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

Jami L Melhorn1, Marnie Burkett2

  • 16619UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.

Journal of Pediatric Hematology/Oncology Nursing
|June 22, 2022
PubMed

Insights

Implementing a new central line dressing protocol significantly reduced skin breakdown in pediatric oncology patients undergoing bone marrow transplant. This change decreased the incidence of skin breakdown by over 80%.

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.

Keywords:
bone marrow transplantcentral lineinfectionnonocclusive dressingskin breakdownthiotepa

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