Help with scab removal?

[Angiepkd]

Hi all! I am starting my 4th week of training tomorrow. I have spent the last week making button holes and will start trying blunt needles on Tuesday or Wednesday.  I have been having trouble removing my scabs. The tweezers are too big and the pickers from the ends of the blunts don't help much, either.  I plan on trying the facial scrubbers when I start at home, but can't use them at my center. Any suggestions?  Thanks!

[Bill Peckham]

Here is the advice from the NW Renal Network (PDF) which is about what Northwest Kidney Centers teaches

Scab Removal

• Moistening scabs allow for easier removal. Scabs can be moistened using a 2x2 with normal saline or alcohol-based gel; scrubbing arm with soap and water; or having patients tape an alcohol pad to their scabs before coming to dialysis.
• Once scabs are moistened, use your thumb and forefinger on top of the 2x2; pinch the scabs off; turn the 2x2 over to make sure you got the entire scab; prep the sites according to policy

[Angiepkd]

Thanks, Bill! I will give it a try today. Hopefully it will help. Right now the scab removal hurts worse than the needles.

[Rerun]

EWWWUUUuuuu


         

[Speedy1wrc]

I use Exsept antiseptic. I soak 4x4's in the solution and lay them over each site for at least 2 min's. The time is for the antiseptic to work. Then I take each gauze and scrub for a minute or so. I try not to wet the pads too much which makes them just a touch abrasive but only as much as a gauze pad can be. I them use the pic, however the scabs are usually pretty much gone by that point. Then I use a clean 4x4 with Exsept to clean again and leave it in place till it's time to cannulate.

Once done and a few hours later when I pull the gauze bandages off after treatment, I put a dab of Neosporin(pain formula) over each site to prevent infection.

So far I have been happy with that technique. The center pays for the 4x4's and I have plenty so it saves buying scrubby pads and it is more antiseptic too.

[dublin]

Hi all! I am starting my 4th week of training tomorrow. I have spent the last week making button holes and will start trying blunt needles on Tuesday or Wednesday.  I have been having trouble removing my scabs. The tweezers are too big and the pickers from the ends of the blunts don't help much, either.  I plan on trying the facial scrubbers when I start at home, but can't use them at my center. Any suggestions?  Thanks!

Hi in the center i am in they have little white pointy hard plastic sticks about 1 inch long you should be able to get them in the center you are in. :bandance;i hope that helps

[Speedy1wrc]

dublin...we actually do. Our blunt needles hav them as part of the needle shield. There is a small pic in the end cap of the needle guard. They are as Angie mentoned sometimes ineffective though.

[Angiepkd]

Thanks everyone! I am still struggling through the scab removal process lol!  On Monday I tried a little neosporin on a bandaid, and put it on before I left for training. That worked pretty well, and most of the scab was removed with a 2x2. My nurse wasn't crazy about that technique, so today I tried the alcohol pad under the bandaid.  This burned a little, so I took the alcohol pads out and wet the band aids with water. This didn't work at all. I picked with the picks from the blunts and rubbed with 2x2's until my arm was sore, but managed to remove the scabs.  Then tried to cannulate with blunt needles for the first time and couldn't get them in.  Tried and tried (arm now really sore) but finally used sharps.  To top it off, came home to find the dog eating the cord that NxStage shipped to me for my cycler. Not one of my better days, but I will try again tomorrow!   Home hemo doesn't use Exsept at my center. Not sure why?

[Speedy1wrc]

Neosporin in an oil based product, so after use you'd need to use a lot of soap and water then alcohol to get rid of any residue.

Exsept is around $20 for 200ml which is only 6+ ounces, so I think it would be cost prohibitive to buy on your own. I use, I think around 12 ounces per week, so that would be in the area of $40. I suppose you could ask if the center will cover it?

Something to think about...you've got a decent amount of saline which is sterile. If you could bleed off enugh to dampen a 4x4(s) when doing setup up, that might work? Let it sit on the site(s) for at least a couple minutes before cannulating. Once they are softened you really shouldn;t have to scrud that hard.

After the prime is done, just before you connect the saline line to the T you can bleed some off there(the saline line, not the T). I'm sure highly against procedure, but maybe?

It took my tracts a good while to develop. The standard 9 or so attempts till use wasn't close. Now they almost always go in like butter. They still hurt some, but behave much nicer. I'd guess it took 6 weeks x 5 day's/week? They can be a touch tougher after my off day, but still no problems.

[Angiepkd]

Thanks, Speedy. I am going to be at home on Monday for my first treatment (with my nurse).  After that I will try using the Stuart Mott scrubber method. Until then I will try the saline. Used sharps today, but will try the blunts tomorrow. I know I will get it eventually! Thanks again for the help!

[amanda100wilson]

I use Emla cream with a Tegaderm but I am worried about ling-term use of lidocaine.  I don't really need it for numbing anymore since we re-did my buttonholes as there is no pain now.  However, I do have problems removing scabs.  I tried the technique that you mentioned, Bill and it didn't work for me.  my scabs always tend to,be a bit recessed so wiping them off with gauze after softening them doesn't work.  I can wipe off the top of,them scab but there is always a clear scab underneath that doesn't come off.

