A comparison of transparent adherent and dry sterile gauze dressings for long-term central catheters in patients undergoing bone marrow transplant. What really affects the incidence of central venous catheter-related infections for short-term catheterization? A comparison of two transparent film-type dressings in central venous therapy. Comparison of central venous catheter dressings in bone marrow transplant recipients.
Patients undergoing bone marrow transplant (BMT) are at great risk of infection and sepsis. Long-term central catheters (LTCCs), required for IV therapy, can be a portal of entry for infectious agents. This randomized, prospective study compared two types of catheter dressings in 98 patients undergoing BMT: a dry sterile gauze dressing (DSGD) changed daily and a transparent adherent dressing (TAD) changed every four days. Study outcomes included incidence and severity of local and systemic complications, patient assessment of comfort, and calculation of nursing time. One case of catheter-related infection occurred during the study. No significant differences existed between the two dressings in the incidence of positive skin cultures or local complications with the exception of skin irritation. The TAD caused less skin irritation, was preferred by patients, cost less, and required less nursing time. The findings indicate that TADs provide a safe, comfortable, and cost-effective alternative to DSGDs for patients undergoing BMT and receiving antibiotic support during aplasia. Central venous catheterization is one of the important sepsis reasons in surgical patients. In this randomized controlled study, the effect of the frequency and type of catheter site care, as well as age, coexisting malignancy or diabetes mellitus, total parenteral nutrition administration and antibiotics use, on central venous catheter infection was investigated. Seventy-two single-lumen polyurethane catheters were included. In group I (n: 33), a transparent occlusive dressing was applied to the insertion site and not removed for 7 days unless there were signs of local infection. In group II (n: 39), daily site care was done with povidone-iodine 10% solution and a new sterile gauze was applied. Chi-square, linear correlation and multiple regression tests were used for statistical analysis. Mean duration of catheters was 8 +/- 4 days. There was no catheter-related sepsis. Ten (13.9%) patients had positive catheter tip cultures of whom three had site infection as well. The incidence of site and tip infections were not significantly different in group I and II (p > 0.05). Site infection and age younger than 60 years significantly increased the rate of tip infection (p: 0.004 and p: 0.02 respectively). Total parenteral nutrition administration was associated with higher rate of tip infection (p: 0.06). Coexisting malignancy or diabetes mellitus, duration of catheter and antibiotics use did not have any significant effect on the rate of central venous catheter infections (p > 0.05). In conclusion, we observed that the frequency of insertion site care and the type of dressing applied to the site had no significant effect on the rate of CVC infection. Insertion site infection was the most significant factor increasing the incidence of catheter tip infection. The use of the CVC for total parenteral nutrition facilitated tip infection as well. A prospective randomized clinical trial has been conducted to compare the clinical performance, with prolonged use, of two film-type transparent dressings used over subclavian and jugular single-lumen venous catheters. 'OpSite', a traditional dressing with a moderate moisture vapour permeability was compared with a new dressing of high moisture vapour permeability, 'OpSite IV3000'. Information was collected daily to assess the nature and incidence of complications, dressing durability and the ease of application and removal. One hundred and one patients provided two well-matched populations receiving a total of 153 dressings for a total of 780 catheter-days. No differences between the two dressings were noted with respect to the incidence of complications, such as moisture accumulation or lifting, and dressing durability. The low incidence of catheter-related sepsis ('OpSite' group three episodes and 'OpSite IV3000' group one episode) suggests that transparent dressings do not increase this risk. This clinical study demonstrated the new 'OpSite IV3000' to be easier to handle, leading to better application, improved catheter fixation and easy removal. To determine the effect of two central venous catheter (CVC) dressing protocols on catheter-related infections in hospitalized patients with long-term tunneled catheters undergoing an autologous bone marrow transplant (BMT), to determine the prevalence of long-term CVC-related infections in this population, and to identify other factors in the study sample related to long-term CVC infection.
                Experimental.
                BMT unit of a regional oncology center in a tertiary care hospital.
                The sample consisted of 101 adult patients with cancer with long-term, tunneled CVCs inserted in the operating room on admission for autologous BMT.
                Patients randomly were assigned to one of two dressing-change procedure groups. The control group received the current standard of care for patients receiving BMT--a dry, sterile gauze dressing (DSGD) changed every 24 hours. The experimental group received Opsite 3000TM (Smith + Nephew Ltd., Massilon, OH) transparent moisture vapor permeable dressings (MVPD) changed weekly.
                CVC infection rates, frequency of IV tubing changes, immune status, duration of catheter use, occurrence and outcome of catheter occlusion, and use of a catheter for total parenteral nutrition.
                Researchers determined the difference in CVC-related infections between the two groups and the impact of select variables on CVC-related infection. When all categories of CVC-related infection (i.e., suspected, sepsis, tunnel) were considered, no statistical difference was found in the likelihood of the groups remaining infection-free (p = 0.76) over time. CVC sepsis occurred in one patient in the DSGD group and five patients in the MVPD group; however, this difference was not statistically significant over time (p = 0.067).
                Development of CVC sepsis or tunnel infection in close proximity to the time of CVC surgical placement suggests that factors other than the assigned dressing were associated with the occurrence of CVC-related infection in three cases. Although the MVPD group required dressing changes more frequently than every seven days (as specified by the protocol) because of exit-site drainage and nonocclusiveness, transparent dressings were more cost-effective than daily gauze dressings in this population.
                For adults undergoing autologous BMT, either DSGD or transparent CVC dressing can be used safely based on patient preference and skin tolerance to the dressing material.
We found a four-fold increase in the rate of catheter related blood stream infection when a polyurethane dressing was used to secure the central venous catheter however this research was at risk of bias and the confidence intervals were wide indicating high uncertainty around this estimate; so the true effect could be as small as 2% or as high as 17-fold. More, better quality research is needed regarding the relative effects of gauze and tape versus polyurethane dressings for central venous catheter sites.