Best TSM dressing, and when is a TSM dressing considered soiled?

We're adding TSM dressings to our CVC policy-which was exlusively gauze-tape.   I need help defining the situations that would call for a dressing to be changed before it's due.  Obviously when the dressing is torn, or if the rim is breached by bleeding/drainage from underneath, or when an edge has loosened enough to allow the site to be exposed to air. But how about when the taped rim becomes wet after a shower, or when a small area of the taped edge isn't sticking--can it be resecured or is it best to change?   Now that nurses can see the site, they feel they need to change the dressing because they can see a small amount of blood at the entry site or around the sutures (our PICCs are still being sutured).   Also, we're using 3M Tegaderm, does anyone recommend another product?

Forums: 

The national standard is to change the dressing when it becomes wet, dirty, or non-adherent. If there is blood under the dressing, I would change it. If the edge is loose, I would change it. I do not ever place tape around the edges of a transparent dressing because I have never found it to be necessary. If you use a skin protectant solution such as SkinPrep or NoSting Barrier, adherence to the skin is never an issue. And I would always use one of these solutions from the very first day because I think they go a long way in preserving the integrity of the skin under the dressing. If the dressing is wet from a bath or shower, I would change it. When in doubt, change it! Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

we like the sorbaview...very adherent yet does not cause skin excoriation...99% of the time it is still secure after a week