1. Welcome to the BioSeal 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 BioSeal CVC Powder Application If CBL does not start automatically, select “View Show” from Slide Show menu above.

2. 2 BioSeal CVC Powder Application 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 BioSeal CVC Powder Work? Hospital Uses of BioSeal CVC Powder Protocol for CVCs and Tubes Application Tips More Information on BioSeal CVC Summary References Menu

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

4. 4 BioSeal CVC Powder Application Introduction BioSeal 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. BioSeal CVC Powder is a brown powder. BioSeal CVC Powder is not a vasoconstrictor or a cauterizing agent. BioSeal CVC is non-systemic, non-toxic and it is not biologically derived. What is BioSeal CVC Powder?

5. 5 BioSeal CVC Powder Application How Does BioSeal CVC Work? BioSeal 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.The polymer rapidly dehydrates the blood and absorbs exudates. 2.The potassium ferrate component agglomerates the blood protein creating an occlusive barrier. Mechanism of Action Actual electron microscopy image5 French catheter Seal Dry powder BioSeal CVC Powder

6. 6 BioSeal CVC Powder Application How Does BioSeal CVC Work? The Difference is the Seal The “BioSeal” 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)

7. 7 BioSeal CVC Powder Application How Does BioSeal 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

8. 8 BioSeal CVC Powder Application Hospital Uses of BioSeal CVC Applications Use BioSeal 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 Photo by Penny Offer, CRNI

9. 9 BioSeal CVC Powder Application How Does BioSeal CVC Work? Review Question The ingredients of BioSeal 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.

10. 10 BioSeal CVC Powder Application How Does BioSeal CVC Work? Review Question A characteristic or benefit of the “BioSeal” 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.

11. 11 BioSeal CVC Powder Application 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 BioSeal CVC Powder from sticking to gloves. For Horizontal Surfaces: 3.Pour powder to completely cover the site (create a small pile). 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 “BioSeal” 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 BioSeal CVC sticker on top of transparent dressing without obstructing view of site. Pour Powder Hold Pressure Seal is formed

12. 12 BioSeal CVC Powder Application Protocol for Dressing Changes 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 BioSeal. 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.

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

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

15. 15 BioSeal CVC Powder Application 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).

16. 16 BioSeal CVC Powder Application Protocol for Central Catheter Removal 7. Hold pressure over site for 2-3 minutes to allow seal to form. 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.

17. 17 BioSeal CVC Powder Application Protocol for PEG Tubes 1.Pour BioSeal 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 “BioSeal” with chlorhexidine (or sterile saline) as needed and gently remove tube. You may feel an initial “tug” as the seal is broken. 2.Apply BioSeal CVC Powder and hold pressure if bleeding occurs. 3.Dress site per protocol.

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

19. 19 BioSeal CVC Powder Application 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 "BioSeal" 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.

20. 20 BioSeal CVC Powder Application 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. Do’s Application Tips Dry/intact dressing 0 to 7 days Photo by Penny Offer, CRNI

21. 21 BioSeal CVC Powder Application Don’t hold pressure over BioSeal 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 BioSeal 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. Don'ts Application Tips

22. 22 BioSeal CVC Powder Application Application Tips Review Question When applying BioSeal 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.

23. 23 BioSeal CVC Powder Application Application Tips Review Question Which of the following should not be used to hold pressure over BioSeal 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.

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

25. 25 BioSeal CVC Powder Application More Information on BioSeal CVC Call Biolife at 800-722-7559 for more information. Ordering Information Order NumberProduct Description LP6066 Applications per Box* LP63624 Applications per Case*

26. 26 BioSeal CVC Powder Application This CBL course has focused on: Uses of BioSeal CVC Powder in a hospital setting The components and mechanism of action of BioSeal CVC Powder Benefits of BioSeal CVC usage Protocol for applying BioSeal 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 BioSeal CVC Powder Summary

27. 27 BioSeal CVC Powder Application 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. References/Credits

28. 28 BioSeal CVC Powder Application 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. Exit Press Esc key to exit presentation and then close PowerPoint ® application.* (*this screen can be customized to interface with each institution’s learning management system).

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

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

31. 31 BioSeal CVC Powder Application Review Question Feedback Return to Course Your answer is correct! BioSeal 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.

32. 32 BioSeal CVC Powder Application Review Question Feedback Return to Course Your answer is incorrect! All of the above is the correct answer. BioSeal 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.

33. 33 BioSeal CVC Powder Application Review Question Feedback Return to Course 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 BioSeal CVC Powder from sticking to gloves.

34. 34 BioSeal CVC Powder Application Review Question Feedback Return to Course 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 BioSeal CVC Powder from sticking to gloves.

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

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

37. 37 BioSeal CVC Powder Application Review Question Feedback Return to Course Your answer is incorrect. When applying BioSeal 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.

38. 38 BioSeal CVC Powder Application Review Question Feedback Return to Course Your answer is correct! When applying BioSeal 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.

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

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