Dressing disruption is a major risk factor for catheter-related infections*

Timsit, Jean François; Bouadma, Lila; Ruckly, Stéphane; Schwebel, Carole; Garrouste-Orgeas, Maïté; Bronchard, Régis; Calviño-Günther, Silvia; Laupland, Kevin B.; Adrie, Christophe; Thuong, Marie; Herault, Marie Christine; Pease, Sébastian; Arrault, Xavier; Lucet, Jean Christophe

doi:10.1097/ccm.0b013e31824e0d46

Cited by 114 publications

(89 citation statements)

References 24 publications

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“…Previous studies have shown that the rate of complications is correlated with the knowledge and expertise of care providers throughout the dwell time of the catheter. 4,5 Although PICCs provide obvious benefits to patients, recent publications have raised safety concerns.…”

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confidence: 99%

Outcomes in a nurse-led peripherally inserted central catheter program: a retrospective cohort study

et al. 2017

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Background: Peripherally inserted central catheters (PICCs) provide enormous benefit to patients. However, recent publications have highlighted relatively high PICC-associated complication rates. We report on patient and device outcomes from a nurse-led program. Methods:We performed a retrospective analysis of a prospective cohort of consecutive patients undergoing PICC insertion at The Ottawa Hospital between Jan. 1, 2013 and Dec. 31, 2014. Of the 8314 BioFlo PASV PICCs inserted, we randomly selected a sample of 700 and obtained a complete data set for 656. We measured the cumulative incidence of major complications (catheterrelated bloodstream infections and deep vein thrombosis) and use of a thrombolytic to alleviate occlusions. Results:The total number of catheter days was 58 486, and the median dwell time 45 days. We observed 4 cases of catheterrelated bloodstream infection (0.6% [95% CI 0.17%-1.55%]) (0.07/1000 catheter days). Ten patients (1.5% [95% CI 0.83%-2.78%]) (0.17/1000 catheter days) had catheter-related deep venous thrombosis. At least 1 dose of thrombolytic was required in 75 catheters (11.4% [95% CI 8.61%-13.39]), 31 (7.1%) of the 436 single-lumen catheters and 113 (25.7%) of the 440 lumina of dual-lumen catheters (p < 0.001). Interpretation:We attribute our low rates of major complications to a nurse-led expert insertion team, standardized care and maintenance protocols, high insertion volumes, novel catheter material and continuous quality-improvement initiatives that are implemented and evaluated regularly. We conclude that the considerable benefits PICCs provide to patients are attained with a low risk of major complications. Abstract ResearchResearch CMAJ OPEN E536CMAJ OPEN, 5(3)

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confidence: 99%

Outcomes in a nurse-led peripherally inserted central catheter program: a retrospective cohort study

et al. 2017

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“…This complication was generally observed in severely ill patients with multiple organ failure, subcutaneous edema, and fragile skin. In a different study, these same authors compared different types of transparent dressings in intensive care unit patients and found that skin injury scores were higher in patients using dressings containing chlorhexidine compared to patients using the transparent film without chlorhexidine [19]. A report of seven cases of erosive contact dermatitis due to the CIGD [33] showed that four out of the seven patients were immunosuppressed, and the majority of catheters had been inserted into the femoral vein.…”

Section: Discussionmentioning

confidence: 99%

Local Cutaneous Effects Associated with Chlorhexidine-Impregnated Gel Dressing in Hematopoietic Stem Cell Transplantation Patients

Santos¹,

Oliveira²,

Braga³

et al. 2018

OJN

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Introduction: Hematopoietic stem cell transplantation (HSCT) often requires a central venous catheter (CVC) for quick and safe vascular access. Currently, new technologies are available to protect the catheter insertion site, such as chlorhexidine-impregnated gel dressings (CIGD). Objectives: To evaluate local cutaneous effects associated with CIGD in patients undergoing HSCT. Methods: In this cross-sectional, prospective study, we evaluated 25 HSCT patients who had a CVC inserted. Patients were visited daily to monitor the CIGD changing procedures and evaluate abnormalities of the underlying skin after dressing removal. Findings: Local erythema was the most frequently detected abnormality, although usually transient and considered secondary to the mechanical trauma of dressing removal. The most severe lesions, consisting of areas of skin loss, erythematous plaques and/or vesicles were classified as skin irritation and presented in 11 (44%) of the 25 patients. An association test showed that skin irritation was more frequent in patients who underwent allogeneic HSCT (p = 0.03). Skin irritation was most frequently observed in areas of contact with the non-woven polyester adhesive tape (n = 22; 88%), which made up the adhesive margins of the dressing. The CIGD was discontinued in 6 (54%) of the 11 patients who presented severe skin injuries. Conclusion: In this study, we detected that skin irritation was more frequent in patients who underwent allogeneic HSCT. The most common skin manifestation was skin loss.

