Comparative analysis of different CVC dressing types convenience and economic effectiveness in allogeneic hemopoietic stem cell transplant recipients

Summary

Introduction

The care for critically ill patients in our clinic requires in most cases the central venous access for therapeutic interventions and diagnostics. The use of central venous catheters (CVCs) has its drawbacks, one of which is development of catheter-associated infections (CAI) found in 20- 55% of patients with sepsis. CAI development leads to significant raise of treatment costs. The prevalence of CAI depends on intraluminal and exit site infections prophylaxis by using appropriate CVC maintenance equipment and techniques.

Materials and methods

A total of 112 of allogeneic hemopoietic stem cell transplantation recipients with AML, ALL, CML and AA were divided into 3 clinical groups based on dressing type used. All patients had CV accesss via v. jugularis interna dextra. In the 1st group (n=38) sterile self-adhesive non-woven pads (Cosmopor) were used. In the 2nd group (n=37) transparent Tegaderm Film dressings were used. In the 3rd group (n=37) transparent gel pads Tegaderm CHG were used. Nurses from CVC care team evaluated patients’ complaints and performed catheter site monitoring for possible presence of local inflammatory changes, allergic reactions and CVC displacement. In addition, dressings changing convenience, catheter site cultures results and economic aspects were analyzed.

Results

The catheter exit site bacterial colonization was lower in patients with Tegaderm CHG dressings (3.4%), than in patients with non-woven pads (5.7%) or Tegaderm Film (5.3%) dressings. In most cases the exit site inflammation was caused by Staph.Аureus, Staph. Epidermidis, Kl.Pneumoniae or Enterococcus spp. All 1st group (non-woven pads) patients reported frequent dressing deformation requiring its replacement and skin discomfort due to residual adhesive material. Patients from the 2nd (film pads) group complained of skin contraction in movement (23%) dressing deformation (22%), itching (18%), while 37% of patients had no complaints. In the 3rd group (transparent gel pads) 92% of patients were satisfied with dressing performance, while 2% reported itching and 6% movement restriction. From nurses’ points of view non-woven pads were inconvenient due to the difficulties of exit site monitoring, need of frequent changing of soiled, wet or deformed dressings. Transparent films were more convenient due to better visual control and less dense change schedule (once 2-3 days). Gel pads were most convenient as they required changing only one in 5-7 days and provided good catheter fixation. The daily cost was greater for daily changed non-woven pads (4.35 euro), than for film pads (2.67 euro) or gel pads (1.72 euro).

Conclusions

Transparent gel pads (Tegaderm CHG) is optimal in post-transplant patients due to less frequent change, which leads to less frequent skin traumas and exit sites infections, is more convenient for patients and nurses. In addition, although gel pads are relatively more expensive, their use provide economic advantages to lower daily cost (1.5-2.5 less than other dressing types) and less frequent CAIs.

Keywords

Central venous catheters, cvc dressings, infection prophylaxis, nurses monitoring, daily cost