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Updated: Jul 30, 2026
Chemotherapy-induced Vascular Toxicity - Real-time In vivo Imaging of Vessel Impairment
Published on: January 7, 2015
Less frequent catheter dressing changes decrease local cutaneous toxicity of high-dose chemotherapy in children,
E Benhamou1, E Fessard, C Com-Nougué
1Department of Biostatistics and Epidemiology, Institut Gustave Roussy, Rue Camille Desmoulins, 94 800 Villejuif, France.
Insights
Reducing catheter dressing changes to every 15 days significantly lowers skin toxicity in pediatric bone marrow transplant patients. This change in frequency for central venous catheter care did not increase infection risks.
Area of Science:
- Pediatric Oncology
- Hematology
- Infectious Disease
Background:
- Catheter dressing changes can cause pain and skin lesions in children undergoing chemotherapy and bone marrow transplantation.
- Optimizing dressing change frequency is crucial for patient comfort and preventing complications.
Purpose of the Study:
- To compare the incidence of skin toxicity and infection between two central venous catheter dressing change frequencies (15 days vs. 4 days) in pediatric patients.
- To evaluate the impact of dressing change frequency on local pain and microbial colonization.
Main Methods:
- A randomized trial involving 113 pediatric patients undergoing high-dose chemotherapy and bone marrow transplantation.
- Patients were assigned to either a 4-day or 15-day dressing change schedule.
- Skin toxicity was graded, and skin cultures were taken at the catheter entry site.
Main Results:
- Fewer children in the 15-day group (8/56) experienced severe skin toxicity (grade ≥2) compared to the 4-day group (24/56) (P=0.001).
- Pain levels and positive skin cultures were similar between groups.
- Nosocomial bloodstream infection rates were also comparable (11% vs. 13%).
Conclusions:
- Decreasing central venous catheter dressing change frequency to 15 days is effective in reducing cutaneous toxicity.
- This reduced frequency does not elevate the risk of local or systemic infections.
- The study supports an 8-day dressing change interval in clinical practice.
Abstract:
Cutaneous lesions caused by catheter dressing changes can be serious and generate local pain in children undergoing high-dose chemotherapy followed by bone marrow transplantation. One hundred and thirteen children entered a randomised trial to compare two catheter dressing change frequencies (15 days vs 4 days). Skin toxicity was classified according to the following scale: grade 0: healthy skin, to grade 4: severe skin toxicity. A qualitative culture of the skin at the catheter entry site was taken whenever the dressing was changed. Of the 112 evaluable children (56 in each group) 32 developed grade > or = 2 local skin toxicity (eight in the 15-day group and 24 in the 4-day group; P = 0.001). Although higher in the 4-day group, the proportions of children experiencing pain during and between dressing changes were not statistically different between the two groups. The proportion of patients with one or more positive skin culture(s) at the catheter entry site during hospitalisation were similar in the two groups (27% in the 15-day group and 23% in the 4-day group) as were the proportions of documented nosocomial bloodstream infections (11% and 13%; NS). Whereas the planned frequency was maintained in the 4-day group (mean = 4 days, s.d. = 1), it was usually shortened in the 15-day group (mean = 8 days, s.d. = 4), mainly because dressings had loosened. Decreasing the catheter dressing change frequency proved efficient in reducing cutaneous toxicity without increasing the risk of local and systemic infection. In our unit, catheter dressings are changed every 8 days since this analysis.
