Advice

The technology

The technology

Tegaderm CHG IV securement dressing (3M) is a sterile, semi-permeable polyurethane adhesive dressing with an integrated gel pad containing 2% w/w chlorhexidine gluconate (CHG). It is used to secure percutaneous devices and to cover and protect central venous and arterial catheter insertion sites. The aim is to form a barrier against external contamination. The integrated CHG gel pad is designed to reduce skin and catheter colonisation by microorganisms commonly linked to catheter-related bloodstream infections (CRBSI) at the catheter insertion site.

Catheters are placed with a large securement tape strip. This helps to make sure they're consistently and correctly applied, as well as improving catheter securement. The securement strip is perforated so that it can be opened to help remove the dressing. The body of the dressing also has a perforated keyhole notch so that it can conform around different catheter types and sizes.

NICE published guidance on Tegaderm CHG for central venous and arterial catheter insertion sites in July 2015. When it was reviewed in 2019, evidence in patient populations outside the scope of the original guidance was identified. This briefing summarises evidence for Tegaderm CHG in those populations: people needing vascular access devices in dialysis, chemotherapy, total parenteral nutrition, and children's intensive care.

Innovations

Tegaderm CHG is the only securement dressing available containing CHG. The dressing is transparent to allow continual monitoring of the access site.

Current care pathway

Current standard care is to decontaminate the skin at a vascular access device insertion site with CHG in 70% alcohol. This is then allowed to air dry before inserting the device. The insertion site is covered with a sterile, transparent semi-permeable membrane dressing. This is changed every 7 days, or sooner if it is no longer intact or if moisture collects under it. A sterile gauze dressing, covered with a sterile transparent semi-permeable dressing, should be considered only if the patient has profuse perspiration, or if the vascular access device insertion site is bleeding or oozing. Healthcare workers should also make sure that catheter site care is compatible with catheter materials (tubing, hubs, injection ports, luer connectors and extensions) and carefully check compatibility with the manufacturer's recommendations.

The following publications have been identified as relevant to this care pathway:

Population, setting and intended user

Tegaderm CHG is primarily used for patients who need a vascular access device, to reduce the risk of catheter colonisation, CRBSIs and exit site infections. This includes people having dialysis, people on chemotherapy, people needing total parenteral nutrition, and children in intensive care.

For people on haemodialysis via a central venous catheter, Tegaderm CHG is used at the catheter exit site. The company said that 25.7% of people needing haemodialysis start treatment using a non-tunnelled (temporary) line. These include people with acute kidney injury who need short-term dialysis and people with chronic kidney disease who may have a non-tunnelled line for the first few months of treatment. Tegaderm CHG may benefit this population because they are at higher risk of developing a CRBSI.

For people on chemotherapy, Tegaderm CHG is indicated for people who need longer-term intravenous (IV) chemotherapy, during which a venous access device remains in place until the course of treatment is completed, usually at least 12 weeks.

Total parental nutrition may be given to people having chemotherapy, or in other instances when additional nutritional support may be required. Nutrition is delivered via a non-tunnelled central venous catheter.

For children in intensive care, Tegaderm CHG can be used to secure central venous catheter or peripherally inserted central catheter (PICC) lines. It should not be used in babies under 2 months old because it may cause hypersensitivity reactions or necrosis of the skin. The company said that the safety and effectiveness of Tegaderm CHG dressings have not been evaluated in children under 18.

Tegaderm CHG is intended for use by people who normally apply and change dressings at vascular device insertion sites. These are typically vascular access specialist nurses, mostly in primary care, outpatient dialysis or chemotherapy clinic.

Costs

Technology costs

The dressing is available in 4 sizes: 1660R (7 cm × 8.5 cm), 1658R (10 cm × 12 cm), 1659R (10 cm × 15.5 cm) and 1657R (8.5 cm × 11.5 cm).

Different sizes are used for different purposes, and usually as follows for:

  • Haemodialysis: 1657R and 1658R

  • Chemotherapy: 1657R or 1658R for internal jugular, subclavian, femoral, or tunnelled central venous catheters; 1659R for PICC and mid-line applications

  • paediatric central venous catheters and PICC lines: 1657R and 1660R for smaller children

  • total parenteral nutrition: 1657R or 1658R for internal jugular or subclavian non-tunnelled central venous catheters; 1659R for a PICC line.

The company said Tegaderm CHG costs between £4 and £5.04 per dressing, excluding VAT. Each dressing needs to be changed at least every 7 days.

Costs of standard care

A standard catheter dressing (defined as a vapour-permeable adhesive film sterile IV dressing) costs from £0.83 to £5.70 depending on size, brand, and use. Each dressing needs to be changed at least every 7 days.

A comparator product, Biopatch (see NICE's briefing on Biopatch for venous or arterial catheter sites), costs £4.44 per patch. This is a hydrophilic foam dressing impregnated with CHG, which is applied under a standard sterile transparent semi-permeable IV dressing.

Resource consequences

Tegaderm CHG is widely used in adult intensive care in the NHS. It is also used for vascular access in adults in haemodialysis and chemotherapy, and in children's intensive care and oncology units. If Tegaderm CHG was more widely used outside adult intensive care, it could reduce catheter-related infections in other populations needing longer-term vascular access. This could reduce the cost of treating infections, and the need for antibiotic use. It could also reduce the need to change catheters, and could improve patient outcomes.

No additional resources are needed to use this technology and the company provides free training. This includes:

  • training on the correct use and application of Tegaderm CHG onsite and remotely

  • trust-specific training resources and materials, video and web-based resources

  • e-resources including 3M Health Care Academy

  • webinars and on-demand learning modules

  • IV forums and summits

  • patient information leaflets.

    Healthcare professionals may also need awareness training about chlorhexidine allergy according to chapter 17 of National Audit Projects (NAP) 6: perioperative anaphylaxis.