My son, Tyler, has had a total of 26 central lines. Some of those lines were temporary and some were meant to last a long time, like the Port-A-Cath that he had last year. Tyler has been very traumatized by these line placements and especially by painful dressing changes. After watching him struggle for years, I finally came up with a better solution: ultraviolet light sterilization.
Unfortunately, Tyler has lost a lot of the permanent lines because of fungemia (fungus or yeast in the blood). Yeast is sticky and cannot be cleared from the line, so if there's yeast, the line must be pulled. There's really no getting around pulling it. Trust me, I've tried everything to save the lines, including extended use of antifungal medications. Some other of Tyler's lines became dislodged, some were pulled out by Tyler, some broke and some just quit working.
Having a line placed 26 separate times has left Tyler understandably traumatized. I can only imagine how he feels. I clearly remember crying hysterically when I was nine years old because I was taken for a blood draw, which is nothing compared to what it takes to place a central line. Maybe I was a little bit dramatic, but I really was scared! Each time we would take Tyler to the hospital, he knew where we were and knew what was to ensue. He would panic. I would panic. My heart would break into a million pieces as I would lower his pants for that shot of Ketamine that would rob my son of consciousness and turn him into a hallucinating, teeth grinding, moaning, blob of a kid.
That sort of sedation is normal where we go for his PICC line placements, much to my dismay. Tyler had his first central line placed when he was only two days old, and the last one, a Broviac, placed when he was six years and two months old, which is what he has now.
Tyler’s anxiety had gotten to the point that he would become hysterical when I would attempt to change his dressing. He knew that the chlorhexidine that I would use to clean his site was going to hurt him. It would always sting. Anytime that there's broken skin, chlorhexidine is going to sting, and Tyler had broken skin every time we needed to do a dressing change. Just removing the occlusive dressing would create small lesions, so it was nearly impossible to use the chlorhexidine without hurting him. I would try to soothe and distract him the best I could, and reassure him that I was being very careful and gentle. But it just didn't matter to him. He knew it would hurt and didn't care what I had to say about it.
He fought me tooth and nail the entire time, making it impossible to do a sterile dressing change. Consistently, Tyler thrashing about would contaminate my sterile field. Not once was I able to keep the central line site sterile. Tyler's free hand was always grabbing for the chlorhexidine wand, and he would end up touching the site that I was trying to clean. After awhile, I measured success by whether I got through the dressing without dislodging the central line. The dressing changes really weren’t successful, though, because they were not performed in a sterile fashion. My standards for dressing changes were lessening and that was not a good thing.
A Better Way
Considering that sepsis (infection in the blood) is the tenth leading cause of death in the United States, I knew that I had to come up with a better way to clean his central line. I needed the lines to last a lot longer than they were. I could have used restraints on Tyler during dressing changes, but I just wouldn't do that to my son. He's already been through enough, and tying him down would only add to his fears and frustrations. I took it upon myself to find a better way to sterilize his line. I needed to find something that was at least as good as a chlorhexidine swab, which according to one manufacturer’s website, "has two distinct mechanisms of action: [alcohol] rapidly kills microorganisms by denaturing cell proteins," and, "[chlorhexidine] maintains persistent antimicrobial activity by disrupting the cell membrane and precipitating cell contents."1
I had been brainstorming about what I could do to help our problem with dressing changes when I thought of a gift that I had given a germ-a-phobe friend of mine; a toothbrush sanitizer that utilized ultraviolet light. I thought of the many products now available on the market that are being used to sanitize various surfaces without the use of harsh chemicals. I thought, "Why not use ultraviolet light to sterilize central lines?" and went straight to Google to see if such a thing were already in existence.
The direct answer to that question is no, there is not a product on the market utilizing ultraviolet light to sterilize central lines. There is, however, a product used to treat infected bedsores that utilizes Ultraviolet-C (UVC). UVC is part of the ultraviolet light spectrum that is filtered out by the earth's atmosphere. During my search, I learned that UVC has been used for over 100 years in different settings to kill germs.
MedFaxx manufactures the V-254 Wound Healing Lamp, which emits UVC radiation. It is FDA approved for the treatment of bedsores, which can be brutal to heal once infected. The lamps have already proven very successful for this use, but I wondered if they could be used for sterilizing a central line. According to the MedFaxx website, "if the lamp is 1 inch away from the wound for 90 seconds then basically all pathogens have been killed, including MRSA and VRE."2 Included on their website is the following description of how the lamp works:
Our UVC light penetrates the outer membrane of viruses, bacteria, mold and even yeasts. This causes the modification of the DNA structure and eliminates the possibility of microbe reproduction resulting in the death of the microbe. Generally speaking, when bacteria is prevented from reproduction then death is imminent. All microorganisms have different levels of tolerance to UV which is called the "D" value, which makes it possible to estimate the time necessary to totally destroy the microbe. No known pathogen has ever been able to mutate and protect itself from the effects of UVC light.3
The last sentence got my attention. This means that it is more effective than any drug that could be used topically on a central line site. UVC has the broadest spectrum of all known sterilizing agents. Nothing can survive. Nothing can mutate to even try to survive. I had found the ultimate way to sterilize my son's central line, and it wouldn't hurt him. I called MedFaxx and spoke with the owner of the company, Mr. Bob Johnson, who was eager to educate me about the benefits of UVC. Though the lamp was not created specifically for central line care, there was no apparent reason why it shouldn't be used for it. After consulting with Tyler's pediatrician and his surgeon, who were intrigued by the idea, I ordered the lamp and eagerly awaited its arrival.
Pain-free Dressing Changes
When it came time to use the lamp for a dressing change, I showed it to Tyler first. I put the lamp over his hand and said, "See? It's just a light! I'm not going to use anything to hurt you! Isn't that great?" I don't think Tyler trusted me completely because he still cried as I took off the occlusive dressing. I kept reassuring him. The moment came when I took the lamp and held it only an inch away from his central line and began to count. Tyler watched attentively as his arm was illuminated in a blue hue. When the time was up, I simply put on a new occlusive dressing. I think Tyler was waiting for me to do something else because I hadn't hurt him. I watched his site carefully for the next week, making sure that he had no burns or signs of infection. Much to my relief, Tyler's site remained infection-free and his skin was its normal color.
It has been over a year now since I have been using the V-254 Wound Healing Lamp to sterilize Tyler's central line, and have done so without incidence. Because Tyler is a little kid who likes to wiggle his fingers underneath his occlusive dressing, we have encountered some infections. When this happens, I use the lamp, and if there is any drainage at the site, I use sterile gauze that has been wetted with sterile saline to wipe it away. I also use a Silverlon Lifesaver (an antimicrobial disc embedded with silver and designed to reduce bacteria) to help prevent infection.
Tyler's central line care has been significantly easier since using the lamp, and his stress level has been reduced tremendously. Overall, my brainstorming idea proved to be a perfect solution for our central line care needs. I am hopeful that in time similar products will be used for all central lines, as it's a drug-free, pain-free, cost-effective way to care for them.
Please Note: Consult your physician before making any changes to your central line care regimen. In addition, the vast majority of UVC lamps available on the market are not FDA approved. It is important to use only approved medical devices, such as the MedFAXX lamp mentioned in this article.
More information and contact information for the author,Laura Bailey can be found here: http://www.complexchild.com/.