REVIEW QUESTION

Which of the available dressing and securement devices for central venous catheters (CVCs) are most effective in preventing catheter-related bloodstream infections?

TYPE OF REVIEW

This is an intervention review comparing available CVC dressings and securement devices to identify which works best.

RELEVANCE FOR NURSING

Many CVC dressings and securement devices are available, and it is the clinician who decides the best type to use to meet best-practice guidelines, reduce bloodstream infection, and increase patient comfort and tolerance. In choosing the dressing, the clinician takes into consideration the patient's life, activities, and comfort, and the site of the catheter on the patient. In caring for the CVC, the clinician is not only guided by the best available evidence, she or he also needs to work within institutional requirements such as the hospital's guidelines, policies, and procedures associated with CVC devices and care.

CHARACTERISTICS OF THE EVIDENCE

Twenty-two studies were identified, with a total of 7,436 participants. The studies were conducted in 25 countries, included a range of settings and populations, and used different types of CVCs. Of these, 13 were randomized control trials (n = 848) investigating the primary outcome of incidence of catheter-related bloodstream infection from

* medication-impregnated dressings versus nonimpregnated dressings.

* chlorhexidine gluconate-impregnated (CGI) dressings versus all other medication-impregnated dressings (such as povidone-iodine or silver).

Further interventions included

* silver-impregnated dressings versus all other medication-impregnated dressings.

* povidine-iodine impregnated dressings versus all other medication-impregnated dressings.

* gauze and tape versus standard polyurethane (SPU) and bordered polyurethane.

Most of the research included in the review was carried out in ICU settings where many CVCs are used for short durations.

It is unclear whether there is a difference in the rate of catheter-related bloodstream infection between securement with gauze and tape and SPU, or between CGI dressings and SPU, because the evidence was of low and moderate quality, respectively. There is high-quality evidence that medication-impregnated dressings reduce the incidence of catheter-related bloodstream infection relative to all other dressing types.

There is moderate-quality evidence that CGI dressings reduce the frequency of catheter-related bloodstream infection compared with SPU dressings. There is also moderate-quality evidence that catheter tip colonization is reduced with CGI dressings compared with SPU dressings, but the relative effects of gauze and tape and SPU are unclear.

BEST PRACTICE RECOMMENDATIONS

The study results show that securing a CVC with a dressing impregnated with a medication (chlorhexidine gluconate or silver) reduces catheter-related bloodstream infection compared with a dressing without medication. The review also highlights reports of possible increased skin irritation or damage from CGI dressings. Where local contact dermatitis occurs from a CGI dressing-for example, in the acutely ill low-birthweight neonate or in people with impaired skin integrity-its use would need to be immediately reviewed.

RESEARCH RECOMMENDATIONS

Many securement products for CVCs have not been adequately investigated. More high-quality research is needed to examine the effectiveness of the wide range of dressings and securement products available.

REFERENCE