Casi Algorithm
Casi Algorithm Local Complications Local Complications
Flowchart

EXIT SITE INFECTION

Redness, induration (hard),

and/or tenderness within

2 cm of the catheter exit site;

possibily with other signs and

symptons of infecton, such

as fever or purulent drainage

at exit site, concomitant

bloodstream infections

EXIT SITE INFECTION

EXIT SITE INFECTION

Redness, induration (hard),

and/or tenderness within

2 cm of the catheter exit site;

2 cm of the catheter exit site;

possibily with other signs and

symptons of infecton, such

as fever or purulent drainage

at exit site, concomitant

bloodstream infections

bloodstream infections EXIT SITE INFECTION

SKIN INJURY


Stripping; Shallow Irregular lessions;shiny skin
Tears: Partial or full thickness tension blisters

SKIN INJURY

SKIN INJURY


Stripping; Shallow Irregular lessions;shiny skin
Tears: Partial or full thickness tension blisters


Stripping; Shallow Irregular lessions;shiny skin
Tears: Partial or full thickness tension blisters SKIN INJURY

SKIN IRRITATION/CONTACT DERMATITIS

Skin color change (red, dark, shiny, dull) persisting

30 min. after dressing change (often mimics shape

of dressing) and/or burning, itchy skin and/or lesion

(macules, papules, vesicles, bullae)

SKIN IRRITATION/CONTACT DERMATITIS

SKIN IRRITATION/CONTACT DERMATITIS

Skin color change (red, dark, shiny, dull) persisting

30 min. after dressing change (often mimics shape

of dressing) and/or burning, itchy skin and/or lesion

(macules, papules, vesicles, bullae)

SKIN IRRITATION/CONTACT DERMATITIS

WEEPING/OOZING

(Non-infectious)

Assess color, consistency,

odor, amount and loction

of exudate

WEEPING/OOZING

WEEPING/OOZING

(Non-infectious)

Assess color, consistency,

odor, amount and loction

of exudate

WEEPING/OOZING

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If Exit Site infection is Suspected:


culture site and draw blood cultures
collaborate with practitioner; may need to remove catheter
Topical antimicrobial agent (bassed on culture results) or consider non-CHG antimicrobial dressing
If there is no resolution with topical therapy or it is accompanied by purulent drainage, start systemic antibodes
consider cauterizing exuberabt granulation tissue at site of long-term CVA

Confirm compatibility with dressing and cather

If Exit Site infection is Suspected:


culture site and draw blood cultures
collaborate with practitioner; may need to remove catheter
Topical antimicrobial agent (bassed on culture results) or consider non-CHG antimicrobial dressing
If there is no resolution with topical therapy or it is accompanied by purulent drainage, start systemic antibodes
consider cauterizing exuberabt granulation tissue at site of long-term CVA

Confirm compatibility with dressing and cather

If Exit Site infection is Suspected:

If Exit Site infection is Suspected:


culture site and draw blood cultures
collaborate with practitioner; may need to remove catheter
Topical antimicrobial agent (bassed on culture results) or consider non-CHG antimicrobial dressing
If there is no resolution with topical therapy or it is accompanied by purulent drainage, start systemic antibodes
consider cauterizing exuberabt granulation tissue at site of long-term CVA


culture site and draw blood cultures
collaborate with practitioner; may need to remove catheter
Topical antimicrobial agent (bassed on culture results) or consider non-CHG antimicrobial dressing antimicrobial dressing
If there is no resolution with topical therapy or it is accompanied by purulent drainage, start systemic antibodes ystemic antibodes
consider cauterizing exuberabt granulation tissue at site of long-term CVA

Confirm compatibility with dressing and cather


Consider non-alcohol antiseptic agent
If skin flap present, approximagr viable skin flap edgesprior to dressing application


Consider non-alcohol antiseptic agent
If skin flap present, approximagr viable skin flap edgesprior to dressing application


Consider non-alcohol antiseptic agent
If skin flap present, approximagr viable skin flap edgesprior to dressing application


Consider non-alcohol antiseptic agent
If skin flap present, approximagr viable skin flap edgesprior to dressing application If skin flap present skin flap edges prior to dressing application


Control bleeding: pressure at site, alginate and/or hemostatic agent under dressing
Apply non-alcohol barrier film and absorbent dressing


Control bleeding: pressure at site, alginate and/or hemostatic agent under dressing
Apply non-alcohol barrier film and absorbent dressing


Control bleeding: pressure at site, alginate and/or hemostatic agent under dressing
Apply non-alcohol barrier film and absorbent dressing


Control bleeding: pressure at site, alginate and/or hemostatic agent under dressing
Apply non-alcohol barrier film and absorbent dressing film and absorbent


Rule out infiltration/extravasation, thrombophlebitis and other skin conditions (e.g., eczema, impetigo)
Identify and avoid suspected irritant :

- Change type/concentration of cleansing solution (see Flg.1)

