We currently use Biopatch for all our home infusion patients with a CVAD and I am looking at trialing Kendall AMD Antimicrobial Foam Disc. I am wondering if anyone has used this product and are willing to give their pros and cons?
Thanks,
Carole
We currently use Biopatch for all our home infusion patients with a CVAD and I am looking at trialing Kendall AMD Antimicrobial Foam Disc. I am wondering if anyone has used this product and are willing to give their pros and cons?
Thanks,
Carole
I see that no one has responded yet to your question. I do not have any first-hand clinical experience with this product and I know it is not recognized yet by CDC or INS documents. I did want to bring something to your attention though. Have you seen this review article:
1. Hadaway L. Polyhexamethylene Biguanide Dressing Another Promising Tool to Reduce Catheter-related Bloodstream Infection. Journal of the Association for Vascular Access. 2010;15(4):203-205.
This review was commissioned by Covidien (formerly Kendal, the product manufacturer). It is a literature review of the antiseptic in theiir product, PHMB. This is a "cousin" of CHG. This antiseptic is being used in surgical wounds with a few early posters to document that use. I am not aware of any posters, presentations or outcome data with this product for CVAD sites. This article will give you more information about PHMB and the evidence to date. Sorry I can't be more helpful. 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
Lynn is correct. The Covidien (Kendall) AMD product has No Clinical Evidence to support it's use nor does GuardIVa. The only two products I have seen clinical evidence on are Tegaderm CHG and Biopatch. PHMB is only a "cousin" to the CHG family and there is very limted information and clinical publications out about the product except the one Covidien commissioned. I question GuardIVA because the amount of chg in the product is reduced to make room for the hemostatic compound.
Until we see supporting evidence on the covidien product and guardiva, I would not go down that route. Stay with tegaderm CHG or biopatch IF you need to use a antimicrobial because of high crbsi rates. I tend to like the Tegaderm CHG because it gives you the added advantage of being a securement device and is Transparent which lets you see the I.V. Site and unlike the biopatch, cannot be applied wrong which when it happens then leaves one with no protection.
Lip
I was going to write a reply as to why this way of thinking contibutes to the many thousands of preventable central line associated deaths that occur every year in the United States but before I engage in that clinical discussion I was hoping LIP could give full disclosure as to her employment?
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
Please read the package insert on this product. I think that I remember reading that the chlorhexidine is in the sponge as a preservative. I think that I remember there is not an indication for this product to reduce BSI.
I do remember that they do have evidence about the impact on the reduction of surgical wound infection. I am not sure how that relates to BSI prevention.
Gwen
There is no CHG in the Kendall AMD dressing. The antiseptic agent is PHMB which is from the same family as CHG.
Biopatch now has added an indication that this product reduces CRBSI, but that was added after there was sufficient clinical evidence to make that statement.
The Kendall AMD dressing does not have the clinical evidence yet. There are studies with its use as a surgical dressing, which was their first product with PHMB. The CHG gel dressing, the PHMB dressing, and silver dressings will need evidence to support their use. But to get that evidence, someone must conduct the studies. So someone has to put it into use. This is the avenue for all devices. We do not have clinical evidence on any device when it is introduced to the market. But that just means that someone has to be willing to trial the product and hopefully publish the evidence. Read the article and you will see that it calls for the evidence needed.
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
Take a look at the HemCon IVa. This is a chlorhexadine glucanate disk that also has a indication to stop surface bleeding. I have no connection to the product but have been impressed with it so far. I had one of those unfortunate incidents where a patient sneezed at the exact same time I was doing my dermatotomy and the scalpel basically got buried to the hilt in the skin. I held a little pressure with gauze after the insertion and this disk completly stopped the bleeding. I went back to patient next day convinced I would need to change the dressing due to the depth of the dermatotomy but the site looked fantastic. I have not used enough of the product to give a full endorsement but so far so good!
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
Just another comment on this new product as it has been a month since I last wrote, many catheters later(hundreds) and not a single premature dressing change due to oozing! Still gathering the infection data but so far we have been really impressed with this product!
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
Thank you for the information on HemCon GuardIVa. We are planning on trialing this starting at the end of the month for a few months. I will round back with everyone with our results.
Carole Rumsey, RN, CRNI
Home Infusion Program Manager
Sutter Infusion and Pharmacy Services
Sutter Care at Home
Northern CA
[email protected]
Just remember to get data on the "concentration of CHG" used in the CHG products....differs beween products.
Tulane Stephen.
If you have data or information we have not seen, please share it. There are many sources of information in this world and unfortunately too many zero in only on what the CDC says. AVA, INS and others all have something to say as well but if you look at only one source that will be the only source you use. These are just guidelines as you well know.
Personally I have never been convinced that the 2011 CDC newest guideline wording mandates use of a specific product as the cdc and says you should be using preventive measures, education, training and skin antisepsis first.
This guideline clearly breaks hospitals down into hospitals who are having problems with crbsi infections and those who do are not with guidance for those who are. The exact quote validates my thought by using the wording : "IF" the crbsi rate is not decreasing despite adherence to basic prevention measures, including education and training, appropriate use of chlorahexidine for skin antisepsis and MSB [93.96-98] See #12 under Catheter Site Dressing Regimens.
LIP( I am not sure what Tulane is referenced too)
Are you a nurse that works with patients or a sales representative that is trying to sell Tegaderm CHG? (Which is a fine product by the way!) If you are a clinician and can provide some disclosure that would be helpful as your posts seem to be very product orientated. You make statements that seem to give guidance to clinicians on what they should do based on your clinical practice, and I am wondering if you have one. It is a fair question. I am at INS now but will provide some more information on my next post, but would like the courtesy of disclosure. As far as disclosure I have no connection to any product, but I am speaking for Rymed at the conference.
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
I wanted to illustrate a point about your posting advice to clinicians who work with patients. From your accumulated posts it is obvious that you have a strong connection to 3M. I think 3M is a great company and you probably could share valuable insights about their product line. I trust your future posts will have that perspective.
As far as "just guidelines" company representatives have to remember nurses do not "practice" medicine. We have an obligation to be reasonable and prudent with patient care and that means following guidelines. In the case of HemCon GuardIVa we had a problem with some patients oozing with BioPatch, probably because we are comfortable accessing pt's. with elevated coagulation times. This is something you see quite a lot in the OP area. I read the information on this FDA approved product and saw the bacterial log reduction studies had very similar results to BioPatch. So far this product has worked very well for us and our patients. Reduced dressing changes, less patient anxiety, reduced nutrient source at the insertion site for bacteria, and lower cost has been a win-win for our clinical practice, and we are still following the guidelines! I always appreciated the fact that BioPatch did their homework and received an FDA indication to reduce infection, however, it took years to get that data, I am hopeful HemCon will do the same but GuardIVa is a new product.
I have no financial ties to HemCon.
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness