Bio Seal CVC Powder Application Welcome to the

Bio. Seal CVC Powder Application Welcome to the Bio. Seal CVC Powder Application Computer-Based Learning Module (CBL) Who should take this CBL? • Any clinician that will insert, maintain or remove a Central Venous Catheter (CVC), other catheter or tube • Any nurse/clinician that may care for patients with bleeding wounds If CBL does not start automatically, select “View Show” from Slide Show menu above.

Menu It will take approximately 20 minutes to navigate through this CBL. Click the links below to jump to selected “chapters” in the course. Introduction How Does Bio. Seal CVC Powder Work? Hospital Uses of Bio. Seal CVC Powder Protocol for CVCs and Tubes Application Tips More Information on Bio. Seal CVC Summary References Bio. Seal CVC Powder Application 2

Introduction Course Objectives • Describe Bio. Seal CVC Powder • Describe the mechanism of action of Bio. Seal CVC Powder • Discuss the benefits of Bio. Seal CVC Powder usage • Explain the many hospital uses of Bio. Seal CVC Powder • Learn protocol for applying Bio. Seal CVC Powder for catheters and tubes • List powder application tips • Learn how to find more information on the product and how to order Bio. Seal CVC Powder Application 3

Introduction What is Bio. Seal CVC Powder? • Bio. Seal CVC is a topical powder that forms an occlusive seal to stop the flow of blood and exudates from a wound and keep microbes from entering the site. • The ingredients are a mixture of a hydrophilic polymer and potassium ferrate. • Bio. Seal CVC Powder is a brown powder. • Bio. Seal CVC Powder is not a vasoconstrictor or a cauterizing agent. • Bio. Seal CVC is non-systemic, non-toxic and it is not biologically derived. Bio. Seal CVC Powder Application 4

How Does Bio. Seal CVC Work? Mechanism of Action Bio. Seal CVC Powder creates a seal or barrier to stop the flow of blood or exudates. The mechanism of action is a simultaneous two step action: 1. 2. The polymer rapidly dehydrates the blood and absorbs exudates. The potassium ferrate component agglomerates the blood protein creating an occlusive barrier. Dry powder Bio. Seal CVC Powder Seal Actual electron microscopy image 5 French catheter Bio. Seal CVC Powder Application 5

How Does Bio. Seal CVC Work? The Difference is the Seal The “Bio. Seal” works as an occlusive dressing to: • Provide a barrier that stops the flow of blood or exudate and prevents microbes from getting in (allows nothing in, nothing out) • Keep access sites dry and intact • Create a hostile environment to inhibit microbial activity • Eliminate 24 or 48 -hour dressing changes and cost of dressing change kits • Increase patient satisfaction (less disruption of site and fewer complications from bleeding/exudate leakage) Bio. Seal CVC Powder Application 6

How Does Bio. Seal CVC Work? More Product Benefits • Proven to achieve hemostasis in less than two minutes for venous access procedures • Seal forms independently of the blood clotting cascade (works for patients on anticoagulation therapy, high INR, low platelets) • Not metabolized by the body and not biologically derived, which minimizes the potential for allergic reactions • Passed all FDA-required biocompatibility tests • Easy to use Bio. Seal CVC Powder Application 7

Hospital Uses of Bio. Seal CVC Applications Use Bio. Seal CVC Powder with the following devices to stop bleeding and oozing and protect the site: Vascular Devices (insertions and removal): • PICCs/Midlines • Central Venous Catheters • Dialysis Catheters • Arterial Catheters (maintenance) Also effective in controlling bleeding and exudate leakage from Non-Vascular Devices such as: • Peritoneal dialysis catheters • Epidural catheters • Large-bore needles used for paracentesis, thoracentesis, or biopsies • PEG/Gastrostomy feeding tubes Bio. Seal CVC Powder Application Photo by Penny Offer, CRNI 8

How Does Bio. Seal CVC Work? Review Question The ingredients of Bio. Seal CVC Powder are: A. An oxidized cellulose gauze B. A hydrophilic polymer and potassium ferrate C. A calcium alginate wound dressing D. Chitosan and potassium Place the pointer over the desired answer and click the left mouse button for immediate feedback. Bio. Seal CVC Powder Application 9

How Does Bio. Seal CVC Work? Review Question A characteristic or benefit of the “Bio. Seal” is: A. It stops bleeding and absorbs exudates. B. It provides a barrier that allows nothing in, nothing out. C. It creates a hostile environment to inhibit microbial activity. D. All of the above. Place the pointer over the desired answer and click the left mouse button for immediate feedback. Bio. Seal CVC Powder Application 10

