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Centre for Applied Nursing Research, Webmaster's note: This Systematic Review has not been produced by the Joanna Briggs Institute for Evidence Based Nursing and Midwifery and remains the copyright of the Centre for Applied Nursing Research NSW, and is used on this web site with kind permission of the authors. Systematic Review
 Links within this web page: Factors that varied among studies
BACKGROUND
Frequency of dressing change
OBJECTIVES
i. the most effective type of central line dressing to use and ii. the frequency of the dressing change that is necessary in all hospital inpatients.
i. mortality ii. local and systemic infection iii. catheter displacement iv. thrombus formation v. catheter breakage or blockage vi. skin irritation or allergic reaction that is a direct result of the dressing type and/or frequency of the dressing change.
CRITERIA FOR CONSIDERING STUDIES FOR THIS REVIEW
i. with a sample population of 30 or more in hospital subjects ii. that either evaluate a dressing material or compare types of dressing materials iii. and/or the frequency of the dressing change with regards to the above identified outcomes.
A CVC is defined as any non tunneled percutaneously inserted catheter with the catheter tip in the superior vena cava. This includes CVCs inserted into the internal jugular vein, the subclavian vein, the femoral vein and Peripherally Inserted Central Catheters (PICC). Types of participants Inclusions All age participants, both male and female treated in a hospital setting with a central venous catheter insitu are included in this study. No participants with any predisposing health risk factors are excluded. All CVC compositions, single and multiple lumen whether antiseptic or antibiotic bonded, tunneled and non-tunneled catheters, in any insertion site are included. CVC for short term and long term vascular access usage to administer IV fluids, medications, blood products, parenteral nutrition and haemodynamic monitoring are included. Exclusions Arterial and Pulmonary catheters Articles that do not specifically identify catheters as being CVC Non specific intravenous lines or peripheral lines Articles that do not specifically evaluate dressing type or frequency of the dressing change Articles that do not assess outcomes of local or systemic infection, catheter displacement or reaction to the dressing Outpatient and hospital in the home population Studies that refer to dressing technique and /or catheter placement site Studies that are a review or discussion of the general care of central venous catheter sites. Types of interventions This review assesses evaluations and/or comparisons of all types of dressing material and all frequencies of dressing change for any central venous catheter site in any age in-hospital population. Types of outcomes The main outcomes of interest are complications that are caused as a direct result of the type of dressing and/ or the frequency of the dressing change. The identified complications are mortality, local or catheter related infection, systemic infection or catheter related sepsis, catheter displacement, thrombus formation, catheter breakage or blockage, skin irritation or allergic reaction to the dressing.
Definitions of outcomes Exit site infection identified by any one or more of the following symptoms - erythema, tenderness, skin necrosis, phlebitis, swelling, exudate including purulence, pain. Catheter Related Infection (CRI ) identified by positive quantitative or semiquantitative culture of the catheter >15 colony forming units. Catheter Related Sepsis (CRS) identified by signs and symptoms consistent with: i. infection (including defervescence or clinical signs of infection prior to removal of catheter) and fungaemia or bacteraemia or ii. a positive catheter tip culture or fever and bacteremia or iii. fungemia in the absence of an exit site or tunnel infection. Bacteraemia Identified when there is a positive blood culture from the central venous catheter. Complications due to catheter material, catheter size, site of catheter placement and composition of the intravenous fluid are acknowledged as being identified in the literature but have not been analysed separately in this review. Types of studies Any research study with a sample population of over 30, that evaluates and/or compares studies of one or more dressings type, and/or frequency of dressing change for a central venous catheter site.
