One complication associated with the insertion of peripherally inserted central catheters is infection. We all have bacterial organisms on our skin. If proper antiseptic technique is not followed, the bacteria may colonize the catheters and migrate into the blood stream causing serious infections which may even turn fatal. Proper antiseptic measures must be taken to prevent this during PICC insertion.
Antiseptic solutions used during insertion greatly reduce the risk of infection when properly used. One such solution, now considered the best for preventing infections during the insertion and maintenance of a PICC line, is Chloraprep. Chloraprep is a new skin disinfectant which contains 2% chlorhexidine gluconate in 70% isopropyl alcohol. It is a recently approved antiseptic, replacing isolated chlorhexidine and recommended by the CDC, for preoperative and preprocedural skin preparation.
Various studies have shown that infection can occur with bacteria like Staphylococcus and Klebsiella. Chloraprep effectively eliminates these bacteria from the catheter entry site thereby preventing infection. Moreover Chloraprep does not cause skin irritation unlike many other antiseptics used for this purpose. It has enhanced antiseptic action against various bacteria, especially against Staphylococcus epidermidis, a common bacteria causing infection in venous access devices, when compared to other antiseptics such an undiluted chlorhexidine or betadine.
In fact, betadine, or povidone iodine, was long considered one of the best known and effective skin disinfectants because it eliminates most of the skins' bacteria. Chloraprep, however, is considered better and studies have proved that it is more efficacious. In one study done by Harvard Medical School concerning neonates with peripheral catheters, the bacterial colonization of the catheter was 9.3% when betadine was used and was reduced to 4.7% when Chloraprep was the antiseptic. Entry of bacteria in to the blood stream occurred only in 0.2% of the patients when both products were used.
However, fighting infection does not end after the PICC line is inserted. A nonabsorbent anchoring device secures the catheter and a small foam disc, called a Biopatch, which is impregnated with chlorhexidine gluconate, can be placed directly at the insertion site. This round patch, which has a slit to assist with its application and removal, fits around the catheter at the site. This patch provides antimicrobial action for up to seven days. A sterile transparent dressing then covers the site.
Proper sterile technique is very important for preventing various catheter related infections and Chloraprep is the current and recently recommended antiseptic of choice to assist in the endeavor. With careful assessment, scheduled dressing changes including the anchoring device and Biopatch, and aspectic expertise, a infection becomes a low risk in a PICC line.
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