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“…Diante deste panorama, o Curativo Gel de Clorexidina (CGCHX) tem se apresentado como a mais atual tecnologia desenvolvida para controle e prevenção de infecções relacionadas ao CVC. Esta modalidade de curativo possui propriedades de redução e controle da presença de microrganismos no sítio de saída do cateter, alto poder de absorção, fixação estéril, estável e transparente que reduz a migração de microrganismos de forma contínua e permite a visualização do sítio de inserção do cateter (8)(9)(10) . Além disso, um ensaio clínico randomizado revelou que o uso do CGCHX reduziu 46% das infecções relacionadas com CVC (11) .…”

Section: Introductionunclassified

Tempo De Enfermagem E Materiais Utilizados No Curativo Gel De Clorexidina

Daniel¹,

Castanho²,

Santos³

et al. 2015

RACS

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ResumoIntrodução: O curativo gel de clorexidina representa a mais atual tecnologia desenvolvida em busca do controle e prevenção de infecções relacionadas ao cateter venoso central. Como vantagens, pode ser mantido por até sete dias e permite a visualização do sítio de inserção do cateter. Objetivo: Identificar o tempo de enfermagem e a quantidade de materiais utilizados para realização do procedimento de troca do curativo gel de clorexidina no cateter venoso central de longa permanência de pacientes submetidos ao Transplante de Células-Tronco Hematopoéticas. Casuística e Métodos: Estudo descritivo. Os dados foram coletados diariamente, no período de setembro de 2013 a maio de 2014, por meio da observação do pesquisador durante a troca do referido curativo e posterior preenchimento do instrumento de coleta de dados. Resultados: O tempo médio para a realização do procedimento foi de 12,7 minutos. Efetuou-se um total de 83 trocas de curativo em 22 sujeitos observados, com média de 3,3 trocas por paciente. Materiais utilizados durante o procedimento: máscara cirúrgica, luva de procedimento, luva estéril, gaze estéril, soro fisiológico 0,9%, clorexidina alcoólica 0,2%, spray de Cavilon e o curativo gel de clorexidina. Conclusões: Na realização do curativo são utilizados materiais comuns àqueles usados em outros tipos de cobertura para o sítio de inserção do cateter venoso central. No entanto, quanto ao tempo de enfermagem gasto p a r a realização , observou-se redução do mesmo na com curativo do paração com os procedimentos que utilizam gaze e fita adesiva ou filme transparente.Descritores: Cateterismo Venoso Central; Transplante de Células-Tronco Hematopoéticas; Curativos Oclusivos; Enfermagem. AbstractIntroduction: Chlorhexidine gluconate-impregnated dressing is the most current and effective technology developed for the control and prevention of central line-associated bloodstream infection, it also allows the visualization of the catheter insertion site and can be changed within seven days. Objective: Identify the nursing time and the amount of materials used to perform the chlorhexidine gluconate-impregnated dressing change in central venous catheter in patients undergoing Bone Marrow Transplantation. Patients and Methods: The researcher performed daily assessments to monitor all dressings replacements performed as routine by the regular nurse and had the instrument for data collection completed from September 2013 through May 2014. Results: The average time for the achievement of the dressing change was 12 minutes and 42 seconds. Eighty-three dressing changes were performed in 22 subjects with average of 3.3 dressing change per patient. Materials most used to perform the dressing change were face mask, gloves, sterile gloves, gauze, saline solution, alcoholic chlorhexidine solution, Cavilon spray, chlorhexidine gluconate-impregnated dressing. Conclusions: To perform catheter insertion site dressing change using chlorhexidine gluconate-impregnated dressing or other kinds of dressings the same materials are requ...

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Dressing disruption is a major risk factor for catheter-related infections*

Abstract: Disruption of catheter dressings was common and was an important risk factor for catheter-related infections. These data support the preferential use of the subclavian insertion site and enhanced efforts to reduce dressing disruption in postinsertion bundles of care.

Cited by 114 publications

References 24 publications

Outcomes in a nurse-led peripherally inserted central catheter program: a retrospective cohort study

Outcomes in a nurse-led peripherally inserted central catheter program: a retrospective cohort study

Local Cutaneous Effects Associated with Chlorhexidine-Impregnated Gel Dressing in Hematopoietic Stem Cell Transplantation Patients

Tempo De Enfermagem E Materiais Utilizados No Curativo Gel De Clorexidina

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