Infection, local reaction and poor fixation of dressings for central venous catheter

Abstract

Objective: To identify factors related to the occurrence of infection, local reaction and poor fixation of dressings for central venous catheters. Methods: Randomized clinical trial conducted with adult patients using central venous catheter for short periods, hospitalized in intensive and semi-intensive care units of a university hospital. Results: 85 patients (43 chlorhexidine dressings; 42 gauze and tape). Use of blood component increases the chance of catheter-related infection; use of dressings for more than three days increases the chance of local reaction; catheter in the jugular vein increases the chance of poor fixation of the dressing. Catheter permanence for more than five days increases the chance of infection, local reaction and poor fixation. Conclusion: Both dressings are effective to cover central venous catheters and can be used for this purpose. ResumoObjetivo: Identificar fatores relacionados à ocorrência de infecção, reação local e má fixação de curativos para cateter venoso central. Métodos: Ensaio clínico randomizado realizado com pacientes adultos em uso de cateter venoso central de curta permanência, internados em centro de terapia intensiva e semi-intensiva de hospital universitário. Resultados: 85 pacientes (43 curativo de clorexidina; 42 curativo de gaze e fita). Uso de hemocomponente aumenta a chance de infecção relacionada ao cateter; uso de curativo por mais de três dias aumenta a chance de reação local; uso de cateter em veia jugular aumenta a chance de má fixação do curativo. Tempo de permanência do cateter superior a cinco dias aumenta a chance de infecção, reação local e má fixação. Conclusão: Ambos os curativos são efetivos para cobertura de cateter venoso central e podem ser utilizados com essa finalidade.Clinical Trials Registration: RBR-7b5ycz

Comparison between types of dressing following catheter insertion and early exit‐site infection in peritoneal dialysis

“…A more recent publication (Pedrolo et al . ) suggests that using dressings with gauze and microporous tape increases the probability of causing a local reaction, consequently facilitating the proliferation of local microbiota and increasing the risk of infectious complications. Another study from Australia revealed the benefits of keeping the exit‐site free from a dressing during healing to avoid further skin irritation (Lily et al .…”

“…Pedrolo et al . () in a randomised controlled clinical trial on central venous catheter dressings, found that polyurethane material dressings presented greater drainage accumulation at the exit‐site as they have no absorption capacity. Furthermore, the research involving a series of cases using polyurethane dressings on central venous catheters demonstrated a greater susceptibility to cutaneous toxicity and thermal barrier, factors that may be linked to an increased number of infections (Silveira et al .…”

Frequency of change of chlorhexidine-impregnated gel dressings for central venous catheters in critically ill patients

“…15 Regarding the dressing adhesiveness, a study showed that the time of permanence of the catheter over 5 days increases the risk of poor fixation of the dressing in more than five times and the risk of development of local reaction by the use of occlusive dressing in continuous contact with the skin in more than four times. 28 In this context the literature shows a study describing that nonintact dressings increase the proliferation of microorganisms at the insertion site. 2,29 Therefore daily inspection and palpation to verify the integrity, adhesiveness, and saturation of chlorhexidine-impregnated gel dressings, as well as reviewing the need for maintaining the CVC, are essential strategies to ensure the safety of patients by preventing catheter-related infections.…”

“…28 Inadequate fixation results in spontaneous detachment of the dressing, a factor the leads to its change. 28 The dressing is intended to be occlusive, therefore it should be maintained totally fixed to the skin of the patient to protect the insertion site of the catheter, provide stability to the device, and reduce the risk of contamination by microorganisms.…”

“…28 Inadequate fixation results in spontaneous detachment of the dressing, a factor the leads to its change. 28 The dressing is intended to be occlusive, therefore it should be maintained totally fixed to the skin of the patient to protect the insertion site of the catheter, provide stability to the device, and reduce the risk of contamination by microorganisms. 17,29 On the other hand, the present study pointed out that only a few cases allowed the chlorhexidine-impregnated gel dressing to be maintained for seven days, as it is recommended in the literature.…”