The Committee noted that the study evidence was largely from intensive care units in France that followed different skin preparation guidelines and that may have had more severely ill patients than those generally found in the UK. The Committee considered that this evidence was nevertheless generalisable to the UK, based on advice from experts and the External Assessment Centre and on the knowledge of its members. The Cheyne Child Development Service - School age Autism (ASD) Assessment Pathway Parent Information

Wrap a piece of occlusive dressing (e.g IV 3000) around the break, to ensure the line does not get dirty Then wrap a piece of gauze around it to make the clamps fit more securely this also prevents damage that the clamps can do to the central line. NHS Clinical Evaluation Team 2018. Clinical Review: Intravenous Vapour Permeable Film Dressings (IV Films) - Part One Securing Peripheral Cannulae in Adults (PVAD). UK. Lemmon JA, Janis JE, Rohrich RJ. Soft-tissue injuries of the fingertip: methods of evaluation and treatment. An algorithmic approach. Plast Reconstr Surg. 2008 Sep;122(3):105e-117e. Williamson DM, Sherman KP, Shakespeare DT. The use of semipermeable dressings in fingertip injuries. J Hand Surg Br. 1987;12(1):125–126.Its breathability reduces pooling of moisture, helping the dressing to stay in place without lifting Richardson MC. Royal Society of Medicine Services International Congress and Symposium, Series No. 179, Harlow, Essex, UK: Royal Society of Medicine Services Limited; 1991:29-33. Timsit et al. (2012) reported a large multicentre randomised controlled trial, based in 12 intensive care units in France, involving 1,879 patients and 4,163 intravascular catheters (2,201 arterial and 1,962 central venous catheters). Patients needing intravascular access were randomised to 1 of 3 groups: Tegaderm CHG (938 patients), standard dressing (Tegaderm transparent film dressing; 476 patients) or highly‑adhesive dressing (Tegaderm HP transparent film dressing; 465 patients). Assessors were blinded to dressing type. Patients had their skin prepared with povidone‑iodine in alcohol or 0.5% chlorhexidine in alcohol. Dressings were replaced after 24 hours and then every 3 to 7 days depending on the centre, or as needed if there was leaking or soiling. The study follow‑up period was 48 hours after discharge from the intensive care unit.

The company searched the Medicines and Healthcare Products Regulatory Agency (MHRA), Food and Drug Administration (FDA) and Manufacturer and User Facility Device Experience (MAUDE) systems to identify surveillance reports relating to Tegaderm CHG, between 7 January 2000 and 29 July 2013. This revealed 1 result from the MHRA and 109 results from MAUDE. The company also searched its post‑marketing surveillance data for reported skin reactions. This identified a marked reduction in reports, both in numbers and relative to increasing sales, after a modification to the dressing design in 2011 to incorporate a breathable film. If the dressing remains intact and there is no oozing then the dressing needs to be changed once a week by the children’s’ community team. Cheyne Child Development: while you wait leaflet - Pre-School Age (Hammersmith and Fulham children) The end of the central line can be taped out of the way when your child has a bath, please ensure that the end does not get submerged in the bath. Some families find it useful to place the bung in a plastic bag, using cling film or a sandwich bag and also tap the line(s) over the shoulders during bath time.The External Assessment Centre agreed with the company's decision to exclude these studies from the clinical evidence. The External Assessment Centre collated information on the ease of use and performance of Tegaderm CHG using advice from experts, evidence from the company and from its own searches. The company proposed that using the 3M Tegaderm CHG IV securement dressing (Tegaderm CHG) would not result in changes to the current care pathway or need additional resources. The External Assessment Centre agreed with these assumptions. CONCLUSION: In conclusion, the IV-3000 wound management protocol is an excellent option for patients unsuited to surgical treatment of fingertip wounds, and it may be easily implemented by plastic surgeons in their daily clinical practice. The dressing allows for outpatient management of fingertip wounds while yielding results that are excellent in terms of aesthetics and preserved digit function.

DISCLOSURES: None of the authors have a financial interest in any of the products, devices, or drugs mentioned in this manuscript. The External Assessment Centre agreed with including Timsit et al. (2012) and excluding the 4 remaining studies identified.

Using Tegaderm CHG instead of a standard dressing does not need any special additional training. At the topic selection phase, the Committee received expert advice that confirmed that minimal additional training would be needed.