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Timing of the first dressing change after CVC insertion in pediatric critically ill patients: a randomized
Wenchao Wang1, Yalan Dou2, Weijie Shen1
1Pediatric Intensive Care Unit, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China.
Insights
Delaying the first central venous catheter (CVC) dressing change to seven days is safe. This practice did not increase skin bacterial colonization or catheter-related bloodstream infections (CRBSI) in pediatric intensive care units.
Area of Science:
- Pediatric critical care medicine
- Infection prevention and control
- Medical device management
Background:
- The optimal timing for the first central venous catheter (CVC) dressing change post-insertion is not well-established.
- Current practices vary, potentially impacting patient safety and resource utilization.
Purpose of the Study:
- To determine if a first dressing change at seven days is non-inferior to an earlier change at 24 hours for CVC sites.
- To evaluate the impact of delayed first dressing changes on skin bacterial colonization and catheter-related bloodstream infections (CRBSI).
Main Methods:
- A multicenter randomized controlled non-inferiority trial involving 280 pediatric patients in four Chinese ICUs.
- Patients were assigned to either a control group (dressing change at 24 hours, then every seven days) or an experimental group (first dressing change at seven days).
- Primary outcome: skin bacterial colonization under the dressing; Secondary outcome: CRBSI rates.
Main Results:
- Skin bacterial colonization rates were similar between groups (25.6% experimental vs. 26.8% control), meeting the non-inferiority margin.
- Catheter-related bloodstream infection rates showed no significant difference between the groups (1.42 vs. 2.72 per 1,000 catheter days).
- Only one instance of skin injury was reported, indicating good local tolerance.
Conclusions:
- Delaying the initial CVC dressing change to seven days is a safe practice regarding skin bacterial colonization.
- The study suggests this delayed approach does not elevate the risk of CRBSI, though larger trials are needed for definitive infection safety conclusions.
Abstract:
The optimal timing of the first dressing change after central venous catheter (CVC) insertion remains unclear. To test whether a first dressing change at seven days is non-inferior to an additional change at 24 h, we conducted a multicenter randomized controlled non-inferiority trial in four Chinese pediatric ICUs (April 2021-December 2022). A total of 280 patients aged 1 month to 18 years with a newly inserted CVC were randomly assigned to the control group (dressing change at 24 h, then every seven days) or the experimental group (first dressing change at seven days). The primary outcome was skin bacterial colonization under the transparent dressing, assessed at day 7 (experimental) and day 8 (control). In the intention-to-treat population, colonization occurred in 25.6% of experimental patients and 26.8% of controls (difference, - 1.1%; 95% CI, - 13.0% to 10.7%), with the upper CI limit below the prespecified noninferiority margin of 20%. Catheter related bloodstream infection(CRBSI) rates were 1.42 vs. 2.72 per 1,000 catheter days (no significant difference). Only one skin injury occurred. Delaying the first dressing change to seven days did not increase skin bacterial colonization and showed no significant difference in CRBSI, suggesting that this practice is safe with respect to colonization risk. Definitive conclusions regarding infection safety require a larger trial.