Background and importance Central venous catheters, peripherally inserted central catheters, Port-a-cath and Midline are fundamental systems to manage acute and chronic treatments in both inpatients and outpatients. Available dressings must provide a protective barrier, avoid the dislocation of these medical devices and be comfortable for the patient. Chlorhexidine releasing polyurethane medications can prevent bacterial colonisation and, consequently, the occurrence of infections.
Aim and objectives The objective of the study was to monitor the introduction in some wards of a chlorhexidine releasing dressing and collect data relating to its appropriate use and exit site.
Material and methods Basing on the typology of the patients and treatments, four pilot wards were chosen (intensive care unit, dialysis, oncology and neurosurgery). After team building meetings, an ad hoc form was introduced and provided to the internal pharmacy service following every application/change of a dressing. The form contained information on the patient’s name and surname, age, diagnosis, type of catheter, treatment, date of first application of the dressing, exit site and reason for dressing substitution. The form was used to fill an Excel database and sum up data using descriptive statistical methods.
Results From October 2018 to June 2019, the dressing was used in 126 patients (55% men, n=69): 53% (n=67) in the intensive care unit, 37% (n=47) in oncology and 7% (n=9) in dialysis. Thirteen patients with an exit site grade (G ) >0 were given the medication: 7 of these patients from dialysis had a 1 ≤G ≤3 already present at the first application, and 4 in oncology and 2 in intensive care developed a G=1 that lasted for a single application and then regressed to G=0. The average number of days of application of the medication was 6. Of the 290 chlorhexidine containing dressings provided to the units, 27 were changed before day 7 (maximum time in place), 67% (n=18) because of ‘self-removal of the previous dressing’, 30% (n=8) due to ‘dirty medication’ and 19% (n=5) because the dressing was ‘wet’.
Conclusion and relevance In 219 of 231 cases, at replacement of the dressing, the exit site grade was G=0, suggesting that this medication may have helped the preservation of skin integrity. In dialysed and oncologic patients, the exit site grade is more difficult to manage, probably due to the complexity of the pathology and therapy.
References and/or acknowledgements No conflict of interest.
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