What are the best dressings for CVADs?

A large systematic review and meta-analysis (Xu et al, 2024) of central venous access device (CVAD) dressings, including studies from all patient populations across all healthcare and community settings, found that medication-impregnated dressing products (that is: chlorhexidine gluconate dressing or disc, polyhexamethylene biguanide disc, silver, iodine) reduce the incidence of catheter-related bloodstream infection (CRBSI) and catheter tip colonisation relative to all other dressing types.

Most of the included studies were conducted in ICU (21 of 46 studies; 46%) or cancer care settings (9 of 46 studies; 20%), so these findings may not be applicable to settings outside ICU and cancer care. 

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). Despite this uncertainty, clinical practice guidelines recommend changing transparent polyurethane dressings at least every 7 days or immediately if the dressing is soiled, loose or damp; and for CVADs dressed with gauze, change every 2 days (Buetti et al, 2022).

A small randomised controlled trial enrolling neonates in ICU found that routine weekly dressing changes, in addition to changing the dressing when not clean, dry or intact, led to a lower incidence of catheter-related BSI (CRBSI), compared with changing the dressing only when not clean, dry and intact (0 CRBSI versus 2% CRBSI) (Su et al, 2021).

Want to know if sutureless securement devices can reduce infections and improve CVAD stability? Click here. 

References:

Buetti N, Marschall J, Drees M, Fakih MG, Hadaway L, Maragakis LL, Monsees E, Novosad S, O'Grady NP, Rupp ME, Wolf J, Yokoe D, Mermel LA. Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol. 2022 May;43(5):553-569. doi: 10.1017/ice.2022.87. 

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.

Su LT, Huang HC, Liu YC, Chang HY, Ou-Yang MC, Chen CC, Chen FS, Chung MY, Chen IL. The appropriate frequency of dressing for percutaneous central venous catheters in preventing catheter-related blood stream infection in NICU - A randomized controlled trial. Pediatr Neonatol. 2021 May;62(3):292-297. doi: 10.1016/j.pedneo.2021.02.001. 

Xu H, Hyun A, Mihala G, Rickard CM, Cooke ML, Lin F, Mitchell M, Ullman AJ. The effectiveness of dressings and securement devices to prevent central venous catheter-associated complications: A systematic review and meta-analysis. Int J Nurs Stud. 2024 Jan;149:104620. doi: 10.1016/j.ijnurstu.2023.104620.
 

Last Updated on: 06/11/2024