Decreasing Skin Breakdown Around Central Lines in Patients Receiving Thiotepa Prior to Bone Marrow Transplantation

Area of Science:

• Pediatric Oncology
• Hematology
• Nursing Practice

Background:

• Skin breakdown around central lines elevates infection risk, especially in pediatric patients receiving intensive therapies.
• Thiotepa treatment prior to bone marrow transplantation was associated with increased skin breakdown in pediatric oncology patients.
• Limited evidence exists for managing central line care in patients with compromised skin integrity.

Purpose of the Study:

• To develop and implement a protocol to decrease skin breakdown around central line dressings in pediatric oncology patients.
• To improve patient outcomes by reducing complications associated with central venous access devices.
• To address the gap in evidence regarding central line care for patients with impaired skin.

Main Methods:

• A new protocol using gauze and self-adherent wrap (non-tape) for central line dressings was developed based on expert consensus.
• Staff nurses received education on the new protocol, and compliance was monitored.
• A retrospective chart review compared skin breakdown and central line-associated bloodstream infections rates before and after protocol implementation.

Main Results:

• The implementation of the new protocol resulted in an over 80% reduction in skin breakdown surrounding central lines.
• Compliance with the new dressing protocol was monitored through observation and electronic medical record documentation.
• The study demonstrated a significant improvement in skin integrity for patients receiving bone marrow transplantation.

Conclusions:

• A revised central line dressing protocol effectively minimizes skin breakdown in high-risk pediatric oncology patients.
• Evidence-based practice changes in nursing care can lead to substantial improvements in patient safety and outcomes.
• Further research may explore long-term effects and broader applicability of non-occlusive dressing techniques.