[noahvale]

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[Bill Peckham]

Please do not use neosporin.  You can quickly build up a tolerance and it can possibly cause a bad rash or even infection.   

citation? Aside from people who have an allergic reaction I haven't seen it contraindicated. Obviously if one is allergic it should not be used.

However, I do have problems removing scabs.  I tried the technique that you mentioned, Bill and it didn't work for me.  my scabs always tend to,be a bit recessed so wiping them off with gauze after softening them doesn't work.  I can wipe off the top of,them scab but there is always a clear scab underneath that doesn't come off.

Amanda I have to dig mine out too about half the time. I am sure to wash my hands and access with soap and water, dry with paper towel and then wipe the sites with an alcohol prep pad. The I use a 20 gauge needle to patiently scrap the scab out of the divot. I use one needle per scab and am careful to not poke myself with the needle.

I also try to go at the scab from different directions day to day. That seems to keep the divot from getting deeper.

[Speedy1wrc]

I use the tiniest amount of Neosporin, but only after a scab is well formed. The Dr actually prescribed it.

So far, so good.

[Angiepkd]

I am in the same boat! It's that clear part in the divot that is really hard to get out. I am starting to wish I had asked for the Emla cream, just for the scabs lol!  Who would have thought I would prefer giant needles to removing some little scabs?!  I will let you know how the facial scrubbers work when I can try them on Tuesday. Hoping for an easy fix!  Thanks again for taking time to reply!  You have all made this journey so much easier for me!

[amanda100wilson]

the facial scrubbers son't work for me because hey don't get the scab off, let alome what is left in the divot.  scab removal is h part I like least.  When I was training, have my husband learn how yo pick the scabs off was, from a psychological viewpoint, the hardest part. Obvupiously that is a not an issue because he foesn't help me.

[KatieV]

I use a 2x2 soaked with saline, with a drop of antibactrical soap that goes right over the scabs.  I have them sit for about 15 minutes or so.  The scabs usually come right off with a little rubbing.

[Angiepkd]

I will try the saline and soap method on Monday! On a happier note, I got both blunts in my buttonholes today with little problem. So, so excited about this accomplishment!  It's the little things, right? Thanks for the input!   

[Speedy1wrc]

After the first time they go in easy, it should be like that from now on. You may have a day here or there where they are a bit more stubborn, but overall they should go in smoothly.

[PKDSTGV]

I use EMLA cream as well. I still have a stinging sensation, even with the buttonholes so the EMLA is for dual reasons. I've found it's the best option for softening scabs and making accessing my fistula more comfortable. I just apply a small amount to my buttonholes one hour prior to treatment (usually when I start my cartridge) and cover with two bandaids. When it's time for me to get on, I remove the bandaids, clean with a 4X4 then alcohol swabs and then use the pick in combo with tweezers. It's important to make sure your buttonhole is as clear as possible so that you don't accidentally push any scab material into your vein. My center taught me to pick the buttonhole until it's "cherry" red and fully open. The EMLA cream helps with any discomfort this might cause. Hope this helps!

[PatDowns]

Please do not use neosporin.  You can quickly build up a tolerance and it can possibly cause a bad rash or even infection.   

citation? Aside from people who have an allergic reaction I haven't seen it contraindicated. Obviously if one is allergic it should not be used.

Efficacy
Despite numerous trials, there is little data that Neosporin provides any benefit to users. As compared to covering a small wound with simple petroleum jelly, Neosporin does not provide any benefit,[4] but commonly causes contact dermatitis[5] while contributing to antibiotic resistance.[6][7]

The high incidence of contact dermatitis associated with Neosporin has earned it the Allergen of the Year award.

References
^ Martin, David (14 September 2011). "MRSA in U.S. becoming resistant to over the counter ointment". CNN. http://thechart.blogs.cnn.com/2011/09/14/mrsa-in-u-s-becoming-resistant-to-over-the-counter-ointment/. Retrieved 2 June 2012.
^ Suzuki, M; Yamada, K; Nagao, M; Aoki, E; Matsumoto, M; Hirayama, T; Yamamoto, H; Hiramatsu, R et al. (2011). "Antimicrobial ointments and methicillin-resistant Staphylococcus aureus USA300". Emerging infectious diseases 17 (10): 1917–20. doi:10.3201/eid1710.101365. PMC 3310646. PMID 22000371.
^ "McNeil Consumer Products Co. strengthens worldwide lead in OTC pain reliever market" (Press Release). Business Wire (Fort Washington, PA: Business Wire). 1997 June 5. Retrieved June 28, 2011
^ Draelos, ZD; Rizer, RL; Trookman, NS (2011). "A comparison of postprocedural wound care treatments: Do antibiotic-based ointments improve outcomes?". Journal of the American Academy of Dermatology 64 (3 Suppl): S23–9. doi:10.1016/j.jaad.2010.11.010. PMID 21247662.
^ Sheth, VM; Weitzul, S (2008). "Postoperative topical antimicrobial use". Dermatitis : contact, atopic, occupational, drug : official journal of the American Contact Dermatitis Society, North American Contact Dermatitis Group 19 (4): 181–9. PMID 18674453.
^ Spann, CT; Taylor, SC; Weinberg, JM (2004). "Topical antimicrobial agents in dermatology". Disease-a-month : DM 50 (7): 407–21. doi:10.1016/j.disamonth.2004.05.011. PMID 15280871.
^ Trookman, NS; Rizer, RL; Weber, T (2011). "Treatment of minor wounds from dermatologic procedures: A comparison of three topical wound care ointments using a laser wound model". Journal of the American Academy of Dermatology 64 (3 Suppl): S8–15. doi:10.1016/j.jaad.2010.11.011. PMID 21247665.
 