Protocol for Catheter Insertion 1. Insert and secure line per protocol. 2. If gloves are wet with blood or other fluids, clean them with sterile saline and dry them with gauze to prevent Bio. Seal CVC Powder from sticking to gloves. For Horizontal Surfaces: 3. Pour powder to completely cover the site (create a small pile). Pour Powder For Vertical Surfaces: 3. Place Powder Containment Device (PCD) around site, fill the PCD with powder. 4. Apply continuous firm pressure directly over powder with clean, dry gloved fingers for 2 minutes to form the “Bio. Seal” and achieve hemostasis. For anticoagulated patients or larger catheter sizes, longer holding times may be required. 5. Cover site with transparent dressing. Press and form transparent dressing around powder to help contain it around the access site. 6. Apply Bio. Seal CVC sticker on top of transparent dressing without obstructing view of site. Bio. Seal CVC Powder Application Hold Pressure Seal is formed 11

Protocol for Dressing Changes/Maintenance 1. Remove transparent dressing from site. Most of powder will come off with the dressing. 2. Gently remove excess powder with dry sterile gauze. 3. Use chlorhexidine to lightly clean around the area. Do not remove the Bio. Seal. The seal is an integral part of physically preventing microbial colonization down the external surface of the line. Aggressive scrubbing is not recommended as it will damage the seal. 4. Observe site for tissue impressions or skin irritation. 5. Reapply transparent dressing per hospital protocol. Bio. Seal CVC Powder Application 12

Protocol Pull Backs If pull back is necessary, brush away excess powder and then use chlorhexidine (or sterile saline) to loosen the “Bio. Seal”. (The seal must be broken before the catheter can be pulled back. ) After pull back, repeat Bio. Seal CVC Powder application steps. Bio. Seal CVC Powder Application 13

Protocol for PICC Line Discontinuation 1. Remove transparent dressing from site. 2. Brush away any excess powder, remove “Bio. Seal” with chlorhexidine (or sterile saline) as needed and gently remove line. You may feel an initial “tug” as the seal is broken. 3. Apply Bio. Seal CVC Powder if bleeding occurs. 4. Dress site per team protocol. Bio. Seal CVC Powder Application 14

Protocol for Central Catheter Removal 1. Follow hospital/team protocol for patient positioning. 2. Remove transparent dressing from site. 3. Cleanse exit site with chlorhexidine. 4. Place the Powder Containment Device (PCD) around catheter. Try to make the application area as flat as possible (less vertical). 5. Fill the PCD with Powder. 6. Gently remove the catheter while simultaneously applying direct pressure to the site (directly over PCD/powder). Bio. Seal CVC Powder Application 15

Protocol for Central Catheter Removal Hold pressure over site for 2 -3 minutes to allow seal to form. 7. • Anticoagulated patients or larger French sizes may require longer hold times. 8. Release pressure slowly – roll fingers off powder. 9. If a rebleed occurs, apply more powder. 10. Dress site per hospital protocol. 11. Provide Patient Discharge Instructions. If patient is being discharged, remind patient not to remove seal. Bio. Seal CVC Powder Application 16

Protocol for PEG Tubes 1. Pour Bio. Seal CVC Powder directly around site/tube. Cover site completely. 2. Apply pressure for two minutes to form the protective seal. If bleeding continues, repeat application. 3. Dress per protocol. For tube removal: 1. Brush away any excess powder, remove the “Bio. Seal” with chlorhexidine (or sterile saline) as needed and gently remove tube. You may feel an initial “tug” as the seal is broken. 2. Apply Bio. Seal CVC Powder and hold pressure if bleeding occurs. 3. Dress site per protocol. Bio. Seal CVC Powder Application 17

Protocols Review Question If gloves are wet with blood or other fluids, clean them with sterile saline and dry them with gauze to prevent Bio. Seal CVC Powder from sticking to gloves. True False Place the pointer over the desired answer and click the left mouse button for immediate feedback. Bio. Seal CVC Powder Application 18

Protocols Review Question For dressing changes you should do which of the following: A. After removing transparent dressing, remove excess powder with your fingers. B. Remove the "Bio. Seal" if it is adhered to the line. C. Use chlorhexidine to lightly clean the area. Do not remove seal. D. Scrub aggressively on top of and around the line with chlorhexidine. Place the pointer over the desired answer and click the left mouse button for immediate feedback. Bio. Seal CVC Powder Application 19

Application Tips Do’s • Completely cover site with powder. • Apply firm, continuous pressure for two minutes directly over site with dry gloved fingers or non-adherent dressing to form the protective seal and achieve hemostasis. • Leave seal over site; it will fall off naturally on its own, or if needed, may be removed with sterile technique. Dry/intact dressing 0 to 7 days Photo by Penny Offer, CRNI Bio. Seal CVC Powder Application 20

Application Tips Don'ts • Don’t hold pressure over Bio. Seal CVC Powder with gauze to avoid tearing the seal. • Don’t check for hemostasis before the recommended holding time. This could disturb the seal formation. • Don’t use Bio. Seal for internal bleeding as it is not biodegradable. Note: Upon application, a temporary warming or sensation may be felt when holding pressure over the powder. Bio. Seal CVC Powder Application 21

