ARTICLE REVIEW
Central venous catheters are used very frequently in intensive care units. According to the most recent CDC Guidelines (1), gauze dressings should be changed every 48 hours and transparent semi-permeable dressings every 7 days or earlier if the integrity of the dressings is compromised or there is blood. However, the evidence supporting these recommendations is limited.
Recently, Gavin et al. published a Cochrane review (2) to assess the effects of the frequency of dressing changes on the incidence of catheter related infections and other outcomes (i.e. mortality, catheter site infection, skin damage, pain, quality of life and cost).
They included only randomised clinical trials that evaluated the effect of the frequency of the dressing changes on the incidence of catheter related infections. Other designs were excluded. There was no limitation of participants’ age, healthcare setting, language or publication year. Quality evaluation was performed using the GRADE system.
Authors identified 471 titles, five of which were included in the review. The five trials involved 2277 participants (range 32-1653); one study involved children and the other 4 involved adults. Two studies were set in a transplant unit, 2 consisted on patients undergoing treatment for cancer and 1 recruited patients from the intensive care unit (3).
The frequency of the dressing changes varied from 2 to 15 days. There was a high heterogeneity of the protocol used in the different studies [frequency of change, dressing type (gauze, transparent semi-permeable, chlorhexidine impregnated sponges) and antisepsis used]. For the analysis, they defined intervention group as dressing changes from 5 to 15 days and control group as dressing changes from 2 to 5 days.
Only one study evaluated the relationship with confirmed catheter-related blood stream infections, two studies analysed suspected catheter-related blood stream infections, all studies determined catheter-site infections, three studies included all-cause mortality, skin damage evaluation was present in four studies, pain was assessed in 2 studies, cost was assessed in one study and quality of life was not reported in any trial.
Authors concluded that the quality of the evidence available is low or really low with a high risk of bias and remains inconclusive regarding whether longer intervals between dressing changes are associated with more or less catheter-related infections, mortality or pain than shorter intervals. Specifically designed studies for intensive care settings are still needed to show whether longer intervals or shorter intervals between dressing changes are more effective in preventing catheter related infections, mortality, skin damage, dressing removal pain, quality of life and cost.
Article review prepared and submitted by ESICM Journal Club member Mireia Llaurado Serra on behalf of the N&AHP Section.
References
(1) O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. 2011. Available at: http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf
(2) Gavin NC, Webster J, Chan RJ, Rickard CM. Frequency of dressing changes for central venous access devices on catheter-related infections (Review). Cochrane Database of Systematic Reviews 2016, Issue 2. DOI: 10.1002/14651858.CD009213.pub2.
(3) Timsit JF, Schwebel C, Bouadma L, et al. Chlorexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults. JAMA 2009;301(12):1231-41.
