Whether your child has a subcutaneous catheter, external catheter, or PICC line, dressing changes will be necessary. Some children don't mind at all having the Tegaderm or tape pulled off. For others, it is traumatic every time. Parents have many suggestions for ways to make it easier for kids. These suggestions also work for removing tape when using plastic dressings over EMLA:
• Don't use Tegaderm if it bothers your child or reddens the skin. Try plastic wrap cut into a square and use paper tape or tape with perforations in it.
• Try Hypafix, a dressing retention material that looks like gauze with a sticky side. Usually, several sterile 2 X 2 gauze pads are put over the needle entry site, then Hypafix is applied to hold them in place.
I like Hypafix because when it's time to take it off, you can use the adhesive dissolver where it's stuck to the skin, and even without the dissolver, it comes off more easily and gently than the Tegaderm. The nurses at our oncology clinic use this all the time. Our local clinic and hospital do not use Hypafix, so I bought a roll and take it with me whenever we have to go locally for a port access so we don't have to use the Tegaderm.
• When it's tape removal time, use an effective adhesive remover such as Detachol (an orange-colored product made by Ferndale Laboratories, Ferndale, MI). If you douse the paper tape with adhesive dissolver and wait a couple of minutes, it will usually pull right off with no pain.
Apryl has had skin tears and reactions from the adhesives as a result of using Tegaderm. We were using Primapore dressings for a while, but after a year she started with the same reaction. When she had her line replaced, I asked for a consultation with the skincare nurse. She recommended All-Dress. It is a waterproof dressing with non-stick gauze in the center surrounded by Hypafix tape. Apryl changes hers once every three days, whether it gets wet or not. She also has this pink tape that has zinc oxide in the adhesive to protect the skin. These two have worked out great.
• Once you have found a routine that works well, negotiate with nursing staff to either do the tape removal yourself or to have them follow your system.
Using adhesive dissolver (or peeling off tape or Tegaderm millimeter by millimeter) takes a bit of time—it's not just a swipe—and it works. It has to sort of soak in and takes some time to dissolve the sticky stuff. I know the nurses are really busy and under pressure to keep on time schedules, so it's probably a conflict for them. I deal with this by always being the one to get the Tegaderm off. This took some "muscling in" with nurses who were used to doing it, but it works much much better. I try to make a joke of it: "I have a deal with my kid that I'm taking off the Tegaderm. It might take a while and I wouldn't want you to fall asleep waiting on us—how about if I holler out the door when it's off and we're ready?" That way they don't have to stand around and wait, and you don't feel like you need to hurry your child.
Removal of indwelling catheters is explained in Chapter 18, End of Treatment and
When Scott (age 3) was diagnosed, his doctor gave us a choice of which central line we could use. He showed us a mannequin with a Broviac and a Port-a-cath. He also told us the pros and cons of each type, then asked us to decide. We chose the Broviac, and feel it was the best decision for Scott. The day it was installed was the end of a lot of unnecessary pain (from needle sticks) for Scott.
Scott finished all his treatments three months ago, and yesterday he had his Broviac removed. It went extremely smoothly. He had only one cuff and it was halfway out already. And to think I fretted and worried about the removal all week!
He has lots and lots of energy. His hair is coming back in and he actually has color in his face. He looks so healthy! I love it!
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