Should We Use Tegaderms for Ultrasound-Guided IV’s?

Should We Use Tegaderms for Ultrasound-Guided IV's?

Over the past year there has been a small bit of controversy regarding the best way to make sure that we aren’t causing iatrogenic infections when placing ultrasound-guided IV’s. To be honest, I took it for granted that tegaderms should be used when we do this potentially life-saving procedure.  Recent posts from ALiEM and EMRAP made me question the utility of these adhesive barriers.  After much research, it turns out that tegaderms are probably perfectly fine to use.  In this podcast, Dallas Holladay, Michael Gottlieb and I sit down to talk about our interpretation of the literature behind using tegaderms for ultrasound-guided IV’s.  Check it out!

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Comments

  1. I have a point to discuss in regards to content in this podcast…
    Why are you all saying its ‘ok’ to use Tegaderm’s as a probe cover IF even the manufacturer (3M) is saying its against the products IFU? While there is growing evidence that supports low to high level disinfection of US probes when in contact with B&BF, there still needs to be protection of the patient, which the Tegaderm is NOT designed to do in this manner. It is an IV dressing and securement device primarily.
    Essentially, this is off-label use of the device and puts (other) clinicians at risk if there was to be a problem/issue related to the procedure.
    There are now small, shorter length US probe covers from several manufacturers available for almost the same cost as an Tegaderm ($3-4) and is the more appropriate and correct product to use. Alternatively, there are other specifically-designed covers, which are more expensive.

    At 3:05 someone stated that a PIV is a clean or “semi-sterile” procedure. Its either sterile or non-sterile. No changing the wording gets around the issue. Current practices are actualy moving away from non-sterile insertion and towards a sterile insertion for all intravascular devices. It is pointless placing a ‘sterile’ dressing on a PIVC that was not placed under sterile conditions and defeats any purpose in actually protecting the patient.

    Unfortunately, many clinicians still today view a PIVC is ‘less risky’ than a CVAD, despite the volume of PIVCs inserted globally (1 billion), it is much greater than total numbers of CVADs. While CLABSI is definitely a costly issue, due to nonreimbursement and hospital fines, PIVC BSI has been flying under the radar for many years and has now captured the attention of CMS, anticipating that there will be likely changes to mandatory reporting for PIVC-related infection and complications by facilities.

    Helm et al (2015) states much of the issue with PIVCs best – Accepted, but Unacceptable – “Insertion of an IV catheter is an invasive procedure that introduces multiple risks and potential morbidities, and even mortality, and should be given the respect that it deserves”.

    If AIUM, ASUM, as well as other esteemed professional organizations are stating the minimum recommendations for probe protection, then it becomes confusing (and riskier) for other clinicians are attempting to follow the current recommendatations/guidelines, when examples of your own practices states otherwise.

    Don’t all patients deserve the right to have the best approach with regards to their vascular access options, with minimal potential for complications, failure or infection? I think we all get the picture, but just consider if it was a relative or family member getting the same procedure eslewhere – what would you have another clinician do? What is best practice or what is easiest? They are not always linked.

  2. Peter Bonadonna : September 2, 2019 at 9:01 pm

    There’s aways one in every crowd! Keep up the good work guys.

  3. Tim, really agree. If the probe cover is too expensive, use o e that is less expensive or do not use ultrasound
    If you get a complication using tegaderm, your fault, you to blame. If you have problems using all sterile procedure : happens. Not your fault

    Btw, you can use the end rubber ring in the glove to hold the glove in your probe in place, like a rubber band. Actually it’s a rubber band that keeps the glove in your hand. Works like a charm

  4. Like your Podcast What about no cover at all if it is HLD in 90seconds?? Quicker than placing gel and Tegaderm on the probe.

    Read the research. Is this an alternative to sterile probe cover + LLD or Tegaderm + LLD ?… conclusion states: Moreover, this method should obviate the use of sterile probe covers, which can improve echogenicity.

    Benefit-to-risk ration
    Reduced Infection risk = HLD + No Cover or Sterile Cover + LLD or Tegaderm + LLD

    Research Paper: Evaluation of a new disinfection method for ultrasound probes used for regional anesthesia: ultraviolet C light. The study was performed with current version of Antigermix AS1 with a 90 seconds cycle. 15 ultrasound probes used in anesthesia for block placement were exposed to a large inoculum of 3 bacteria: Staphylococcus aureus, Escherichia coli, and Enterococcus faecalis. All probes were infected after inoculation (>150 colony-forming units) but were considered sterile (<10 colonyforming units) after disinfection. Moreover, for the authors, this method could obviate the use of sterile probe covers, which can improve echogenicity.
    Bloc S. and al., Evaluation of a new disinfection method for ultrasound probes used for regional anesthesia: ultraviolet C light. J Ultrasound Med. 2011 Jun;30(6):785-8.

    Let me know your thoughts?

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