SEARCH STRATEGY FOR IDENTIFICATION OF STUDIES The search was restricted to English language articles that were published after 1980. The search strategy and the search process of the identification of articles was documented. Search terms used vascular catheters, central venous catheters, central venous therapy, peripherally inserted central catheters, parenteral nutrition, wound infection, dressing, dressings, occlusive dressings, biological dressings, transparent dressings, bandages and dressings, infection control, complications, and Boolean combinations of the above. Electronic database search The electronic databases searched were Medline 1981 - September 1997, CINAHL 1982 - July 1997, HealthStar 1975 - September 1997, and the Cochrane Library 1997 Issue 3. All abstracts and presentations identified were followed up by searching for the authors collectively as well as searching each cited author, individually. Hand search The CINAHL and Medline journal index were searched to identify journals that were not catalogued in these databases. Full text hand searches of the Journal of Intravenous Nursing January 1994 - August 1997, Intravenous Connections - NSW Nurses Intravenous Society January 1996 - September 1997, Australian Clinical Review 1981 - 1993 and Journal of Critical Care 1986 - August 1997 were conducted. Reference list search Potential articles that satisfied the Inclusion/Exclusion criteria were retrieved. All reference lists of the potential articles identified were searched. Papers published prior to 1980 were identified, excluded, and not retrieved. The reference list of 434 articles from the Guidelines for Prevention of Intravascular Device-Related Infections from the Centers for Disease Control and Prevention, Atlanta, Georgia, March 1997 was searched and 2 new articles were retrieved. Unpublished articles Two 1997 conference presentations were identified. The authors were contacted. No data is available till publication early next year. Other Expert opinion and guidance was sought from the Clinical Nurse Consultant for Central lines, Tim Spencer, Liverpool Health Services, South West Sydney Area Health Service. He commented that he felt that the sources searched were comprehensive and could offer no further suggestions. Towards the end of the search process, searching of the reference list of the articles retrieved identified repeat articles and no new articles were being identified. This indicated to us that the search process was comprehensive and there were no new articles left to retrieve. METHOD OF THE REVIEW Data abstraction: In all a total of 146 possible articles was identified. Forty-four articles were repeated either in more than one electronic database or in the reference lists of identified articles. Thirty-two articles were not CVC or did not assess dressing type or dressing frequency. A total of seventy articles were retrieved. When the Inclusion/Exclusion criteria were applied to the title and abstract, thirty-seven potential studies were identified. (One of these was a meta analysis of transparent polyurethane film as an intravenous catheter dressing.) Sixteen of these articles were subsequently excluded. The reasons for exclusion were: not evaluating dressings, not evaluating identified complications, includes arterial catheters, peripheral IV catheters, dressing type identified only as regular. The search strategy, search process, Inclusion/Exclusion criteria, Exclusion of Potential Studies and the Data Abstraction forms were developed by the CPRN, trialed, and refined. Two reviewers of the Clinical Practice Review Network independently assessed each article to be included in the review by applying the Inclusion/Exclusion criteria. Following the inclusion of the article for review, data extraction of each article was conducted independently by two reviewers. The reviewers were not blinded. Any disagreements were resolved by the project leaders. Description of studies (see Table 1) Twenty-one studies were identified. One cohort study (Moro, M., Lepri, V. et al. 1994), two experimental studies (Brandt, B., DePalma, J. et al, 1996; Shivnan, J., McGuire, D. et al 1991), one quasi experimental study (Freiberger, D., Bryant, J. et al 1995) and one clinical trial study (Willie, J., Albas, B. et al. 1993) were identified. Thirteen of the studies were case series of comparative studies of two or more dressing types and three studies evaluated a single dressing type. The study sizes ranged from 32 to 3931 participants. The age range of eighteen studies was from one day to 91 years of age. Three studies did not identify the age range of the participants. Sixteen studies evaluated both dressing type and frequency of dressing change. Five studies evaluated dressing type with the frequency of dressing change not identified. The type of patients identified were medical/ surgical (10 studies), total
