Forum topic

6 posts / 0 new
Last post
Hortense Jones
7 day dressing change

How did the iv therapy community determine a 7 days for a dressing change protocol for central venous catheters?

Is there evidence that supports that

a) fewer dressing changes reduce the risk of infection

b) 7 days  or greater than 3 days is preferred?

The footnote in the CDC 2002 Catheter Care Guidelines references an abstract by Maki.  Footnote #65 Maki, Ringer 1987 JAMA.

The conclusion "These data indicate that it is not cost effective to redress perpheral venous catheters at periodic interfals;  for most patients either sterile guaze or a transparent dressing can be used and left on until the catheter is removed."  This a good start but does not get to a definitive number of days.

Could it be that 7 days is the maximum one can expect a transparent dressing to remain in place?

I'm asking because several MDs insist on a 3 day dressing change (no gauze). 

 I'm looking for evidence to support lengthening the dressing change interval beyond 3 days.

 

 

 

lynncrni
There are numerous studies

There are numerous studies published on dressing changes through the years. So I am sure a thorough literature search will provide the information you are looking for. I can not remember what the 1996 CDC guidelines stated but there could be some information for you in that document.  

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

sable
hi do any of you put 2x2
hi do any of you put 2x2 under your central line dressing ?
MARIAJ
We do not, at our

We do not, at our facility.  We use Tegaderm and Biopatch.  We change the dressing every 7 days and PRN.

We, as a PICC team, change the PICC/Midline dressings, but the nurses in the units change all the other central line dressings.  Unless the patient is allergic to Tegaderm, and a Covaderm is indicated, we all use the same procedure.

Putting a 2x2 would change the time of redressing the site to every 48 hours.

Maria Kendrick, RN

DENISE123
I would like to ask a few
I would like to ask a few questions concerning your MD's requests for 3 day dsg changes.  1. Are the majority of these pts. recieving TPN, or are transplant reciepients.  2. Are Biopatches being used, and do the MD's understand their purpose & the data behind them?  I worked at a facility that their policy was 3 day changes on all pt.'s recieving TPN due to the increased glucose creating the probability of an increase in infection rate but this was before Biopatches came around.  If you can't find specific data to support the 7 day dsg changes maybe you could suggest a trial period in a particular area of your facility and compare the data.  I'm interested in what information you find so please report back.  Denise
lynncrni
I think you are confusing

I think you are confusing the various causes of BSI. I recently gave a presentation title Pathogenesis Predicts Prevention where I looked at the causes of 4 complications and then the specific interventions to prevent it. With BSI, you have 2 major causes - the skin of the patient and the caregivers and the amount, frequency and type of hub manipulation. The glucose will encourage the growth of biofilm by providing nutrients for it. This is all inside the catheter lumen, so your focus should be on all of those tasks we do with the catheter hub. Dressings, the change frequency, procedure etc are directed at the patient's skin. Research has shown that catheters indwelling for less than 7 days have more biofilm on the outside of the catheter wall. Catheters in for 30 days have more biofilm on the internal lumen. So Biopatch will prevent infections caused by the skin, but would have no impact on BSI caused by the glucose in the solution. For that focus on hub manipulation task. Extend the life of the tubing to 96 hours. Eliminate stopcocks. Never allow the continuous tubing to be disconnected for any reason. Clean all injection surfaces and luer lock connection surfaces with alcohol scrubs before each and every connection. So look at the cause of the infection to determine what aspects of your care to change in order to see an improvement. Changing the wrong aspect will not cause an improvement.  

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Log in or register to post comments