Whether your child has a subcutaneous port, external catheter, or PICC line, dressing changes will be needed. Some children don’t mind having the Tegaderm® or tape pulled off. For others, it is very difficult. The hospital may have rules about use of certain products, but following are suggestions from parents about ways to make dressing changes easier for children and teens.

• To cover EMLA®, try plastic wrap cut into a square and use paper tape or tape with perforations. If you turn the ends back of the paper tape to form tabs, you won’t have to pick at the corners when it needs to be pulled off.

Our daughter, diagnosed with T-cell ALL at age 5, is allergic to almost every adhesive and has developed horrible PTSD from tape removal. We can’t even use plastic wrap over EMLA, and we need to bring our own brand of Band-Aids®. We tried everything, and what works best is using Mepitac®, a soft brown spongy tape used for preemies and Brava®, a spray adhesive remover.

• Don’t use Tegaderm® if it bothers your child or reddens the skin.
• Try Hypafix®, a dressing retention material that looks like gauze with a sticky side. Usually, several sterile 2x2 gauze pads are put over the needle entry site, and then Hypafix® is applied to hold them in place.

I like Hypafix® because when it’s time to take it off, you can use the adhesive dissolver where it’s stuck to the skin, and even without the dissolver, it comes off more easily and gently than the Tegaderm®. The nurses at our oncology clinic use this all the time. Our local clinic and hospital do not use Hypafix®, so I bought a roll and take it with me whenever we have to go locally for a port access so we don’t have to use the Tegaderm®.

• Use an adhesive remover such as Detachol® (an orange-colored product made by Eloquest Healthcare—www.eloquesthealthcare.com/detachol).

My 4-year-old daughter hated shots and had very sensitive skin. Any Band-Aids® or dressing changes were really difficult. For EKGs, we’d ask them to clip the lines so we could pull off the stickies when she was sleeping. The nurses used adhesive dissolver for dressing changes, but it was still hard and left her skin raw. We did the bravery beads. Now, at 11 years old, she doesn’t remember what each of the beads mean except the round green ones—for dressing changes. While she doesn’t remember what exactly a dressing change was, she remembers that they hurt and that she didn’t like them.

• Ask for expert advice.

Apryl has had skin tears and reactions from the adhesives as a result of using Tegaderm®. We were using Primapore® dressings for a while, but after a year she started having the same reaction. When she had her line replaced, I asked for a consultation with the skin care nurse. She recommended All-Dress®. It is a waterproof dressing with non-stick gauze in the center surrounded by Hypafix® tape. Apryl changes hers once every three days, whether it gets wet or not. She also has this pink tape that has zinc oxide in the adhesive to protect the skin. These two materials have worked out great.

Using adhesive dissolver (which involves peeling off tape millimeter by millimeter) takes a bit of time, but it works. It has to soak in and takes some time to dissolve the sticky stuff. Once you find a routine that works well, work with the nurses to help determine what works for your child and is within the institution’s policies and procedures.

I know the nurses are really busy, so I deal with this by always being the one to get the Tegaderm® off. I try to make a joke of it: “I have a deal with my kid that I’m taking off the Tegaderm®. It might take a while and I wouldn’t want you to fall asleep waiting on us—how about if I holler out the door when it’s off and we’re ready?” That way they don’t have to stand around and wait, and you don’t feel like you need to hurry your child.

Catheters are usually removed when treatment ends; this process is explained in Chapter 24, End of Treatment and Beyond.

When Scott (age 3) was diagnosed, his doctor gave us a choice of which central line we could use. He showed us a mannequin with a Broviac® and a PORT-A-CATH®. He also told us the pros and cons of each type, then asked us to decide. We chose the Broviac®, and feel it was the best decision for Scott. The day it was installed was the end of a lot of unnecessary pain (from needle sticks) for Scott.

Scott finished all his treatments three months ago, and yesterday he had his Broviac® removed. It went extremely smoothly. And to think I fretted and worried about the removal all week! He has lots and lots of energy. His hair is coming back in and he actually has color in his face. He looks so healthy! I love it!