parenteral nutrition (6 studies), bone marrow transplant (3 studies), one chemotherapy,
and one study did not describe the patients involved. The location of the central lines were subclavian and jugular (5 studies), subclavian (4 studies), jugular (1 study), subclavian and cubital (1 study), subclavian, jugular and cubital (1 study), subclavian, jugular and femoral (1 study). Eight studies did not identify the location of the CVC. The studies were conducted at tertiary teaching hospitals in twelve studies,
two tertiary teaching hospitals and five large non teaching hospitals in one study,
district hospital in one study, and seven were not identified Table 1: Characteristics of included studies
Methodological quality of included studies The method of allocation of participants to seven studies was random with participants in one study assigned consecutively, in two studies assigned sequentially, in three studies assigned by hospital number and in one study assigned by date of birth. The method of random allocation in eight studies was not described. One study did a retrospective audit of medical records, four studies included all participants and one study did not identify the method of allocation of participants to the study. The attrition rate identified in five studies was 5 out of 79 participants, 12 out of 32 participants, 22 out of 145 participants, 0 out of 365 participants and 61 out of 104 participants. Fifteen studies did not identify the attrition rate. None of the studies described any method of blinding. Quality of Evidence (see Table 2 and Figure 1) To assess the quality of the evidence, the studies were scored using weighted variables. The best possible score was 18 and the worst possible score was 46. The mean score of the studies was 29.67, with a median score of 30, a mode score of 29, and a standard deviation of 3.76. Four studies scored 27 or under with twelve studies scoring between 28 to 30 and five studies scored over 30. Table 2. & Figure 1. Weighting of included studies
FACTORS THAT VARIED AMONG STUDIES There were several factors that varied amongst the twenty one studies. Location of CVC The CVC sites identified were subclavian in four studies, jugular in one study, subclavian and jugular in five studies, subclavian and cubital in one study, subclavian, jugular and cubital in one study and subclavian, jugular and femoral in one study. Eight studies did not identify the location of the CVC. Clinical use of the CVC The CVC lines were used for the following purposes-TPN in six studies; monitoring, antibiotic therapy and TPN in three studies; chemotherapy in one study; and eleven studies did not identify the reason for use of the CVC line. Insertion technique and skin disinfection 13 CVCs were inserted by doctors, with 4 CVCs inserted in the operating theatres by an anaesthetist and 2 CVCs inserted either in the operating room or the intensive care unit. Nine studies did not identify the person insertinging the CVC. The technique used to insert the CVC was aseptic in eleven studies, protocol in two studies, sterile gloves in one study, and not identified in seven studies. The disinfection solutions in inserting the CVC were povidone iodine in three studies, acetone alcohol and povidone iodine in two studies, iodine and povidone iodine in one study, iodine in two studies, iodine and alcohol in one study, iodine and chlorhexidine 70% in one study, 0.5% aqueous chlorhexidine in one study. Nine studies did not identify the skin disinfection solution used at insertion of the CVC. Regimen/technique for dressing change The disinfection solutions used were acetone alcohol and povidone iodine in seven studies, povidone or Hibiclens in one study, acetone alcohol and aqueous chlorhexidine gluconate 0.5% in one study, aqueous chlorhexidine gluconate 0.5% in one study, 70% alcohol in one study, 70% alcohol and 2% chlorhexidine in one study, and hydrogen peroxide and povidone iodine in one study. In one study the dressing solutions used were described as published standard guidelines (which were CDC guidelines), and in seven studies it was not identified. Health status of patient The predisposing health factors were carcinoma in five studies; carcinoma, cardiovascular disease and gastrointestinal disease in 2 studies; gastrointestinal disease in one study; and major surgery in one study. In one study the patients were immunosuppressed. Eleven studies did not identify the predisposing health status of the patients.
