My 12yo has had a PICC for 6 weeks w/IV rocephin. A rash under the dressing has been getting more and more intolerable to him. It is red, itchy, like fire ants he says -and looks like poison ivy. As soon as it is uncovered it seems to calm down.
We've been to ER three times in past week for dressing changes, in case of infection etc. No infection, they do not think it is fungal (cultures negative).
We don't know if it is dressing, gauze, or cleaner related. We've tried tegaderm/IV3000 - skipping chloroprep in favor of betadine. Today he only has rolled gauze on it - and I know we need to get to ER to get it protected somehow - or get it taken out.
1. What else can be used to cover this thing? Does it always HAVE to be 'sealed' shut? He can't tolerate having any tape/adhesive touching his skin at this point. Even Paper tape seems to meld with his skin.
2. I wish I could get my hands on Primapore today (Sunday) - does anyone know if CVS carries anything similar?
3. Can I use a topical steroid? I know steroids are bad for Lyme. I read that one person used Nasonex spray on a PICC rash, but I am unwilling to put anything non-sterile near the PICC.
4. We have nursing service - but anytime I call for advice, they always say "go to ER".
5. I've been going to a small local hospital where the PICC was put in (more supportive of LLMD) - but maybe we should go to the big hospital to get better options/supplies for this issue? I hate getting questioned about Lyme.
Anything to keep the PICC in - and keep his sanity. It seems we are getting close to his breaking point and will have to pull the PICC. I feel like I am torturing this poor kid, though I know we are trying our best.
any ideas would be appreciated. thanks so much if you got this far, racer
-------------------- Me - Igenex: IgM: 41IND, IgG: 39IND, 41+ but Plasmid PCR Positive Kiddo - after 1 year IV - positive Lyme culture (before IV: IgM:31,34,41,83-93 IND; IgG: 41+++, 66+) Posts: 133 | From CT | Registered: Feb 2011
| IP: Logged |
posted
We had a really bad situation and handled it.
I'm gonna PM you. Don't want to post it..
Anyone else want to know... PM me.
Mary
-------------------- Son, 26, Dx Lyme 4/10, Babs 8/10 Had serious arthritis, all gone. Currently on Valtrex Daughter, 26,bullseye 7/11 arthritis in knees, cured and off all meds. . Self:Lyme, bart, sxs gone, no longer treating. Posts: 496 | From Washington, DC | Registered: Jul 2010
| IP: Logged |
blinkie
Frequent Contributor (1K+ posts)
Member # 14470
posted
You likely do not need to have his line pulled. I had this problem very badly for months.
1. I skipped chloraprep as I had a reaction to it.
2. I switched my dressing from tegaderm to mepalex for several weeks.
3. And this is the MOST important. The rash is likely yeast. Double the amount of probiotics he takes and it might be necessary to do a 2-4 week course of diflucan.
I had this bad for a long time and had to figure it out on my own but loads of good quality and high count probiotics are the best thing.
Posts: 1104 | From N.California | Registered: Jan 2008
| IP: Logged |
posted
Hi I'm the one who recommended Nasonex. It works and will take care of the problem. There is not enough steroids to be worried about much being absorbed via skin.
The key is after whoever changes dressing swab with chloroprep or bentadine allowing to dry then a slight mist spray of Nasonex also alowing to dry before covering with bandage.
You may also want to try a different bandage. Ask for the ones for sensitive people.
The site has to be covered it cannot be exposed to air. I doubt that it is a yeast problem.
-------------------- HERX is a Four Letter Word! Posts: 716 | From If you're going through hell, keep going......Winston Churchill | Registered: Apr 2007
| IP: Logged |
sammy
Frequent Contributor (5K+ posts)
Member # 13952
posted
The rash is likely yeast. It is so terribly itchy. I've experienced this myself and wouldn't wish it on anyone else. Please call your doctor and ask for Diflucan. As Blinkie said, you will probably need a 2-4wk treatment for it to go away totally. If you stop treating it before the skin is healed it will come back.
You need to keep the PICC line clean and covered so that your son does not end up with a blood infection. Can his nurse come out today to fix the dressing?