http://thechart.blogs.cnn.com/2011/09/14/mrsa-in-u-s-becoming-resistant-to-over-the-counter-ointment/

[NDXUFan]

Thanks, Bill! I will give it a try today. Hopefully it will help. Right now the scab removal hurts worse than the needles.

Bill is correct, you do not need those stupid tweezers.  Centers are moving away from that method.  My center, Indiana University, has an infection rate of 0% with fistulas.  I will post the IU method, if you are interested, it is extremely easy. 

[Bill Peckham]

Please do not use neosporin.  You can quickly build up a tolerance and it can possibly cause a bad rash or even infection.   

citation? Aside from people who have an allergic reaction I haven't seen it contraindicated. Obviously if one is allergic it should not be used.

Efficacy
Despite numerous trials, there is little data that Neosporin provides any benefit to users. As compared to covering a small wound with simple petroleum jelly, Neosporin does not provide any benefit,[4] but commonly causes contact dermatitis[5] while contributing to antibiotic resistance.[6][7]

The high incidence of contact dermatitis associated with Neosporin has earned it the Allergen of the Year award.

References
^ Martin, David (14 September 2011). "MRSA in U.S. becoming resistant to over the counter ointment". CNN. http://thechart.blogs.cnn.com/2011/09/14/mrsa-in-u-s-becoming-resistant-to-over-the-counter-ointment/. Retrieved 2 June 2012.
^ Suzuki, M; Yamada, K; Nagao, M; Aoki, E; Matsumoto, M; Hirayama, T; Yamamoto, H; Hiramatsu, R et al. (2011). "Antimicrobial ointments and methicillin-resistant Staphylococcus aureus USA300". Emerging infectious diseases 17 (10): 1917–20. doi:10.3201/eid1710.101365. PMC 3310646. PMID 22000371.
^ "McNeil Consumer Products Co. strengthens worldwide lead in OTC pain reliever market" (Press Release). Business Wire (Fort Washington, PA: Business Wire). 1997 June 5. Retrieved June 28, 2011
^ Draelos, ZD; Rizer, RL; Trookman, NS (2011). "A comparison of postprocedural wound care treatments: Do antibiotic-based ointments improve outcomes?". Journal of the American Academy of Dermatology 64 (3 Suppl): S23–9. doi:10.1016/j.jaad.2010.11.010. PMID 21247662.
^ Sheth, VM; Weitzul, S (2008). "Postoperative topical antimicrobial use". Dermatitis : contact, atopic, occupational, drug : official journal of the American Contact Dermatitis Society, North American Contact Dermatitis Group 19 (4): 181–9. PMID 18674453.
^ Spann, CT; Taylor, SC; Weinberg, JM (2004). "Topical antimicrobial agents in dermatology". Disease-a-month : DM 50 (7): 407–21. doi:10.1016/j.disamonth.2004.05.011. PMID 15280871.
^ Trookman, NS; Rizer, RL; Weber, T (2011). "Treatment of minor wounds from dermatologic procedures: A comparison of three topical wound care ointments using a laser wound model". Journal of the American Academy of Dermatology 64 (3 Suppl): S8–15. doi:10.1016/j.jaad.2010.11.011. PMID 21247665.
 
http://thechart.blogs.cnn.com/2011/09/14/mrsa-in-u-s-becoming-resistant-to-over-the-counter-ointment/

oops did you forget to change your login? I think Noah was the one who was suppose to provide the citation but thanks Pat

[Simon Dog]

Once done and a few hours later when I pull the gauze bandages off after treatment, I put a dab of Neosporin(pain formula) over each site to prevent infection.

I put a betadine patch under the gauze when taping up for the same reason.  I could never get comfortable with putting non sterile gauze (the FMC clinics use clean gause in bulk packs, not sterile packets of gauze - and issue the same to us home hemoites).

[obsidianom]

Our FMC clinic suppies us with STERILE 2by 2 and 4by 4s. Also we get sterile island dressing which I use to cover the buttonholes during the day after changing the original dressing. I treat the buttonholes like a surgical wound and use only aseptic technique and a mask and gloves ALWAYS.