Bacteriological methods used to confirm infection The bacteriological methods used to confirm local and systemic infection of the CVC were one or more of the following: blood sample from the CVC, skin culture of insertion site, blood sample from peripheral site and CVC tip culture. `Blood sample from the CVC Samples were taken from all patients in nine studies, patients suspected with CRI in two studies, and not identified in ten studies. Skin culture of insertion site The skin culture of the CVC site was performed in thirteen studies-in all patient in ten studies, in patients with suspected infection in one study, in 75 out of 103 patients in one study due to laboratory difficulties, and not identified in one study. Skin cultures were done at the time of insertion of the CVC and/or during dressing change and/or at the time of the removal of the CVC. Nine studies did not identify whether skin cultures of the CVC was performed. Blood sample from peripheral site Blood samples were taken from another peripheral site in all patients in 6 studies and in patients with suspected CRS in 2 studies. 13 studies did not identify if a blood sample was taken from another peripheral site. CVC tip culture The CVC tip was cultured for all patients in 13 studies, for patients suspected with CRI in 4 studies. 4 studies did not identify if CVC culture tip was performed. Additional variables that may affect the infection risks associated with CVCs i.. The duration of catheter use The duration of catheter use varied from 2 days to 120 days in 12 studies. 9 studies did not identify the duration of CVC use. ii. The frequency of dressing change The frequency of dressing change was daily, second daily, three times a week, weekly and every 7 to 10 days. 5 studies did not identify the frequency of dressing change. iii. The use of antiseptic ointment at the insertion site 7 studies used Betadine ointment at the insertion site of the CVC and 1 study used an antibiotic ointment consisting of bacitracin, neomycin and polymyxin.
Results Tables 4-19 present the results of the data abstraction.
Limitations of the review process The limitations of the review process were that only English language and published articles were used. The search included articles from 1980 onwards as, prior to this period, there was little use of and information on the use of central lines. The time frame of the project limited the hand searching. Articles that were identified for the review, but which did not provide adequate information, were followed up with search of author names that appeared on the article as well as search of individual author names. No authors were contacted directly. All abstracts and presentations identified were followed up by searching for the authors collectively as well as searching each cited author individually. Limitations of the studies Type of studies identified No RCT or CCT studies were identified. The 21 studies used in this Systematic Review were: 1 cohort study (Moro, 1994), 2 experimental studies (Brandt ,1996; Shivnan, 1991), 1 quasi experimental study (Freiberger, 1992), 1 clinical trial (Wille, 1993), 13 case series (Reynolds, 1997; Treston-Aurand, 1997; Maki ,1993; Conly, 1989; Young, 1988; Lawson, 1986; Andersen, 1986; Wheeler, 1986; Powell, 1985; Prager, 1984; Nehme, 1984; Palidar, 1982; and Powell, 1982) and 3 evaluation studies (Taylor, 1996; Engervall, 1995; and Vazquez, 1984) were identified. Weighting of the studies No suitable scale to evaluate the quality of the studies was identified. The CPRN team designed a scale based on Ciliska et.al 's (1996) method of evaluation of using weighted variables. Important factors contributing to the complication rates in CVCs were identified. The variables used were: type of study, allocation to the study, sample size, predisposing health status of the participants, type and site of CL, insertion technique, the use of the CL, duration the CL was in situ, the reason for removal of the CL, dressing frequency, attrition rate, antibiotic therapy and the bacteriological method used to identify local and systemic infection. The studies were then assessed using this weighted scale. With a best score of 18 and a worst score of 46, four studies scored from 22 to 27 inclusive; and the remaining seventeen studies scored from 28 to 36. The studies were graded using the following scale: 18-27 good quality, 28-37 medium quality, 38+ poor quality. This resulted in four good quality studies; 17 studies of medium quality, and no poor quality studies were identified.
