VAD coordinators carefully develop what they have determined is the best group of dressings and supplies to keep their patients infection-free and healthy along with a specific procedure for applying them. It is not uncommon, however, for some patients to experience skin stripping or breakdown, itching, burning and inability to keep the selected dressings on the skin.
Chlorhexidine gluconate (CHG), an antimicrobial agent used in cleansers and antimicrobial discs to control or prevent infection, is a common irritant. Many VAD patients experience skin sensitivity and discomfort related to the use of these products. Listed below are descriptions of some of the more commonly-used CHG-based products:
Chloraprep One-Step®-clear cleanser containing a solution of 2% CHG and isopropyl alcohol
Chlorascrub Swabsticks-cleanser containing a solution of 3.15% CHG and isopropyl alcohol
Exidine-clear 4% CHG solution
Hibiclens-pink 4% CHG commonly mixed with saline or sterile water for cleansing
Biopatch-foam CHG disc used to provide antimicrobial protection for several days
Allowing a liquid CHG product to thoroughly dry before applying a film dressing is always necessary to avoid a negative reaction, and using a CHG product having lower strength can sometimes alleviate the symptoms. However, some patients simply cannot tolerate CHG or are sensitive to dyes or fragrance in some CHG products. Many VAD patients prefer a cleanser that doesn’t contain CHG such as Anasept Antimicrobial Skin and Wound Cleanser® or povidone iodine (such as Betadine) swabs. Those who are sensitive to the CHG in Biopatch may experience less irritation with an antimicrobial silver product that provides equal or greater antimicrobial protection such as Silverlon contact layer or Silverlon Lifesaver Disc.
Because of the frequency of dressing change or skin sensitivity, many VAD patients are particularly prone to skin-stripping or breakdown caused by tape adhesive. This can be reduced by using a gentler tape such as 3M Medipore H Tape. Others prefer using 3M Kind Removal Tape with silicone-based adhesive because it is much easier on the skin and provides for gentle removal without the skin-stripping or hair-pulling caused by other adhesives. Some use an adhesive remover to ease tapes or dressings off the skin instead of simply pulling it. A perfect product for this use is FreeDerm® Adhesive Remover which contains no acetone or petroleum products that can damage the driveline. This product leaves the skin clean with no adhesive residue.
Other problems include itching or burning related to the adhesive on tapes and dressings as well as inability to keep certain dressings on the skin. Using a skin barrier or “prep” before application may assist patients in keeping products in place. For those with skin sensitivity or an inability to keep anchors in place, WCR now offers the Uni-Grip®. This alternative anchor has a unique hydrocolloid base layer and either one or two attached clips for driveline securement. The Uni-Grip® is highly recommended by VAD patients who report that the product stays in place, is comfortable to wear, and causes no skin irritation. It is important for the patient to also have FreeDerm® Adhesive Remover on hand to assist in product removal if necessary.
Using products with silicone adhesive typically eliminates itching or burning that can be caused by traditional adhesives. Patient satisfaction with Kind Removal Tape has prompted WCR to find more silicone dressing alternatives. Currently, WCR is asking VAD coordinators to trial and approve or suggest changes for a silicone-based film dressing that will be a skin-friendly alternative to other clear dressings and securement devices having traditional adhesives.
As a company that has specialized in wound care since 2006 and which is known for its work with VAD patients, Wound Care Resources is frequently approached by dressing manufacturers to discuss new products or to request input when products are in development. WCR’s commitment to the VAD community is to search for and provide alternative products and supplies for VAD patients having special needs.
The product information on www.VADsupplies.com is for patient education and retail purchases by those who do not have insurance . The dressings and supplies mentioned in this article and on this site can be billed to most patient insurance with little or no copay expense.
Wound Care Resources, specializing in providing surgical dressings since 2006, bills Medicare, Medicaid and commercial insurance nationally for VAD dressing supplies including prepackaged trays, and individualized traditional and alternative products such as those mentioned in this blog. As specialists in the clinical formulation and use of surgical dressings, WCR is a leader in the VAD dressing supply business.
It is the right of any patient to choose which company will bill your insurance and provide dressing supplies. If you have sensitive skin or are unable to keep dressings in place and cannot access alternative products easily and without cost from your current dressing provider, please call or ask a member of your VAD team to contact the WCR office at (855) 400-2433.
by Sheri Bishop