Gauze and tape and transparent polyurethane dressings for central venous catheters
Abstract
Background
Central venous catheters facilitate venous access, allowing the intravenous administration of complex drug treatments, blood products and nutritional support, without the trauma associated with repeated venepuncture. However, central venous catheters are associated with a risk of infection. Some studies have indicated that the type of dressing used for central venous catheters may affect the risk of infection. Gauze and tape, transparent polyurethane film dressings such as Tegaderm® and Opsite®, or highly moisture permeable transparent polyurethane film dressings such as Opsite IV3000®, are the most common types of dressing used to secure central venous catheters. Currently, it is not clear which type of dressing is the most appropriate.
Objectives
To compare gauze and tape and transparent polyurethane central venous catheter dressings in terms of catheter related infection, catheter security, tolerance to dressing material and dressing condition in hospitalised adults and children.
Search methods
For this second update, we searched the Cochrane Wounds Group Specialised Register (March 2008) and the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2008, Issue 1), Ovid MEDLINE (1950 to February Week 4, 2008), Ovid EMBASE (1980 to Week 9, 2008) and Ovid CINAHL (1982 to February Week 4, 2008)
Selection criteria
All randomised controlled trials evaluating the effects of dressing type (i.e. gauze and tape and/or transparent polyurethane dressings) on central venous catheter related infection, catheter security, tolerance to dressing material and dressing condition in hospitalised patients.
Data collection and analysis
Two review authors independently assessed trial quality and extracted data. We also contacted study authors for missing information.
Main results
Six studies were included in the previous version of the review. Three further studies were identified by the first update search but these were excluded. Twenty‐four further references were screened in this second update but none of these were relevant to the review. Of the six included studies with available data, two compared gauze and tape with highly permeable transparent polyurethane dressings, two compared transparent polyurethane dressings with highly permeable transparent polyurethane dressings, one compared gauze and tape with transparent polyurethane dressings, and one compared two different transparent polyurethane dressings. There was no evidence of any difference in the incidence of infectious complications between any of the dressing types compared in this review. Each of these comparisons was based on no more than two studies and all of these studies reported data from a small patient sample. Therefore it is possible that the finding of no difference between dressing types is due to the lack of adequate data.
Authors' conclusions
There is a high level of uncertainty regarding the effect of CVC dressings on the risk of infection. Therefore, at this stage it appears that the choice of dressing for central venous catheters can be based on patient preference and/or cost.
Plain language summary
Do different types of dressing used to protect the central venous catheter site reduce the chance of developing a catheter related infection?
A central venous catheter is a small tube inserted into a major vein to allow medications and other fluids to be 'dripped' in over a period of time without repeated injections. It is used in preference to a peripheral catheter (e.g. in the hand or arm) when access is required for long periods of time or the fluids that are administered may be damaging to the tissues. However, because central catheters are open to large veins they are associated with a risk of blood infection. Several different kinds of dressing are used for protecting the central venous catheter site, including transparent polyurethane dressings, gauze and tape. These dressings may vary in their durability, ease of use, ability to prevent infections and skin reactions. However, the review of trials found there is not enough evidence to determine whether any of the dressings for central venous catheters are better than any of the others.
