhesive, skin prep). The pediatric version of the Stat-Lock is shaped as a teddy bear. Too cute!!

For those sensitive to adhesives, the Stat-Locks are highly irritating to the skin.  

Create a barrier between the skin and Stat-Lock with a safe dressing if a Stat-Lock is desired but is too irritating to the skin. Place a tolerated, sterile dressing over the area that the Stat-Lock will lay.  The tiny IV3000 in the dimensions 2 3/8" x 2 1/4" is perfect for this. Next, stick the Stat-Lock on top of the tiny dressing, clip the line into the device, and then continue the dressing change as normal. Your regular dressing should still cover the entire Stat-Lock and line site. 


  • Skin Prep 
The skin prep inside of the Stat-Lock and dressing kits is meant to make the adhesives stick better. It prolongs the length of time a dressing lasts on the skin. Doing a dressing change before the full week is up is never fun!

Skin prep can contain Chlorhexadine for sanitization, and other ingredients to create a tacky, sticky surface for adhesives to stick to. 


They are not well tolerated. I throw them out of my kits. I received a chemical burn from the use of Chloraprep for the tape to hold my NJ tube in place. 

  • Antiseptic Patches 
A BioPatch is a popular brand of antiseptic patches. They are circular disks saturated in Chlorhexadine, an aseptic solution. It sits on top of the entrance site of a tunneled central line or the needle of a port. There are various widths to accommodate different line sizes. 


"Will I tolerated a BioPatch if I cannot use Chlorhexadine on my skin?" 

While I do get chemical burns on my skin from Chlorhexadine and its related products, I have no issues with the BioPatches because it is in such minute amounts. The patches do decrease the risk of bloodstream infections, but they are not required. However, do not panic if you are not able to tolerate a patch. You are not doomed to infection if you cannot. Generic brands may be tolerated if the BioPatch brand is not working. 

Overall, line supplies largely goes by a trial and error process. Do not be discouraged. In time, you will find what is optimal for your body. 








"Have I not commanded you? Be strong and courageous! Do not tremble or be dismayed, for the LORD your God is with you wherever you go." - Joshua 1:9
Are you interested in cleaning a surface before your sterile dressing change? Check out my video Household Cleaning Products For Mast Cell Disease + Chemical Sensitivities.