What are the best dressings for CVCs?

A Cochrane review (Ullman et al, 2015) found that medication-impregnated dressing products reduce the incidence of catheter-related bloodstream infection (BSI) relative to all other dressing types. There is some evidence that chlorhexidne-impreganted dressings, relative to standard polyurethane dressings, reduce catheter-related BSI for the outcomes of frequency of infection per 1000 patient days, risk of catheter tip colonisation and possibly risk of catheter-related BSI.

Safdar and colleagues (2014) published a meta-analysis of 9 clinical trials assessing the efficacy of chlorhexidine (CHG) impregnated dressings in patients with central vascular catheters (CVC) that found 1.2% of patients developed catheter related bloodstream infections (CRBSI) in the CHG group and 2.3% in the comparator group and that CHG impregnated dressings reduced CRBSI (random effects RR 0.57, 95% CI 0.420.79, P=0.002). The authors conclude that the findings support the use of CHG-impregnated dressings in central lines and that the greatest benefit is expected from reduction of extra-luminal infectious complications in short-term catheters.

How often should I change the CVAD dressing?

Change the CVAD dressing whenever it is not clean, dry and intact. The best available evidence is currently inconclusive regarding whether longer intervals between CVAD dressing changes are associated with more or less catheter-related infection, mortality or pain than shorter intervals (Gavin et al, 2016).

Are sutureless securement devices effective at reducing BSI?

A multiple treatment meta-analysis (Ullman et al, 2015) found that sutureless securement devices are likely to be the most effective at reducing catheter-related BSI though this is low quality evidence. Most studies were conducted in intensive care unit (ICU) settings. More, high quality research is needed regarding the relative effects of dressing and securement products for CVCs. Future research may adjust the estimates of effect for the products included in this review and is needed to assess the effectiveness of new products.

References:

Ullman AJ, Cooke ML, Mitchell M, Lin F, New K, Long DA, Mihala G, Rickard CM. Dressings and securement devices for central venous catheters (CVC). Cochrane Database of Systematic Reviews, No. 9, 2015. DOI:10.1002/14651858.CD010367.pub2.

Gavin NC, Webster J, Chan RJ, Rickard CM. Frequency of dressing changes for central venous access devices on catheter-related infections. Cochrane Database of Systematic Reviews, No. 2, 2016. DOI: 10.1002/14651858.CD009213.pub2.

Safdar N, et al. Chlorhexidine-impregnated dressing for prevention of catheter-related bloodstream infection: a meta-analysis. Critical Care Medicine, Vol 42, No 7, 2014. DOI: 10.1097/CCM.0000000000000319.