We have been using Chloraprep/Tegaderm for any person over 2 months of age for any CVAC drsg. change since 2006. Initially I was very glad to switch to CHG because we saw so many iodine reactions in the home. Now however, we're seeing a lot more CHG reactions than Betadine. I have a theory, since we ALWAYS let the CHG dry thoroughly before we apply the Tegaderm, that the patient's perspiration "reactivates" the CHG such that you get the same itchy terrible rash that you get when you DON'T let CHG dry thoroughly. Not a problem when the patient does not perspire, but oh boy if he does...
What do you think? Can anyone corroborate this?
It is well known that as environmental exposure increases, then allergic reactions will also increase. Latex gloves are a perfect example, the combination of universal precautions and Latex caused a sharp rise in latex sensitivities among healthcare workers. The British Journal of Anesthesia published some great articles on the difficulty in recognizing chlorhexidine anaphylaxis and reaction and discovered that many of these reactions were blamed on other drugs but were actually the Chlorhexidine. I suspect as we have more and more exposure to Chlorhexidine we will see increases in severe reactions. That being said I firmly believe in external application of Chloraprep and BioPatch/Tegaderm CHG. I am not connected to either of these companies.
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
Stephen is correct. The absolute number of patients with this reaction may increase, however the increasing number of patients exposed to CHG means the incidence rates remain very low. Lose of skin integrity adds risk for infection so it is critical to keep the skin as healthy as possible. CHG binds to skin cells rendering it more effective over time. This benefit could be the cause of the problem in some patients, but I don't know that for sure. Do these patients have many other allergies? This means they are considered "atopic" or they have a genetic disposition to form IgE and create more allergies. Have you sought information fromt he CHG manufacturer? Do these same patients react the same way to alcohol alone? That might be a way to provide some additional insight about whether this is due to the CHG or the alcohol as all skin prep products in the USA contain both agents. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
In my experience, almost all CHG reactions I have witnessed could be tracked to failure to use a skin barrier (Aplicare) prep prior to applying tegaderm. It is easy to forget that the original intended design of Tegaderm was to promote phagocytic action on the wound bed where it was appiled. Without a barrier, it is intended to draw moisture from the intradermal layers and cause maceration of the underlying skin. It works very well for this purpose. We kind of hijacked it from this intended use when we discovered it would also give us a continuous unimpeded view of a catheter tunnel site. It was only the use of ostomy skin barrier prep that made this use possible. Failure to use a barrier results in tegaderm reverting to it's original purpose, promoting phagocytosis. Repeated use of CHG will ultimately result in more people becoming allergic to it. However, I believe there are chemical molecular interactions between CHG/alchohol and the polymers in tegaderm that have never been researched, since the products were developed at different times and for different uses. IV site dressings is probably still concidered an "off label" use of tegaderm.
I have no connection with either product. I was just around for the original release of them.
Daniel Juckette RN, CCRN, VA-BC
Dan, sorry but I can not agree with your assessment. Transparent membrane dressings are now being made with a gel pad containing CHG as part of the dressing. If your theory of polymer interaction is correct, this combination product would probably not be possible. It is important to remember that Tegaderm® is a trademarked brand name and not a generic name for all semipermeable transparent membrane dressings. Also, alteration in the moisture vapor transmission rate in these transparent dressings have rendered them very appropriate for the site of any VAD, and this is a labeled indications for these dressings. If these companies did not have this indication in their labeling, they could not be marketing it to us as they do. So there is no off-label use for a transparement semipermeable membrane dressing. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I still think clear dressings can cause the site to mascerate if applied without a barrier and left on for for a week. Also, there are significant variances in permiability with different products. Maybe someone can invent a "paint on" dressing that is alcohol soluble and won't loosen in the shower.
Daniel Juckette RN, CCRN, VA-BC