Thursday, 16 July 2009: 10:30 AM
Learning Objective 1: discuss evidence on central venous catheter dressings in patients undergoing hematopoietic stem cell transplantation.
Learning Objective 2: identify key gaps in nursing research that should guide future studies on central venous catheter dressings.
Purpose: Patients need a safe venous access to go through hematopoietic stem cell transplantation; nevertheless, the presence of long-term central venous catheter can lead to complications, infection is the most preoccupying one. Dressing is a procedure that contributes to reduce this complication, on the other hand, depending on the kind of dressing and its frequency of change, injuries may occur on patients’ skin due to its adherence. The study aimed to identify the evidences about the most effective kind of dressing used in long-term central venous catheter in the incidence of intravascular catheter-related infection and skin toxicity in patients undergoing hematopoietic stem cell transplantation.
Methods: Searches were carried out on CINAHL, EMBASE, Cochrane Register of Controlled Trials, LILACS and MEDLINE databases and on the periodical Bone Marrow Transplantation for reports on randomized controlled trials of kind of dressing used on long-term central venous catheter in patients undergoing hematopoietic stem cell transplantation. Additional references were sought from the studies included in the review.
Results: From 42 papers initially identified, 6 studies met the inclusion criteria. Regarding intravascular catheter-related infection assessed in five studies, four found no statistically significant differences in the incidence of infection, both with the use of polyurethane dressing and its use in longer intervals. There was statistically significant reduction in the incidence of infection using polyurethane dressing impregnated with chlorhexidine. Regarding skin toxicity evaluated in two studies, one showed statistically significant difference in the reduction of skin lesion when the polyurethane was changed in a longer interval, whereas no difference was found in the other study.
Conclusion:There are few evidences indicating difference on the incidence of infection between gauze and tape and/or transparent polyurethane film dressings in long-term central venous catheter in patients undergoing hematopoietic stem cell transplantation. Future studies are needed to evaluate skin toxicity.