Comparison of two different time interval protocols for central venous catheter dressing in bone marrow transplant patients: results of a randomized,multicenter study

Background and Objectives. Care of central venous catheter (CVC) in patient s undergoing bone marrow transplantation (BMT) raises significant problems related to the high risk of local infections due to the immunodeficient sta tus, which in itself Is a; predisposing factor for systemic blood-stream in fections. Although frequent changes of CVC dressing might theoretically red uce the incidence of infections, they are also accompanied by significant s kin toxicity and patient discomfort. No study has yet addressed these point s. The objective of this study was to compare two different time interval p roto,cols for CVC dressing in order to assess the effects on local Infectio ns and toxicity. Design and Methods. In a multicenter study, 399 bone marrow transplant (BMT ) patients with a tunneled CVC (Group A, 230 pts) or a non-tunneled one (Gr oup B, 169 pts) were randomly allocated to receive CVC dressing changes eve ry 5 or 10 days, if belonging to Group A, or 2 or 5 days, ii in Group B. Tr ansparent, impermeable polyurethane dressings were used for all patients. T he rate of local infections at the site of CVC insertion was assessed by mi crobiological assays every 10 days, while the severity of skin toxicity was measured according to the ECOG scale. Results. Sixty-five per cent of enrolled patients were finally evaluable. P atients (in both Groups) receiving CVC dressing changes at longer intervals did not show a significant increase in the rate of local infections, while those who received dressing every 2 days had a significant increase in foc al skin toxicity. Longer intervals were accompanied by a reduction in costs . Interpretations and Conclusions. The results of this study demonstrate that the Increase in tim e intereval between CVC dressing changes in BMT patients did not raise the risk of local infections, while sig significantly reducing patient discomfo rt and costs. (C) 2000, Ferrata Storti Foundation.