The argument for transparent dressings
The argument for transparent dressings
A look at gauze vs. transparent dressings
While transparent dressings are relatively new kids on the block, they have yet to fully supplant gauze as the standard for covering catheter sites.
According to the industry standard-setters, there’s good reason to consider both gauze and transparent dressings.
Elise Jochimsen, MD, a medical epidemiologist for the Centers for Disease Control and Prevention (CDC) in Atlanta, notes that there isn’t a body of evidence that suggests one dressing is preferable to another.
"There has not been enough research, and the studies that have been done have been controversial because there have been contradictory findings," she says.
As a result, the CDC’s Guideline for Prevention of Intravascular Device-related Infections recommends either gauze and tape or transparent dressings for catheter sites.
"It basically leaves it up to the individual whether they use gauze and tape or transparent dressing, and dressings should be changed when they become damp, loosened or soiled," she says.
The benefits of transparent dressings
Jochimsen notes there is a clear benefit of using transparent dressings.
"You can observe the insertion site without necessarily removing it, whereas if you have a gauze dressing, in order to inspect the catheter site you’re going to have to replace the dressing so it may take more personnel time and more effort," she says. "The patient may feel more comfortable with the transparent dressing so they can see the site. You need to consider what is going to help the patient more, and that may be a transparent dressing."
This is in line with the Cambridge, MA-based Intravenous Nurses Society (INS) Standards of Practice, which recommends that a site covered with gauze and tape "should be visually inspected and palpitated for tenderness daily through the intact dressing. If there is tenderness at site, fever without obvious source, or symptoms of local or bloodstream infection develop, the dressing should be removed and site inspected directly."
Noreen Meanor, RN, OCN, president of the League of Intravenous Therapy Educators (LITE), based in Pittsburgh, says most providers have switched to transparent dressings, but such dressings are not appropriate for all patients.
"There are patients who are allergic to the transparent dressings and in that case you would use some type of gauze dressing," she says.
In addition to the benefit of visual site inspection, Jochimsen notes transparent dressings allow patients to bathe and shower without saturating the dressing, and require less frequent dressing changes than standard gauze and tape.
Debbie Benvenuto, CRNI, nurse educator for INS, says the INS prefers transparent dressings. "We prefer transparent dressings because you can do visualization of a site, site assessment, and hopefully pick up early signs of complications," she says. "Our standards are based on research material and the recommendations of the CDC."
Home infusion nurses who may be visiting a patient for the first time are at a disadvantage when it comes to gauze.
"If you have a gauze-and-tape dressing and I’m the nurse coming in, I’m going to have to take that tape off to inspect the site and that is interrupting the integrity of that system," says Meanor.
Benvenuto says in addition to the transparent dressings being beneficial barriers to contamination, they can be cost effective because it is a one-time dressing that allows visual inspection of the site without removing the dressing.
Although there are benefits for transparent dressings, Jochimsen says there is no immediate need to switch if you are using gauze and achieving desirable outcomes.
"Some are more comfortable with the gauze because that is what they are used to, and that’s fine," she says. "There is no evidence that that is wrong."
Benvenuto agrees gauze has its place in today’s high-tech world.
"We would like to use gauze on some of the big dressings, like chest dressings, especially right after insertion, because the gauze is a wick to move material away from the infection site so you don’t have bloody sites and medium to grow bacteria," she says.
But she cautions using gauze on a long-term site.
"With too much continual taping and retaping, after a time you start to worry about eroding the catheter material," she says.
Looking for a standard
Unfortunately, studies conducted until now present conflicting data on the gauze vs. transparent dressing debate.
According to the CDC’s Guideline for Prevention of Intravascular Device-related Infections, some studies have shown an increase in microbial colonization of the catheter site and the risk of subsequent catheter-related infection, while other studies have shown no difference in catheter colonization and infection rates between the use of transparent dressings and of gauze and tape dressings.
The report notes, "The potential risk of infection posed by transparent dressings appears to vary with the type of catheter (peripheral or central venous catheter) they are used to dress and, perhaps, with the season of the year."
However, one of the largest controlled trials of dressing regimens to date examined the infectious morbidity associated with the use of transparent dressings on more than 2,000 peripheral catheters.1
The findings suggested no significant difference in that rate of catheter colonization between catheters dressing with transparent dressings (5.7%) and gauze (4.6%).
There also was no significant difference in either the incidences of catheter site colonization or phlebitis.
The study did suggest transparent dressings left on peripheral venous catheters for the duration of catheter insertion did not increase the risk of thrombophlebitis.
The CDC report notes studies of transparent dressings on central venous catheters have yielded conflicting data. Some report an increased risk of catheter-related infection among central venous catheters with a transparent dressing compared with those covered with gauze, while other studies report comparable risk of infection.
However, most of the collected data concerns short-term, non-tunneled central venous catheters, with limited data available on the use of transparent dressings on long-term, tunneled CVCs.
Also noted in the report is a meta-analysis of catheter dressing regimens, which CVCs covered with a transparent dressing "had a significantly higher incidence of catheter-tip colonization, but a non-significant increase in the incidence of catheter-related bloodstream infections.
"Preliminary data suggest newer transparent dressings that permit the escape of moisture from beneath the dressing may be associated with lower rates of skin colonization and catheter-related infection, but the length of time that a transparent dressing can be safely left on a CVC catheter site is unknown."
A pair of controlled studies addressed in the CDC report also notes, with adherence to strict infection control protocols, semipermeable, transparent dressings can be used as an alternative to gauze and tape for dressing total parenteral nutrition catheter insertion sites and can be changed safely at seven-day intervals.
Other alternatives
The CDC report notes collodion has been evaluated for use as a potential dressing for catheter sites. In a retrospective study of 34 central venous catheters, a low incidence of catheter-related infections was reported despite catheters remaining in place an average of 16.5 days.
The report notes the need for more randomized trials comparing collodion with existing dressings before collodion can be recommended for routine use as a catheter site-dressing. There is also limited evidence of the benefit of using no dressing at all in certain instances. (See related story, at right.)
For a copy of the CDC report and citations for numerous studies on the use of transparent vs. gauze dressings, a copy is available on the Web at www.cdc.gov/ncidod/hip/iv/iv.htm or call the CDC at (404) 639-3311.
Reference
1. Maki DG, Ringer M. Evaluation of dressing regimens for prevention of infection with peripheral intravenous catheters: Gauze, a transparent polyurethane dressing, and an iodophor-transparent dressing. JAMA 1987; 258:2,396-2,403.
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