There is a new way to clean your access site using antibacterial soap. At the Annual Dialysis Conference in Seattle last February, Kim Hadely RN and John Moran MD of Satellite and Wellbound by used this technique in a study:
Moisten two 2x2 gauze with tap water.
Add a few drops of liquid antibacterial soap to the gauze pads.
Put both gauze pads on top of the scabs and soak for 20 minutes to soften scabs.
Hold the gauze pads between your thumb and forefinger and remove the softened scabs.
Continue with your routine hand and access wash prior to cannulation.
I have my patients use this same technique with a shower scrubber instead of gauze pads.
Advantages:
Avoids breaking the scab into pieces or cutting the skin.
Prevents trauma and torn or ragged tissue at the tunnel mouth.
Reduce the chance of forming loose tunnel mouths that could let germs in.
Prevents trauma that could lead to larger scabs forming.
This technique may be especially helpful in home patients who dialyze 5 to 6 times per week.
I am quite surprised at this procedure as it sounds so stressful. How could a shower scrubber even be sterile? I use Lidocaine cream just as I did when I was in-center. I have tried skipping the cream, but find the needles irritating and painful without it. 99% of the time the scabs are completely removed when the cream is removed so I don’t even have to go through the process of scab removal. I keep the cream on for about 1 hr. covered by Tegaderms. This allows me to be productive prior to tx and not have to be concerned that the coverings could fall off. I have used Lidocain Cream for many years and have never had an infection.
It is not. The use of the antibiotic soap is the key: the scrubber is rinsed under the hot water, and then the soap is applied. This process takes less than 3 minutes. What you will notice after the scab is removed is that there is a thin layer of skin left. This layer is part of the protection of the access tunnel–it is the same size as the buttonhole needle. As stated in the previous message, this method causes less trauma to the access tunnel than using a sharp instrument like a needle or tweezers. Patients use this procedure in-center and at home. This technique is just one more option—and anyone who looks at this Board should consider his or her own ideas about it. The patents who use this technique are happy with it and do not have to worry about trauma to their accesses
This would be another way to do it, but would not be an improvement to me with what I am already doing. With Lidocaine cream, on the few occasions there is a scab, the scab comes off very easily when lifted off with a needle. Sometimes a corner is a little stuck, so I then use a gauze pad to grab the corner and gently pull it away. There is no tearing of the skin. The process of scrubbing with a shower scrubber sounds uncomfortable/stressful to me, but other patients may like it. What I am doing is definitely much easier since as soon as I wash my arm with antibacterial soap, the softened scabs are washed away most of the time. I like the most stress-free way of doing things as stress really gets me down.
I read at one time that the number one thing that prevents infection is washing with the antibacterial soap, so this I have always done and may explain why I have never gotten an infection. But now, there are medical reports that antibacterial soap is not good for the body as first thought, so I am looking for a natural substitute. But I will not switch until I am sure the replacement works as well.
I like to aim for about an hour, but I have gone less and much longer with good results. The time does not seem to be critical, but the important thing is to be sure the cream hasn’t slidden off under the Tegaderm. I keep an eye on it and if I see any slippage, I move the cream back on the site with my finger from atop the Tegaderm window. With Tegaderms, I can even take a bath before txs as no bath water can get in. Much better then the saran wrap days.
Re articles, simply google antibacterial soap and you will find ample articles some of which cite studies, FDA etc.
[QUOTE=Jane;19599]I like to aim for about an hour, but I have gone less and much longer with good results. The time does not seem to be critical, but the important thing is to be sure the cream hasn’t slidden off under the Tegaderm. I keep an eye on it and if I see any slippage, I move the cream back on the site with my finger from atop the Tegaderm window. With Tegaderms, I can even take a bath before txs as no bath water can get in. Much better then the saran wrap days.
Re articles, simply google antibacterial soap and you will find ample articles some of which cite studies, FDA etc.[/QUOTE]
Is insurance covering your Tegaderms, or are you paying out of pocket? And if it’s out of pocket, have you found a source where you can get them relatively inexpensively? My insurance company refuses to cover Tegaderm despite my being allergic at my PD catheter exit site to every single other adhesive that can be used to hold gauze pads on my exit site. I get a terrible rash. Nonetheless, the insurance company refuses to cover Tegaderm and I can’t afford to buy it at what my pharmacy wants to charge for it. Any help would be greatly appreciated, especially for large pieces of Tegaderm.
Hi River,
I am Medicare and Tegaderms have been covered ever since I started home txs. 5 yrs ago. I hope they always continue to cover them as they make the taping so much easier. If they stopped coverage, I would have to find a way to afford them as I am that sold on them. I looked up the cost on the net one time and they were going for $45/100 at the first site I checked for the small size I use. I wish I had a solution for you, but hopefully someone else will have some ideas.