CVC related infections There are numerous factors associated with CVC related infections and the role played by specific factors in increasing the risk of infection is not entirely clear. Skin colonization and CRI Skin colonization is a major determinant for endemic CRI and heavy colonization of the insertion site is highly predictive of CRS. Septicaemias begin with invasion of the transcutaneous insertion tract by microorganisms from the patient's skin flora (Maki & Ringer 1993, Nehme & Trigger 1984). Microbial colonization of the CVC is the most frequent factor limiting their prolonged used and is attributed to skin organisms that either migrate down fibrin sleeves or are introduced during placement of the CVC (Prager & Silva 1984). Conly et al. (1989) analyzed 20 variables to predict the occurrence of CRI or CRS using stepwise multiple logistic regression analysis. Cutaneous colonization at the insertion site of > 103 cfu/ml (relative risk 13.16) and difficulty of insertion (relative risk 5.39) were significant factors for CRI. Moro et al. (1994), also using logistic regression, confirmed the importance of skin colonization and hub colonization in causing CRI. Other factors identified as being responsible for skin colonization are age, jugular insertion site, duration of the CVC catheterization and the use of transparent dressing. Influence of dressing type on CRI Several studies have raised the possibility that transparent dressings may increase the risk of CRI. Conly et al. (1989) found significantly greater skin colonization after 48 hours of CL insertion in the transparent versus gauze dressing (p < 0.009). They suggest that transparent dressings are associated with significantly increased rates of insertion site colonization, local catheter related infection, and systemic catheter related sepsis in patients with long term CVC after finding that local CRI in the gauze dressing group was less than in the transparent dressing group (p <0.002). Andersen et al., (1986) [good quality] in their non-randomized study comparing gauze dressings with transparent (Opsite) dressings, found more phlebitis and catheter tip infection when a transparent dressing was used. Differences in the frequency of positive tip culture, positive skin culture and clinical signs of local infection at the skin puncture site were significant (p < 0.05) between the gauze dressing group (5/75) and the transparent dressing group (15/60). The mean function time of the catheters with positive tip or skin culture was significantly lower in the transparent dressing group than in the gauze dressing group (p < 0.001). Treston-Aurand and Olmsted (1997) [medium quality], in their non-randomized retrospective study, demonstrated that the use of transparent or tape and gauze dressings resulted in fewer CRIs (p < 0.001) than Highly Permeable Transparent Dressing (HPTD). Vazquez and Jarrard (1984) [medium quality] claim that transparent dressings
inhibit bacterial growth, but have failed to carefully evaluate bacterial growth
beneath the dressings in high risk patients over an extended period of time. Shivnan et al's (1991) [good quality] prospective randomized study found fewer infections with gauze dressings. Only a small portion (4%) developed exit site infection or CRS even though 36% had a positive blood culture. The limitation of this study was that it was not large enough (n = 98) to allow analysis of differences between subgroups, and therefore we cannot conclude that the low incidence of CRS is related to the type of dressing used. Powell and Regan (1982) [medium quality] in their prospective randomized study compared transparent versus gauze dressings for TPN and demonstrated a consistent but not significant increase in CRI in the group receiving transparent dressings. Brandt et al (1996) [medium quality] and Lawson et al (1986) [medium quality] found no statistical difference in CVC related infection between gauze and transparent dressings. Hoffman et al (1992) carried out a meta analysis of seven studies (Powell et al., 1982; Andersen et al., 1986; Conly et al., 1989; Maki & Ringer, 1987; Littenberg & Thompson ,1987; and Hoffman et al., 1988) of CVCs and found no significant relationship between dressing type and the incidence of phlebitis, bacterial infiltration and skin colonization but concluded that there was a significant increase in the risk of catheter tip infection when using transparent dressings as opposed to gauze dressings (RR 1.78, 1.38-2.30).
Influence of dressing frequency on CRI Less frequently changed transparent dressings have been supported in the literature not because of a correlation with a reduction in CRS but mainly due to cost reduction in the overall number of dressings used per CVC site as well as the subsequent reduction in nursing time necessary. Lawson et al. (1986) [medium quality] compared gauze dressings changed three
times a week to transparent dressings changed weekly and found no statistical
difference but concluded that cost could be reduced by using transparent dressings. Palidar et al. (1982) [medium quality], in their retrospective non-randomized study comparing gauze dressings changed twice a week and transparent dressings changed once a week, came to the same conclusion. Shivnan et al (1991) [good quality], whilst finding no difference in CRS rates between gauze dressings and transparent dressings found that nursing times and dressing costs were significantly reduced in the transparent dressing group (p < 0.0001) when compared to the gauze dressing group (p<0.000). Overall patient comfort in the transparent group was reported as p<0.001. Wheeler et al. (1988) compared gauze dressings changed three times a week to transparent dressings changed once a week and found no statistical difference in infection rates but noted that transparent dressings showed significant time and expense savings and offered superior occlusive protection. Young et al. (1987) [good quality] compared gauze dressings changed three times a week with transparent dressings changed twice weekly, weekly, and every ten days. They found no significant differences between the groups and recommended the use of transparent dressings changed weekly with a safety margin of 10 days based on savings in cost and nursing time. Engervall et al. (1995) compared transparent dressings changed once a week to transparent dressings changed twice a week and concluded that twice a week dressing change is superior to once a week dressing change. The once a week group had more positive CVC tip cultures (p < 0.05), more cultures from the exit skin site showing higher numbers of colony forming units (p 0.07) and more gram positive septicaemias (p 0.08).
