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» LymeNet Flash » Questions and Discussion » Medical Questions » Infection under PICC dressing? Update

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Author Topic: Infection under PICC dressing? Update
sammy
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Has anyone dealt with a yeast infection under their PICC dressing?

I've been dealing with a rash under my PICC dressing for a little over a week now. The rash looks a lot like poison ivy, little red bumps with a small amount of yellow crust on top. It is very itchy.

Was diagnosed with a yeast infection and prescribed Nystatin powder to apply with dressing changes on tues. It was still incredibly itchy on Wed so my LLMD called in Diflucan. I was only supposed to take one tab on wed and thurs then twice weekly for a month to prevent the infection from reoccurring.

I changed the dressing yesterday and applied more Nystatin powder. The actual PICC site looks fine. The rash looked worse yesterday and same today so I took another dose of diflucan yest and again this evening.

Examining it now, it actually looks a little better but not good.

So, my question is has anyone dealt with this issue before? How long did it take for the rash to clear up? Any advice?

Thanks so much.

[ 09-10-2009, 12:51 PM: Message edited by: sammy ]

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catskillmamala
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I had that. It wasn't yeast, it was an adhesive allergy. Try having them bathe it with something that isn's isopropyl alcohol. Also, you may want to try dressings such as tagaderm.

I eventually went to the local wound care specialist at my local hospital who put a pectin dressing on. I still couldn't get it under control, pulled the picc and went to daily infustions.

I know there have been several threads here about picc dressing problems.

Here's one that cites others:

http://flash.lymenet.org/scripts/ultimatebb.cgi/topic/1/69795?

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sammy
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Thanks cat, I also read the links you provided.

My current dressing change protocol consists of cleansing the site with chlorprep, applying Nystatin powder, skin prep, stat lock to hold the PICC in place, Biopatch at the site, and Tegaderm to top it all off.

The whole area under the dressing looks worse every morning and a little better each night. I think it gets worse at night because I sweat.

I showed the rash to an ER doc at church today and he was unsure whether it was a yeast infection or contact dermatitis. Told me to show it to my friend (who wasn't at church today) who is a wound care specialist. He was pleased at how well the actual site looked. That made me feel better knowing that at least the line is OK.

My grandma (an RN) stopped by this afternoon so I also asked for her opinion on the rash. She said that it was definitely yeast and that it might not go away until I can leave the dressing off after the line is pulled. Not the answer I wanted to hear.

So I put a call in to my friend who is a wound care specialist. I talked with her earlier this week, she is the one that initially suggested that it was a yeast rash. Hopefully she'll have some helpful tips for me.

I'm just concerned because the infection/rash is not going away. I don't want to further jeopardize the integrity of my skin which may allow secondary infections, infections at the PICC site, etc. This is scary to me.

Does anyone else have any wisdom to share with me? I would greatly appreciate it.

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Kerryblue
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Hi, Yes, also had,also under boobs, I am chesty.
OK, maybe hear from some guys now,lol

Severe mouth thrush/yeast unable to rid of wherever moist area.
So very well could be being we are walking yeast infections for many.
Huggggsss, to all in need,Kerry

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sammy
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I'm now on day 6 of Diflucan, was only supposed to take it 2days per week for one month but the infection did not clear after the initial 2doses.

The rash does not seem to be getting worse but not better either. I'm sure if I could switch to a non-occlusive dressing (like Primapore)that it would breath better and possibly heal faster but I simply cannot do that. My site would be too exposed and open to infection at work, there is no way that I could keep the area sterile.

Has anyone else dealt with a problem like this before? Any suggestions?

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SL10
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Yes! My husband had exactly this problem. It was the CHLORAPREP!

The nurses also thought it yeast infection. The home health nurse swore that the chloraprep was was so gentle that they used it on newborns, but my husband had the same reactions that you did.

Here's what we did: For dressing changes insist that they use betadine instead of chloraprep.

Have them cut down the dressing adhesive so that it covers the smallest possible area around the insertion site.

If you can get help from someone at home, use sterile procedures and remove the dressing when you get home from work and replace with a breathable dressing/bandage for a few hours....put a regular dressing back on before bed.

My husband's cleared mostly within a week once we stopped using the chloraprep - but you have to be able to "air" out the affected area while keeping the insertion site protected.

Once it started healing over, we also started applying Vitamin E oil - but not until it had dried out and wasn't raw anymore.

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Dawn in VA
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Same here: the bumps and extreme itchiness was due to an allergy to chloraprep for me. Oh, the itchiness drove me NUTS!

I asked my home health nurse to switch to betadine, too. (actually, alcohol swab, wait till dry, then betadine- for extra disinfection and to appease my paranoia)

Took about about a week/week and 1/2 for mine to clear up.

--------------------
(The ole disclaimer: I'm not a doctor.)

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keltyl
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Sammy, Sorry you are going through this. I'm getting my picc in Fri., and have that fer since I've been allergic to adhesives before. Now it sounds as if there are others to worry about too.

Seems as if it were yeast, it would have cleared by now.

Best,
Linda

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sammy
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Thank you all. It sounds like sensitivity chlorprep is a fairly common problem.

When I did my dressing change today I used the alcohol swabs instead of the chlorprep wand. I also moved the stat-lock to a different area and tried to reposition the Tegaderm leaving some of the rashy area open to air. I also reapplied the Nystatin powder just in case. I hope that these changes help.

I'm also conducting an experiment on myself. This required sacrificing a dressing change kit, which is not fun since i'm on a tight budget. So I scrubbed an area on my abd with the chlor prep, an area with the chlorprep and skin prep, and an area with just skin prep. Then I covered it all with the Tegaderm. So hopefully if i'm sensitive to one of these things i'll react on the test spot and I can eliminate it from my dressing change routine.

