Maki DG, et al. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc. 2006 Sep;81(9):1159-71.
Included English-language articles of prospective studies of adults published between January 1, 1966, and July 1, 2005, identified in MEDLINE.
Tables 3 summarizes data for various types of catheters and reports incidence by infections per 1,000 catheter days.
Marschall J, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29(Suppl 1):S22-S30.
For nontunneled CVCs in adults
Transparent dressings: change and disinfect site with chlorhexidine‐based antiseptic every 5‐7 days or more frequently for soiled, loose, or damp dressing
Gauze dressings: Change every 2 days or more frequently for soiled, loose, or damp dressing
Evidence for this practice came from ≥ 1 properly randomized, controlled trial and evidence considered to be good to support a recommendation for use from the Society for Healthcare Epidemiology of America.
Detailed instructions for changing a dressing are found within the following review article.
Macklin D. Catheter management. Semin Oncol Nurs. 2010;26(2):113-120.
Reviewed and updated 4/11/2014 ldt
Webster J, et al. Gauze and tape and transparent polyurethane dressings for central venous catheters. Cochrane Database Syst Rev. 2011 Nov 9;(11):CD003827.
Reviewed six studies; “four compared gauze and tape with transparent polyurethane dressings (total participants – 33) and two compared different transparent polyurethane dressings (total participants = 126).” A four-fold increase in CLABSIs was found with polyurethane dressings. However, because of a risk of bias and wide confidence intervals the “true effect could be as small as 2% or as high as 17-fold.”
McCann M, Moore ZE. Interventions for preventing infectious complications in haemodialysis patients with central venous catheters. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD006894.
Includes review of one study (n=58) on use of polyurethane transparent dressings and gauze in hemodialysis patients. There was no statistically significant difference in incidence of central line site infection or central-line associated bacteremia between gauze and polyurethane.
Gillies D, et al. Central venous catheter dressings: a systematic review. J Adv Nurs. 2003 Dec;44(6):623-32.
Searched Cochrane databases, Medline, CINAHL, and CancerLit. Identified and reviewed 8 studies that evaluate various dressings in the incidence of CVC-related infection and in catheter-related sepsis in hospitalized patients.
RESULTS: Studies included comparison of gauze/tape v. Opsite IV 3000; Opsite v. Opsite IV 3000; Tegaderm v. Opsite IV 3000; Tegaderm v. Opsite.
In the 6 studies with pooled data, odds ratios did not favor either group for incidence of infection. Review was limited in that all studies had small populations.
See Table 4 for summary of meta-analysis.
Hoffman K, et al. Transparent polyurethane film as an intravenous catheter dressing. A meta-analysis of the infection risks. JAMA. 1992 Apr 15;267(15):2072-6
This is a systematic review of 7 studies, but a couple of the studies compared gauze plus a topical antiseptic preparation to occlusive dressing without the topical.
Reviewed and updated 4/24/2014 ldt
Welcome. This blog facilitates communication on issues of evidence-based practice by Emory Healthcare Nursing Quality Initiatives teams. Questions posed by the teams and information to address those questions will be documented in these posts.
Evidence Matters 