WHEN STICKING IS NOT AN OPTION Jocelyn Hill, MN, RN, CVAA(c), VA-BC™ | Clinical Nurse Specialist for IV Therapy, Vascular Access and Chemotherapy/ Hematology at St. Paul’s Hospital, Providence Health Care in Vancouver, BC
The insertion of central vascular access device (CVAD) is done with full intention that the CVAD will stay in place for the duration of required clinical indication without complications. Adhesive-based dressings have been part of the standard of care for decades to cover and protect the CVAD site with the assumption that some dressings can fully secure a CVAD.1 Problems can arise when the patient’s disease process, trauma, or skin condition ceases to allow the adhesive to adhere to intact, healthy skin around the CVAD site.2,3 As a result, the clinician is challenged with how to protect and secure the VAD in place without using adhesives in any form, neither the dressing nor the securement device.2,4 The purpose of this article is to highlight an effective strategy and describe how a securement device that is adhesive-free can be used as an option to allow for the surrounding skin to heal once impaired. Two clinical scenarios and situations will be used to provide context and help guide clinical practice.
CLINICAL SCENARIO – 1
A 30 year-old male patient (Mr. A) required a peripherally inserted central catheter (PICC) for home IV antibiotics for 6 weeks. The patient has a chronic condition of atopic eczema on is his hands and arms and he complains of sweating and severe itchiness with adhesive tapes and dressings. Mr. A presented with areas of reddish-pink, raised and scaly areas on his skin to his upper arms where the PICC is to be placed. The insertion procedure occurred with no complications with the use of a subcutaneous anchoring securement system (SASS SecurAcath, Interrad Medical, Plymouth, MN) as the standard of care to prevent catheter pistoning at the site and malposition. The use of the SASS in this particular situation was even more beneficial as the routine care and maintenance of the PICC can now include the use of just gauze and silicone adhesive tape with a light gauze wrap (stockinet) without the skin contact and irritation from an acrylic adhesive found in most semi-permeable adhesive dressings. Using an adhesive dressing was not an option. The skin surrounding the PICC site was still typical for him with symptoms of atopic eczema but he tolerated the SASS well and his symptoms did not worsen during therapy. The patient was able to complete his home IV therapy without any interruptions or complications of catheter-related infection or malposition.
CLINICAL SCENARIO – 2
Figure 1: PICC in situ to upper arm with surrounding rashy skin. Patient has history of atopic eczema. Subcutaneous anchoring securement system (SASS - SecurAcath, Interrad Medical, Plymouth, MN) in place for optimal PICC securement and allows for alternative non-adhesive dressing of dry gauze and silicone tape. Photo courtesy of M. Brodie, Vancouver, BC Canada)
Figure 2: Tunneled silicone CVAD in situ on chest with subcutaneous cuff pulled out from exit site on Day 14
CONTINUED ON NEXT PAGE NOVEMBER 2021 4