Application Tips Review Question When applying Bio. Seal CVC Powder following line insertion, you should check for hemostasis before the recommended holding time of two minutes. True False Place the pointer over the desired answer and click the left mouse button for immediate feedback. Bio. Seal CVC Powder Application 22

Application Tips Review Question Which of the following should not be used to hold pressure over Bio. Seal CVC Powder? A. Telfa B. Dry, gloved fingers C. Gauze D. All of the above Place the pointer over the desired answer and click the left mouse button for immediate feedback. Bio. Seal CVC Powder Application 23

More Information on Bio. Seal CVC Educational Tools There are resources available to educate both patients and clinicians about Bio. Seal CVC Powder. These resources include: • Instructions for Patients and Medical Staff • Posters • Protocol sheets • These resources are available at www. biosealcvc. com. Bio. Seal CVC Powder Application 24

More Information on Bio. Seal CVC Ordering Information Order Number Product Description LP 606 6 Applications per Box* LP 636 24 Applications per Case* Call Biolife at 800 -722 -7559 for more information. Bio. Seal CVC Powder Application 25

Summary This CBL course has focused on: • Uses of Bio. Seal CVC Powder in a hospital setting • The components and mechanism of action of Bio. Seal CVC Powder • Benefits of Bio. Seal CVC usage • Protocol for applying Bio. Seal CVC Powder for CVC insertion, maintenance and removal as well as protocol for tubes • Powder application tips • How to find more information on the product and how to order Bio. Seal CVC Powder Application 26

References/Credits • Wang DS, Chu LF, Olson SE, Miller FJ, Valji K, Wong WH, Rose SC, Austin M, Kuo MD. Comparative Evaluation of Noninvasive Compression Adjuncts for Hemostasis in Percutaneous Arterial, Venous, and Arteriovenous Dialysis Access Procedures. J Vasc Interv Radiol 2008; 19: 72 -79. • Photos are the property of Biolife, LLC. Bio. Seal CVC Powder Application 27

Exit We hope this Computer Based Learning course has been both informative and helpful. Feel free to review the screens of this course until you are confident about your knowledge of the material presented. Press Esc key to exit presentation and then close Power. Point® application. * (*this screen can be customized to interface with each institution’s learning management system). Bio. Seal CVC Powder Application 28

Review Question Feedback Your answer is correct! Bio. Seal CVC Powder is made of a hydrophilic polymer and potassium ferrate. Return to Course Bio. Seal CVC Powder Application 29

Review Question Feedback Your answer is incorrect! Bio. Seal CVC is made of a hydrophilic polymer and potassium ferrate. Return to Course Bio. Seal CVC Powder Application 30

Review Question Feedback Your answer is correct! Bio. Seal CVC Powder stops bleeding and absorbs exudates, provides a barrier that allows nothing in, nothing out and creates a hostile environment to inhibit microbial activity. Return to Course Bio. Seal CVC Powder Application 31

Review Question Feedback Your answer is incorrect! All of the above is the correct answer. Bio. Seal CVC Powder stops bleeding and absorbs exudates, provides a barrier that allows nothing in, nothing out and creates a hostile environment to inhibit microbial activity. Return to Course Bio. Seal CVC Powder Application 32

Review Question Feedback Your answer is incorrect! If gloves are wet with blood or other fluids, they should be cleaned with sterile saline and dried with gauze to prevent Bio. Seal CVC Powder from sticking to gloves. Return to Course Bio. Seal CVC Powder Application 33

Review Question Feedback Your answer is correct! If gloves are wet with blood or other fluids, they should be cleaned with sterile saline and dried with gauze to prevent Bio. Seal CVC Powder from sticking to gloves. Return to Course Bio. Seal CVC Powder Application 34

Review Question Feedback Your answer is incorrect! The correct answer is C. Use chlorhexidine to lightly clean the area, but do not remove the “Bio. Seal”. Return to Course Bio. Seal CVC Powder Application 35

Review Question Feedback Your answer is correct! For dressing changes, use chlorhexidine to lightly clean the area, but do not remove the “Bio. Seal”. Return to Course Bio. Seal CVC Powder Application 36

Review Question Feedback Your answer is incorrect. When applying Bio. Seal CVC Powder, do not check for hemostasis before the recommended holding time of 2 minutes as this could disrupt the seal and cause a rebleed. Return to Course Bio. Seal CVC Powder Application 37

Review Question Feedback Your answer is correct! When applying Bio. Seal CVC Powder, do not check for hemostasis before the recommended holding time of 2 minutes as this could disrupt the PRO QR seal and cause a rebleed. Return to Course Bio. Seal CVC Powder Application 38

Review Question Feedback Your answer is incorrect. C - Gauze is the correct answer. Gauze should not be used to hold pressure over Bio. Seal CVC Powder as it can disturb the seal and cause a rebleed. Return to Course Bio. Seal CVC Powder Application 39

Review Question Feedback Your answer is correct! Gauze should not be used to hold pressure over Bio. Seal CVC Powder as it could disturb the seal and cause a rebleed. Return to Course Bio. Seal CVC Powder Application 40