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Use of occlusive dressings on central venous catheter sites in hospitalized children
D Taylor1, S T Myers, K Monarch
1Department of Nursing, Children's Hospital of Oklahoma, Oklahoma City 73126, USA.
Insights
Occlusive dressings on central venous catheters (CVCs) in hospitalized children over 1,800g did not increase site infections. Microbial growth beneath dressings was observed but did not correlate with a higher sepsis rate in this pediatric group.
Area of Science:
- Pediatric Nursing
- Infectious Disease Control
- Medical Device Management
Background:
- Occlusive dressings are common for central venous catheters (CVCs) but their use in pediatrics is debated.
- Limited research exists on microbial colonization under occlusive dressings in pediatric CVC sites.
Purpose of the Study:
- To investigate microbial colonization and inflammation under repeated occlusive dressings at pediatric CVC sites.
- To assess the relationship between microbial growth and CVC site infections in hospitalized children.
Main Methods:
- Noninvasive skin cultures were taken at CVC placement, during routine changes, and at CVC removal.
- Study included 104 hospitalized children aged neonate to 18 years.
- Analysis compared microbial growth patterns with systemic sepsis rates, excluding neonates under 1,800g.
Main Results:
- Significant microbial growth increased under occlusive dressings, particularly with serosanguinous drainage.
- Microbial growth continued after dressing discontinuation, yet systemic sepsis rate was low (0.3%).
- Excluding neonates under 1,800g eliminated the notable pattern of microbial growth (p = .2119).
Conclusions:
- Prolonged use of occlusive dressings for tunnelled CVCs in children over 1,800g does not appear to increase CVC site infections.
- The observed microbial growth beneath dressings may not indicate clinical infection in this pediatric population.
- Further research on pediatric CVC dressing management is warranted.
Abstract:
Although the use of occlusive dressings in adults has been criticized in the literature, there has been little written on their use in the pediatric population. Management of dressing sites requires nursing judgement unique to this population. This study focused on the progression of microbial colonization and signs of inflammation occurring beneath repeated occlusive dressings applied to central venous catheter (CVC) insertion sites among 104 hospitalized children (neonate to 18 years). A noninvasive skin culture was obtained within 24 hours of CVC placement, 3 to 7 days later before the next routine dressing change, and at the time the CVC was discontinued or the child was discharged, whichever occurred first. Results showed a significant increase in microbial growth (p < or = .001) at the second dressing change, when serosanguinous drainage was heaviest, and continued significant growth (p < or = .001) when the dressing was discontinued. This microbial growth pattern was curious in the face of a 0.3% systemic sepsis rate. When neonates under 1,800 g were excluded from calculation, the pattern was not notable (p = .2119). Findings suggest the use of occlusive dressings during prolonged hospitalization for tunnelled CVCs does not lead to increased site infections in children over 1,800 g.