Effect of antiseptic solution for skin preparation Two factors associated with infection related phlebitis are the skin preparation and the frequency of the dressing change. Maki and Ringer1(993) [medium quality] compared the effect of 2% chlorhexidine, 70% alcohol and 2% povidone iodine. The CVCs in the chlorhexidine 2% group, were less likely (p 0.02) to show local CRI on removal than were catheters in the povidone iodine group. Chlorhexidine 2% significantly prevented local CRI (p 0.02) and showed a strong trend towards significant benefit in the prevention of catheter related bacteremia (p 0.18). Freiberger and Bryant (1992)[medium quality] demonstrated no significant differences in incidence of bacterial growth between dressings groups of Betadine and Tegaderm, Betadine and Gauze, Hibiclens and Tegaderm, Hibiclens and gauze. The limitation was the use of a convenience sample rather than probability sampling and the duration of the study. The sample was not large enough to determine if one dressing was better than the other in decreasing the incidence of infection. Bacteriological methods The contamination of an intravenous pathway may be manifested by local infection of the insertion site, septic phlebitis or thrombophlebitis or septicaemia or bacteremia. The methods of diagnosing infection can be semi quantitative or quantitative. Speechley (1986:95) identified the bacteriological methods used to confirm local and systemic infection of the CVC as one or more of the following: catheter lumen flushed through with broth, the catheter tip rolled on blood agar, the CVC lumen cleaned with stilleto and then rolled onto blood agar, the catheter tip cultured in broth, the catheter tip is gram stained, the insertion site is swabbed and blood specimen collected from the CVC site and/or a site different to the CVC. The categories of CVC infection identified and the methods used to diagnose CRI and CRS were different and posed a significant problem in the translation and comparison of results between the studies. The redness of the CVC site is often taken to be an indication of infection but it may not be associated with higher bacterial count but may mean irritation. The insertion site may have bacterial growth even though there is no redness, therefore a culture is the best measure for determining exit site infections (Freiberger & Bryant, 1992). Nine studies in this review did not identify whether exit site colonization of the CVC had been done. Diagnosis of CRI requires a positive catheter tip culture >15 colony forming units. Four studies did not identify if the catheter tip had been cultured. Diagnosis of CRS requires either a positive catheter tip culture or fever and a positive blood culture from the central venous catheter and was not identified in 10 studies. Conclusions The numerous differences between patient groups and research design methods
indicated that the studies were not similar enough for either comparison or meta-analysis.
The numerous variables associated with CVC related infections and the role played
by specific factors in increasing the risk of infection is not entirely clear.
The evidence was inconclusive to substantiate that any one type of dressing or
frequency of dressing change was superior in preventing CVC complications.
Implications for practice Inconclusive evidenceexists as to the effectiveness of any particular type of CVC dressing or frequency of dressing change. Although transparent dressings have been found clinically if not consistently stastically to increase risk of catheter-related infections, the cost implications of reduced frequency of dressings and reduction in nursing time have also played an important part in clinical decision making. The use of the transparent dressing and the potential for shanging every 10 days may be considered. Many studies have used the once per 7 days dressing change; only one study examined the 10 day option, although it was supported. The quality of the evidence is medium to good and does provide clinicians with access to no other source of evidence with some beginning points for decision making. These studies and their implications should be reviewed and debated by clinicians to shape practice. However, it is recommended that strict aseptic techniques for the placement and care of CVC be employed in the care of central line dressings. Implications for research More research is needed to identify the effect of dressings on CVC related
infections. Literature on the subject of central line infections show a lack of
consensus on research methods as well as operational definitions of the terms
used. For comparison, interpretation and synthesis of studies, the definition
used must clearly convey the intended meaning. Clarification about the bacteriological
methods used to identify, skin colonization, CRI and CRS is also necessary. All Reviewers At the recruitment phase, all potential reviewers completed a self assessment
of their educational level and skill levels. The average years of nursing experience
for all reviewers was 14.707 years. Skill levels on a scale of where 1 = unskilled
and 4 = skilled, library catalogue skills was 2.595, computer skills searching
the medline and CINAHL database was 2.119, critiquing skills of articles was 2.309
and summarising skills of articles was 2.523.
