Beruflich Dokumente
Kultur Dokumente
2
0
0
3
B
l
a
c
k
w
e
l
l
P
u
b
l
i
s
h
i
n
g
L
t
d
,
J
o
u
r
n
a
l
o
f
A
d
v
a
n
c
e
d
N
u
r
s
i
n
g
,
4
4
(
6
)
,
6
2
3
6
3
2
Table 3 Included studies (data available)
Authors Patients Setting Interventions Outcomes Exclusions Comments Days in study
Brandt et al.
(1996)
Patients 18 years
of age who were
to have a tunnelled
CVC inserted
following admission
for an autologous BMT
BMT unit of a
regional oncology
centre, USA
Random allocation:
G & T (/daily)
IV3000 (24/week)
Catheter-related
sepsis
Exit site infection
Tunnel infection
Those with
sepsis within
14 days of
study entry or
with short
term CVCs
Dropouts: 38% G & T 223 days
IV3000 210 days
Ha gerstro m
et al. (1994)
Patients with
dialysis CVCs
Department of
Nephrology Dialysis
Unit, Sweden
Random allocation:
G & T (2/week)
IV3000 (2/week)
Catheter-related
sepsis
Not stated Dropouts:
not stated
3 months
Neufeld (1991) All adult inpatients
who had percutaneous
or tunnelled central
lines in place
for >48 hours
ICU and unspecied
wards, Canada
Random allocation:
Opsite
(/7 days or PRN)
IV3000
(/7 days or PRN)
Site colonization.
No dressings
changed/week
Oncology
and haematology
patients
There was an
additional
change of
dressings at
72 hours in the
Opsite group.
Dropouts: 432%
At least 48 hours
Petrosino et al.
(1988)
Adult oncology
patients with a
newly inserted
tunnelled CVC
Two medical
oncology units at
two acute care
institutions, USA
Random allocation:
Tegaderm
(/7 days or PRN)
Opsite (/7days or PRN)
Exit site
infection
Did not complete
7 days because
of death, exit
site bleeding, cuff
extrusion, catheter
removal, excessive
diaphoresis, dislike
or reaction to
povidone
Dropouts: 21%.
Blinding was
not used
710 days
Reynolds et al.
(1997)
Patients critically ill
with liver disease,
majority having
had liver transplants
Liver ICU, England Alternate allocation:
Tegaderm (/2days)
IV3000 (/2days)
Site
colonization
Not stated Confounders:
None stated.
Dropouts: 25%
56 days
Wille et al.
(1993)
Patients >16 years
of age scheduled to
have a CVC in a
newly created site
A district general
hospital,
The Netherlands
Random allocation:
Opsite (/7days)
IV3000 (/7days)
Catheter-related
sepsis
Not stated Higher proportion
of males in IV3000
group, 28% were
shaved compared
with the Opsite
group (20%).
Dropouts: 114%
120 days
CVC, central venous catheter; BMT, bone marrow transplant.
I
n
t
e
g
r
a
t
i
v
e
l
i
t
e
r
a
t
u
r
e
r
e
v
i
e
w
s
a
n
d
m
e
t
a
-
a
n
a
l
y
s
e
s
C
e
n
t
r
a
l
v
e
n
o
u
s
c
a
t
h
e
t
e
r
d
r
e
s
s
i
n
g
s
2
0
0
3
B
l
a
c
k
w
e
l
l
P
u
b
l
i
s
h
i
n
g
L
t
d
,
J
o
u
r
n
a
l
o
f
A
d
v
a
n
c
e
d
N
u
r
s
i
n
g
,
4
4
(
6
)
,
6
2
3
6
3
2
6
2
9
(Opsite: 038, Opsite IV3000: 018). All data for these
analyses were from the study by Neufeld (1991), which had a
total sample number of 25.
Tegaderm vs. Opsite IV3000
There was no signicant difference in the incidence of site
colonization or mean number of colony-forming units (cfus)
when Tegaderm was compared with Opsite IV3000. All data
for these analyses were from the study by Reynolds et al.
(1997), which had a total sample number of 75.
Tegaderm vs. Opsite
There was no signicant difference in the incidence of exit
site infection when Tegaderm was compared with Opsite. All
data for this analysis were from the study by Petrosino et al.
(1988), which had a total sample number of 21.
Discussion
Despite the relatively high number of studies identied as
relevant to this review, few could be included. This was not
because the inclusion criteria were particularly strict. For
example, quasi-randomized trials were included and observ-
ers did not appear to be effectively blinded in any included
study.
The included studies covered dressings of gauze and tape,
Tegaderm, Opsite and Opsite IV3000. The outcomes from
these studies were catheter-related sepsis, exit site infection,
tunnel infection, site colonization and number of dressings
changed per day. However, it is impossible to draw any
conclusions from these studies about the risk of infection
with each of the dressing types. For each outcome reported,
data were from no more than two studies. In addition, the
sample numbers in these studies were quite small, the largest
reporting data from 101 participants. Therefore, all of the
included studies were probably too small to show any
difference in outcomes. In particular, the sample numbers
would have been too low to show any difference in the
incidence of the most clinically important outcome, catheter-
related sepsis. For example, a sample number of approxi-
mately 450 per group would be required for a doubling in the
incidence of catheter-related sepsis to be signicant (where
the incidence in the control group was 005 and power was
08). Clearly this is much higher than the sample numbers of
5060 per group that were obtained for the analyses of
catheter-related sepsis in this review.
Conclusion
There is a high level of uncertainty about the risk of infection
with the CVC dressings included in this review. Therefore, at
this stage it appears that choice of dressing for CVCs can be
based on patient preference. Based on our ndings, policy at
The CHW has been changed to allow the decision to use
gauze and tape or Opsite IV3000 to be based on the
preferences of patients and carers. However, as new data
become available this policy may have to be changed if an
increased risk is found to be associated with any of these
CVC dressings.
Further research is necessary to determine what is the
appropriate dressing to use for CVCs. It is paramount that
any future studies investigating this issue be rigorously
Table 4 Meta-analytic results
Comparison/outcome
No. of
studies
No. of
participants
Odds ratio
(95% CI)
Risk difference
(95% CI)
Weighted mean
difference (95% CI)
G & T
vs. IV3000
Catheter-related sepsis 2 115 115 (003, 4323) 006 (043, 031)
Exit site infection 1 101 232 (040, 1327) 005 (005, 014)
Tunnel infection 1 101 064 (014, 283) 003 (014, 007)
Opsite
vs. IV3000
Catheter-related sepsis 1 101 031 (003,312) 004 (012, 004)
Site colonization (incidence) 1 25 Not estimable 000 (015, 015)
Dressings changed/day 1 25 020* (037, 003)
Tegaderm
vs. IV3000
Site colonization (incidence) 1 75 066 (026, 167) 010 (032, 012)
Site colonization (mean cfus) 1 75 090 (415, 235)
Tegaderm
vs. Opsite
Exit-site infection 1 21 075 (012, 466) 006 (047, 034)
*P < 005.