I'll keep you posted on my little experiment.

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Carol in PA
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Sammy, that set up is a great way to figure out what you might be allergic to!

Carol

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cactus
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I too was allergic to the prep, and also to several of the dressings.

I think the nurse ultimately ended up cleaning the site, and leaving off the prep entirely.

If you can get them, can you try several different dressings? There are a few types, and some will be easier on your skin than others.

Tegaderm was one that made me react, but with much trial and error, we finally found a dressing that worked.

I don't remember which dressing was best for me, except that it was one with a "window" over the stat lock, and some padding around it.

Paper tape was also necessary, rather than the usual tape - but even that could make me react after a while.

I hope you find something that works for your skin, and soon!

--------------------
Did you ever stop to think, and forget to start again? - A.A. Milne

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tanzi2u
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We ended up being allergic to both the chlor prep and the adhesives on most coverings, and esp to the adhesive on the stat lock.

What the infusion nurse now uses is an iodine swab, then an alcohol one for the prep. (If the rash, which sounds like yours, is real bad we'll administer some Rx triamcinolone cream first, and let it soak in before the prep.)

Instead of a statlock, we cushion the line with a piece of sterile gauze, and secure it with steri-strips. For some unknown reason, there hasn't been an allergic reaction under the biopatch.

Good luck!

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sammy
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Update 8/26/09

My little experiment is not proving to be as helpful as expected. The test dressing has been intact for approx 27-28hrs now. So far, no itching, not rash, no signs of irritation what so ever! Looks like I may not really be reacting to the cleanser, prep or dressing after all.

The rashy area under my PICC dressing looks the same as yesterday. Thankfully it hasn't spread as some clear skin is now also covered by the dressing.

Bad news is the rashy area that was previously under the dressing that I left open to air since yest afternoon is looking much worse today. The little red dots have merged to form blobs. Now the whole area looks splotchy and angry. It is very red and irritated.

I'm stumped. And I had a terrible day at work so this just adds to my stress and complicates everything.

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Dawn in VA
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Huh.

If it's still really bothering you, could you have a doc scrape off a sample and check it out?

--------------------
(The ole disclaimer: I'm not a doctor.)

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sammy
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Update 8/27/09

Its been 48hrs and my experimental dressing site looks perfect. PICC dressing area looks terrible [Frown]

I tried to get an appt with my doctor or his partner today but they did not have any openings. They never have any openings when I need seen. This upsets me, like jump up and down while screaming kind of upset.

So instead of throwing a fit like a 2yr old, I ended up having lunch with my lovely friend the wound care specialist. She looked at my site again and said that it is definitely yeast not a contact dermatitis/allergy.

Now i'm just frustrated because my arm won't heal and I can't get in to see my own doctor when I really need to be seen. And my LLMD's office is in another state a whole day's drive away so that is not an option either. I could try calling my LLMD but i'm sure at this point he will want me seen rather than prescribing anymore Diflucan over the phone.

I guess i'll just keep trying the more frequent dressing changes with the Nystatin powder and hope that it eventually clears up on its own. I'm scheduled to see my LLMD next fri so if it gets worse at least i've got an appt then.

I would greatly appreciate any prayers as this complication, though minor compared to some, has been very stressful for me.

Thanks so much:)

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Dawn in VA
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Sammy, sending prayers your way.
[group hug]

--------------------
(The ole disclaimer: I'm not a doctor.)

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sammy
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Update 9/10/09

I had a f/u with my LLMD on fri and he verified that it is a yeast infection under my PICC dressing. Good news is that it is healing (though very slowly!).

I'm still taking Diflucan, only 3 days left on my 14day RX. It looks like my arm will not be clear by then so i'll be requesting a refill. This is a very stubborn infection!

Word of wisdom to those with PICCs, try to avoid the heat and humidity if at all possible. Change your dressing more frequently in the summer (every 3-4 days instead of 7). We all know to change the dressing if you sweat or if it gets moist underneath but I do believe that these other conditions may have contributed to the development of the skin infection.

I try to take excellent care of my PICC site and dressing yet I still developed this complication. I've learned that you do what you can to prevent problems, keep a close eye on any changes, and call your doctor ASAP if you do develop a problem. I'm usually more of a watch and wait person so learning to call and ask for help is a new thing.

Take care my friends:) Thanks for all your support and advice!

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AliG
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Can you ask the Dr if it would be OK to follow the powder with a little Desitin cream? It did wonders to help my skin heal when it had blistered off from the Chloraprep.


It also acts as a moisture barrier. If the area is good & dry before applying, it should help suffocate the yeast. I use it to heal all kinds of rashes & skin irritations.


Just a note for anyone who suspects that they may have developed a sensitivity to the chloraprep:

I did the same test as sammy with different dressings & the chloraprep & it didn't happen where I had tried it.

I think the skin gets more sensitive under the dressing area & the chloraprep penetrates through several layers of skin. With each dressing change you're scrubbing off more layers & being protected by the dressing, they don't toughen up as much.

I think it might take at least a couple of dressing changes to show up in a test area.

Mine was DEFINITELY caused by the chloraprep & I had no further problems when we used Betadine, instead of Chloraprep, to prep the skin for the dressing.


I'm glad that you got a definitive answer and are finally starting to heal. [group hug]

--------------------
Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner.

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sammy
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Thank you AliG.

Did you have trouble getting your dressing to stick well over the Desitin cream? That would be my biggest concern as tape/ dressings never want to stick well to my skin.

I'm due for a dressing change in another day or two so depending on how things look by then I will give the Desitin a try.

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