- Ensure solution and barrier film are allowed to dry fully before dressing application

- If no resolution, change brand/type of dressing

- Consider open allication test of dressing/antiseptic solution on unaffected skin (see Flg.2)


Rule out infiltration/extravasation, thrombophlebitis and other skin conditions (e.g., eczema, impetigo)
Identify and avoid suspected irritant :

- Change type/concentration of cleansing solution (see Flg.1)

- Ensure solution and barrier film are allowed to dry fully before dressing application

- If no resolution, change brand/type of dressing

- Consider open allication test of dressing/antiseptic solution on unaffected skin (see Flg.2)


Rule out infiltration/extravasation, thrombophlebitis and other skin conditions (e.g., eczema, impetigo)
Identify and avoid suspected irritant :


Rule out infiltration/extravasation, thrombophlebitis and other skin conditions (e.g., eczema, impetigo) Rule out infiltration/extravasation, thrombophlebitis and other skin conditions (e.g., eczema, impetigo)
Identify and avoid suspected irritant :

- Change type/concentration of cleansing solution (see Flg.1)

(see Flg.1)

- Ensure solution and barrier film are allowed to dry fully before dressing application

Ensure solution and barrier film are allowed to dry fully before dressing application

- If no resolution, change brand/type of dressing

- Consider open allication test of dressing/antiseptic solution on unaffected skin (see Flg.2)

Consider open allication test of dressing/antiseptic solution on unaffected skin (see Flg.2)


Apply alcohol-free barrier film and appropriate dreesing
Consider anti-infiammatory, anti-pruritic agents and/ or analgesis; cool compresses (applied on top of dressing)
Assess irritted skin every 24 hrs; monitor for signs and symptoms of infection - If no improvement to sites with suspected contact dermatits, consider short - term use of topical corticosteroid (do not apply directly on exit site)
If no improvement within 3-7 days, consult wound/skin specialist


Apply alcohol-free barrier film and appropriate dreesing
Consider anti-infiammatory, anti-pruritic agents and/ or analgesis; cool compresses (applied on top of dressing)
Assess irritted skin every 24 hrs; monitor for signs and symptoms of infection - If no improvement to sites with suspected contact dermatits, consider short - term use of topical corticosteroid (do not apply directly on exit site)
If no improvement within 3-7 days, consult wound/skin specialist


Apply alcohol-free barrier film and appropriate dreesing
Consider anti-infiammatory, anti-pruritic agents and/ or analgesis; cool compresses (applied on top of dressing)
Assess irritted skin every 24 hrs; monitor for signs and symptoms of infection - If no improvement to sites with suspected contact dermatits, consider short - term use of topical corticosteroid (do not apply directly on exit site)
If no improvement within 3-7 days, consult wound/skin specialist


Apply alcohol-free barrier film and appropriate dreesing Apply alcohol-free barrier film and appropriate dreesing
Consider anti-infiammatory, anti-pruritic agents and/ or analgesis; cool compresses (applied on top of dressing) Consider anti-infiammatory, anti-pruritic agents and/ or analgesis; cool compresses (applied on top of dressing)
Assess irritted skin every 24 hrs; monitor for signs and symptoms of infection - If no improvement to sites with suspected contact dermatits, consider short - term use of topical corticosteroid (do not apply directly on exit site)
If no improvement within 3-7 days, consult wound/skin specialist


Educate staff and/or patients/caregivers on proper dressing selection, atraumatic application/removal, site care
identify patients at risk and take precautions with site care (e.g. malnutrition, dehydration, eiderly/neonates, dermatologic conditions, low/high humidity, rediation therpy, medications [chemotherapy, anti-inflammatories, including long-term corticosteroid use, anticoagulants])


Educate staff and/or patients/caregivers on proper dressing selection, atraumatic application/removal, site care
identify patients at risk and take precautions with site care (e.g. malnutrition, dehydration, eiderly/neonates, dermatologic conditions, low/high humidity, rediation therpy, medications [chemotherapy, anti-inflammatories, including long-term corticosteroid use, anticoagulants])


Educate staff and/or patients/caregivers on proper dressing selection, atraumatic application/removal, site care
identify patients at risk and take precautions with site care (e.g. malnutrition, dehydration, eiderly/neonates, dermatologic conditions, low/high humidity, rediation therpy, medications [chemotherapy, anti-inflammatories, including long-term corticosteroid use, anticoagulants])


Educate staff and/or patients/caregivers on proper dressing selection, atraumatic application/removal, site care Educate staff and/or patients/caregivers on proper dressing selection, atraumatic application/removal, site care
identify patients at risk and take precautions with site care (e.g. malnutrition, dehydration, eiderly/neonates, dermatologic conditions, low/high humidity, rediation therpy, medications [chemotherapy, anti-inflammatories, including long-term corticosteroid use, anticoagulants]) dermatologic conditions, low/high humidity, rediation therpy, medications [chemotherapy, anti-inflammatories,