Did the rash spread under the Biopatch, or is that area clear? If the area is clear then I would recommend switching back to the Chloraprep cleanser. It is more effective than the betadine. Since your son's skin is so irritated, open, and weepy right now any cleanser is going to burn like fire. But you've got to go ahead and clean the site today (to prevent infection).
Give your son some Benadryl and Ibuprofen 45min before the dressing change. Hold a cold compress (wrap it in a paper towel or wash cloth to absorb the moisture) to the site for 20min, this will immediately relieve the itching and pain to make the dressing change more bearable. You can also do these things regularly until his skin heals, Benadryl every 6hrs, Ibuprofen every 6hrs (dose based on weight) and cold compress as needed.
OK, back to the dressing change. Clean the site with Chloraprep, let dry for at least 2min. Then spritz the area with Benadryl spray (you can buy this at CVS), let dry thoroughly.
Is your son's rash under the Stat-lock also? It probably is, that foam holds moisture. If it is rashy there, do not reapply a Stat-lock, that will keep the skin from healing. Fold a 2x2 gauze pad in half and place it under the PICC body (to make it more comfortable). Then use a steri-strip to anchor the PICC and keep it from slipping out.
Before you cover the PICC, remember to place the Biopatch. This is very important to help prevent infection.
Since his arm cannot tolerate a sticky dressing right now (and you don't have access to Primapore) you can use a 4x4 "sterile non-stick gauze pad" to cover the area. If you can, use cloth or paper tape to seal all the edges around the dressing. If you cannot use tape, wrap the dressing and his arm in rolled gauze, tape the gauze to itself. Then cover with Curad brand "Hold Tite tubular stretch bandage" make the dressing more secure.
If you use this gauze dressing it will need to be changed in 48hrs. Resist the temptation to remove the dressing any sooner (unless it gets wet or dirty). Remember when you expose the PICC to air you are exposing it to germs and increasing your risk of infection.
Once his skin is healed a little more and stops weeping/oozing then you can try to move back to the transparent dressing. Try the IV3000, Sorbaview, or the Mepore film dressing. You can purchase these online if necessary. They are more breathable than the Tegaderm. If you use a transparent film dressing like these above you should only have to change it once weekly unless it get dirty or wet.
Make sure the nurse uses adhesive remover to gently lift the sticky dressings off his skin. It is also important to use a skin prep protective wipe before applying the sticky dressing. This helps the dressing stick better and protects the skin from tape stripping/irritation. I like the Smith&Nephew brand "Remove" and "No-Sting Skin-Prep". They work well for me.
OK, so here's the whole dressing change sequence for the nurse: Apply adhesive remover, gently remove dressing and stat-lock, clean with Chloraprep, dry 2min, spritz with Benadryl spray, dry for 1min, apply skin prep, let dry, apply stat-lock or steri-strip, apply Biopatch, then end with dressing of choice.
If you do not let the chloraprep cleanser or skin prep dry thoroughly they may cause an itchy rash that will make you think that you are allergic. Just keep that in mind because sometimes nurses are used to working quickly and don't like to wait.
Next time your son has the urge to itch his arm give him some Benadryl and an ice pack instead. Scratching can make things worse by causing microtears in the skin (that can lead to infection).
I hope I didn't just overwhelm you. These are all things that I've learned from experience. Good luck to you and your son!
Posts: 5237 | From here | Registered: Nov 2007
| IP: Logged |
blinkie
Frequent Contributor (1K+ posts)
Member # 14470
posted
Lots of great tips Sammy!
I cannot personally tolerate chloroprep.
I second making sure to let it dry very well before they apply anything that sticks to the skin. The moisture under there will feed the yeast.
Also, I got the oozy sores and major, major intesnse itching with redness(think fireengine red). The itching made me want to scratch my arm off.
Anyway, also, it the itching is outside the dressing, which mine did, you can apply spray benadryl to that area. I did that so I could sleep at night. My nurses would never let me apply that under the dressing. Not sterile.
One more thing I forgot to mention, have them relocate the stat lock at each dressing change to let the skin underneath breathe.
If there is no infection or blood clot, you have no reason to pull that line. If you have a good care facility, they will know this.
Posts: 1104 | From N.California | Registered: Jan 2008
| IP: Logged |
Amanda
Frequent Contributor (1K+ posts)
Member # 14107
posted
Your poor son - I have similar issues with my port dressing.
