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Comparative Evaluation of Chest Tube Insertion Site Dressings: A Randomized Controlled Trial
Michelle D Wood1, Jan Powers2, Jennifer L Rechter2
1Michelle D. Wood is a clinical nurse specialist for Parkview Heart Institute, Jan Powers is director of nursing research and professional practice, and Jennifer L. Rechter is clinical nurse specialist for the medical intensive care unit, Parkview Health, Fort Wayne, Indiana. michelle.wood@parkview.com.
Background:
Little empirical evidence is available to guide decisions on what type of dressing to use and how often to change the dressing after placement of a thoracostomy tube.
Objectives:
This prospective randomized controlled study was conducted to compare various dressing types and procedures after placement of thoracic and mediastinal chest tubes. Outcome measures included length of time between dressing changes, skin integrity, air leak presence, and patient-reported pain.
Methods:
The study involved a convenience sample of 127 patients with 236 chest tubes from 3 intensive care units at a midwestern regional medical center. The patients were randomized to 1 of 3 groups: (1) gauze and tape dressing changed once daily, (2) gauze and tape dressing changed every 3 days, and (3) silicone foam dressing changed every 3 days.
Results:
Patients with silicone foam dressings reported less pain at the insertion site than did patients with standard gauze and tape dressings, and patients with daily dressing changes reported significantly more pain with dressing removal than did patients with dressing changes every 3 days. The silicone foam dressing was associated with better skin integrity than the gauze and tape dressing. Dressing intactness, number of days with a chest tube inserted, and patient demographic characteristics did not differ significantly among the 3 groups.
Conclusions:
Overall, the best type of dressing for promoting skin integrity and patient comfort was the silicone foam dressing. The results of this study may help identify best practices for dressing type and procedures among patients with chest tubes.