Studies included in this review 1. Andersen, P., Herlevsen, P., Schaumburg, H., 1986. A comparative study of Opsite and Nobecutan gauze dressings for central venous line care. J. of Hospital Infection 7:161-168. 2. Brandt, B., DePalma, J., et al. 1996. Comparison of central venous catheter dressings inbone marrow transplant recipients. ONF 23. no.5:829-36. 3. Conly, J., Grieves, K., et al. 1989. A prospective, randomized study comparing transparent and dry gauze dressings for central venous catheters. The Journal of Infectious Diseases 159, no.2:310-319. 4. Engervall, P., Ringertz, S., et al. 1995. Change of central venous catheter dressing twice a week is superior to once a week in patients with haematological malignancies 29:275-286. 5. Freiberger, D., Bryant, J., et al. 1992. The effects of different central venous line dressing changes on bacterial growth in a pediatric oncology population. Journal of Pediatric Oncology Nursing 9(10:3-7. 6. Lawson, M., Kavanagh, T., et al. 1986. Comparison of transparent dressing to paper tape dressing over central venous catheter sites. NITA Vol 9:40-43. 7. Maki, D., Ringer, M,. et al. 1993. Prospective, randomized trial of povidone-iodine, alcohol and chlorhexidine for prevention of infection associated with central venous and arterial catheters. CINA Vol 9,no.1:10-15. 8. Moro, M., Lepri, V., et al. 1994. Risk factors for the central venous catheter related infections in surgical and intensive care units. Infection Control and Hospital Epidemiology 15, no.4:253-264. 9. Nehme, A., Trigger, J., 1984. Catheter dressings in central parenteral nutrition-A prospective, randomized comparative study. Nutritional Support Services 4(9) 42,48,50. 10. Palidar, P., Simonowitz D., et al. 1982. Use of Opsite as an occlusive dressing for total parenteral nutrition catheters. Journal of Parenteral and Enteral nutrition 6(1):150-151. 11. Powell, C. Regan, C. et al. 1982. Evaluating of Opsite catheter dressing for parenteral nutrition: A prospective, randomized study. Journal of Parenteral and Enteral nutrition 6(1): 43-47. 12. Powell,C. Traetow, M., et al. 1985. Opsite dressing study: A prospective, randomized study evaluating povidone-iodine ointment and extension set changes with 7 days Opsite dressing applied to total parenteral nutrition subclavian sites. Journal of Parenteral and Enteral nutrition 9(3): 443-446. 13. Prager, R., Silva, J. 1984. Colonization of central venous catheters. Southern Medical Journal Vol 77 no.4:458-461. 14. Reynolds, ., Tebbs, S., et al. 1997. Do dressings with increased permeability reduce the incidence of central venous catheter related sepsis? Intensive and Critical Care Nursing 13:26-29. 15. Shivnan, J., McGuire, D., et al. 1991. A comparison of transparent adherent and dry sterile gauze dressings for long term central catheters in patients undergoing bone marrow transplant. Oncology Nurses Forum 18(8):1349-1356. 16. Taylor, D., Myers, S., et al. 1996. Use of occlusive dressings on central venous catheter sites in hospitalized children. Journal of Pediatric nursing 11(1):169-174. 17. Treston-Aurand, J., Olmsted, R., et al. 1997. Impact of dressing materials on central venous catheter infection rates. Journal of Intravenous Nursing 20(4):201-206. 18. Vazquez, R., Jarrard, M. 1984. Care of the central venous catheterization site: The use of a transparent polyurethane film. Journal of Parenteral and Enteral Nutrition. 8(2):181-186. 19. Wheeler, W., Messner, R., et al. 1988. A comparison of transparent dressings and gauze dressings for single, lumen, non tunneled central, parenteral nutrition catheters. Nutritional Support Services. 8(9):27-28. 20. Wille, J., Albas, B., et al. 1993. A comparison of two transparent film-type dressings in central venous therapy. Journal of Hospital Infection 23:113-121. 21. Young, G., Alexeyeff, M., et al. 1988. Catheter sepsis during parenteral
nutrition: the safety of long term opsite dressings. Journal of Parenteral and
Enteral Nutrition.12(4):365-369.