I have found that it was a combination of the alocohol, followed by teh chloroprep and teh bandage.
I use sorbaview bandages, betadine (every other time I still use chloroprep). Also, make sure that the area is completely dry after betadine/alcohol and chloroprep before they put teh bandage on there
Also, I have two days in between when I pull the needle out of the port (which you can't do with teh picc, I know). This has helped a lot with the rash and reduced itchiness.
-------------------- "few things are harder to put up with than the annoyance of a good example" - Mark Twain Posts: 1008 | From US | Registered: Dec 2007
| IP: Logged |
posted
These are such good suggestions - thank you everyone. I tend to agree with the yeast opinions since the rash doesn't seem to follow exactly where the adhesive was (like a tape rash).
We're doing lots of gauze now - the rash is still bad, but he's more comfortable tonight.
I'll need to order some supplies, since we're going through gauze like an army.
Insurance isn't covering us anymore (post-30 days) so I have to order biopatch and statlocks - $$$.
racer
-------------------- Me - Igenex: IgM: 41IND, IgG: 39IND, 41+ but Plasmid PCR Positive Kiddo - after 1 year IV - positive Lyme culture (before IV: IgM:31,34,41,83-93 IND; IgG: 41+++, 66+) Posts: 133 | From CT | Registered: Feb 2011
| IP: Logged |
sammy
Frequent Contributor (5K+ posts)
Member # 13952
posted
If you need to pay out of pocket for Biopatches and Stat-locks consider contacting Infuserve for less expensive alternatives. http://www.infuserveamerica.com
They carry "Silverlon Lifesavers" which are antimicrobial patches that you can place at the insertion site instead of using the Biopatch. They also carry "Universal Securement Devices" that you can use to stabilize the PICC instead of using a Stat-lock. I like and use both of these products.
Take care.
Posts: 5237 | From here | Registered: Nov 2007
| IP: Logged |
posted
I had same symptoms with my first midline and than PICC line.
My first LLMD diagnosed this as candida .
I initially started with these items - chloraprep? spelling, tegaderm and stat lock.
When I switched to Povidone swabstics, IV3000 Standard dressing(instead of tegaderm) and Grip-lock (instead of statlock)- all symptoms went away.
I also used !!!ARGENTIN23 GEL!!! - this is silver gel. This gel was huge help and it worked wonders for me. Can be applied over the dressing tape and/or before placing the dressing tape.
Keep the PICC line area dry, dry, dry. I used DryPro to protect picc site during the shower and was able to swim while on vacation.
Good luck
Posts: 191 | From va | Registered: Sep 2008
| IP: Logged |
posted
I never realized how lucky hubby has been -- he has had very few problems with bandages etc. You guys must spend a fortune in supplies.
I just use hydrogen peroxide and sometimes rub alcohol pads to clean and disinfect with. Then use regular bandaids (generic of course) to cover the site. Use Durapure cloth tape by 3M. I use a medium size bandaid and tape it all around and then put a large size bandaid over that and tape that one all around as well. I do use statlocks but only change them every couple of months when they no longer will stick.
I guess hubby has been really lucky considering he has had the PICC line for about 8 years now.
Bea Seibert
Posts: 7306 | From Martinsville,VA,USA | Registered: Oct 2004
| IP: Logged |
scorpiogirl
Frequent Contributor (1K+ posts)
Member # 31907
posted
Bea,
You don't even know! I have my own pharmacy at home from all the supplies I ordered to try. Turned out I am allergic to ALL adhesive, skin prep gel, Chloraprep and Biopatch! I lost one Picc line and one Hickman line before anyone listened to me!!
This last Picc line I had the reaction by the next day. So I did what Sammy told me to do and now my skin is healing. The infusion nurse came today to change and asked if I wanted to put the Biopatch on and I told her no way no how. With me less is better!
-------------------- Posts: 1391 | From Lyme Land | Registered: May 2011
| IP: Logged |
The Lyme Disease Network is a non-profit organization funded by individual donations. If you would like to support the Network and the LymeNet system of Web services, please send your donations to:
The
Lyme Disease Network of New Jersey 907 Pebble Creek Court,
Pennington,
NJ08534USA http://www.lymenet.org/
UBBFriend: Email this page to someone!
Printer-friendly view of this topic