Management of CHG-Associated Dermatitis at Central Line Sites in Pediatric Patients

Management of CHG-Associated Dermatitis at Central Line Sites in Pediatric Patients

Clinical Problem: Multiple cases of clearly demarcated contact dermatitis from chlorhexidine gluconate (CHG) impregnated dressings and CHG cleansings have been treated by the authors. Three such caseswill be displayed: a 9-month old infant with a tunneled central catheter receiving treatment for a brain tumor, a 4-year-old receiving long-term antibiotics via peripherally-inserted central catheter (PICC) to treat osteomyelitis, and an 18-year-old in the pediatric intensive care unit (PICU) who required a non-tunneled central catheter for treatment.

Past Management:While the CDC (O’Grady, et al., 2011) recommends CHG dressings be used to protect central line insertion sites in an effort to prevent central line-related blood stream infections (CRBSIs), the continuous application of CHG to the skin over an extended period of time can result in skin breakdown. This can be particularly challenging among children who are immunocompromised or have fragile skin.

Current Approach:Patients with contact dermatitis secondary to CHG cleansing and CHG dressings were cleansed using provodone-iodine, then covered by silver hydrofiber dressing and film dressing. These dressings were changed weekly unless soiled, not intact, or removed by the child.

Patient Outcomes:In one of the three noted cases, nursing was challenged by atypical routine, resulting in exacerbation and recurrence of skin breakdown. However, all patients who have been treated with this innovative approach have ultimately demonstrated excellent healing without secondary sequelae.

Conclusions:Silver hydrofiber and film dressing with betadine cleansing has proven to be an effective alternative for the authors in treating contact dermatitis related to CHG cleansing and dressings while still protecting the patients from CRBSIs.