Studies excluded 1. Babycos, C., Barrocas, A., et al. 1990. 2. Callahan, J. Wesorick, B. 1987. 3. Dickerson, N. Horton, P. et al. 1989. 4. Haffejee, A. Moodley, J. et al. 1991. 5. Hoffmann, K. Weber, D. et al. 1992. 6. Jarrard, M. Olson, C. et al. 1980. 7. Keenlyside, D. 1993. 8. Lam, S., Scannell, R., et al. 1994. 9. Levin, A. Mason, J. et al. 1991. 10. Lucas, H. Attard-Montalto, S. 1996. 11. Lucas, J., Berger, A., et al. 1992. 12. Petrosino, B. Becker, H. et al. 1988. 13. Popovsky, M. Ilstrup, D. 1986. 14. Raad, J., Davis, S., et al. 1993. 15. Richet, H., Nitemberg, G., et al. 1990. 16. Schwartz-Fulton, H. Colley, R. et al. 1981. Unpublished studies that were not available 1. McKinley, S., Low, H., Mackenzie, A., Finfer, S., O'Connor, A., Green, S. 1997. Gauze dressings, antiseptic impregnated catheters and central venous catheter infections. 2. Nikoletti, S., Gandossi, S., Coombs, G., Wilson, R. 1997. Comparison
of transparent polyurethane and hydrocolloid dressings for central venous catheters.
Key to Tables
Some Tables contain considerable data and may be slow to load Table 1: Characteristics of included studies Table 2. & Figure 1: Weighting of included studies Table 3 : Summary of All Studies Table 4 : Summary of transparent versus gauze dressings Table 5 : Summary of transparent versus gauze with betadine dressings Table 6 : Summary of gauze dressings Table 7 : Summary of transparent dressings and transparent and other dressings Table 8 : Summary of transparent, gauze and other combinations of dressings Table 9 : Summary of studies with any significant results Table 10 : Summary of studies with dressing change 2nd daily (including MWF dressings) Table 11 : Summary of studies where dressing frequency is not identified Table 12 : Summary of studies of transparent dressings change of Once a Week Table 13 : Summary of studies of transparent dressings change less than OW Table 14 : Summary of studies with gauze dressing change of OD Table 15 : Summary of studies with gauze dressing change of 2nd daily Table 16 : Summary of studies with gauze dressing change of OW REFERENCES
Callahan, J., Wesorick, B. 1987. Bacterial growth under a transparent dressing. American Journal of Infection Control 15; 6:231-237. Lucas, H., Attard-Montalto, S., 1996. Central line dressings: study of infection rates. Paediatric Nursing Jul 8; 6:21-23. Petrosino, B., Becker, H., Becky, C. 1988. Infection rates incentral venous catheter dressings. ONF 15; 6:709-719. Richet, H., Nitemberg, H., Andremont, A., et al. 1990. Prospective multicenter study of vascular catheter related complications and risk factors for positive central catheter cultures in intensive care unit patients. Journal of Clinical Microbiology. Nov 28; 11:2520-2525. Speechley, V.1986. Intravenous therapy; peripheral/central lines. Nursing:
the Journal of Clinical Practice, Education and Management Mar 3; 3:95-100. |
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Last revised:
01 Jan 1970
URL:http://www.joannabriggs.edu.au/cvl/cvl.php |
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