Improving central venous catheter dressings for ICU patients

CVCs are essential for the treatment of ICU patients, with millions of CVCs placed worldwide every year.

However, up to a quarter of them fail from either non-infectious, such as thrombosis or dislodgement, or infectious local or systemic complications. When a CVC fails, patients often have longer ICU stays and are at an increased risk of morbidity and mortality.

One of the key factors in CVC failure is how poorly the catheter is secured to the skin, especially for CVCs placed in the jugular vein, which are at high risk of being pulled out. Improving how CVC dressings are applied can help reduce the chances of failure and complications. However, it’s challenging to find a dressing that stays secure in this difficult location.

RBWH Nursing and Midwifery Director of Research Professor Nicole Marsh sought to improve on current practice through testing the safety and effectiveness of medical liquid adhesive added to jugular CVC dressings compared to usual care.

“CVC dressings have been reported to fail as soon as 25–46 hours after being applied, with the risk of bloodstream infections tripling if a dressing is disrupted two or more times,” Professor Marsh said.

“Our previous randomised controlled trial examining dressing failure found nearly 40 per cent of jugular CVC dressings had lifting edges due to pull-out forces caused by patient movement, light sedation and the tugging of infusion sets on bed rails.

“Frequent dressing changes can also lead to skin damage, which is more common in critically ill patients due to their weakened health. Additionally, repeated changes add extra costs in both labour and materials costs.”

Professor Marsh worked alongside an interdisciplinary investigative team including clinical and research nurses, intensive care and infectious disease specialist doctors, health economists, microbiologists and statisticians.

The investigator team was from RBWH, The Prince Charles Hospital, Logan Hospital and Liverpool Hospital, the University of Queensland, Griffith University, Queensland University of Technology and Wollongong University.

“Among ICU patients with jugular CVCs who had medical liquid adhesive applied, compared with standard dressings alone, there was a significant reduction of 22 per cent in dressing failure due to lifting and an extended time to dressing change,” Professor Marsh said.

“There was also a significant cost saving of labour and materials.

“Importantly, medical liquid adhesive is an easy-to-use product which was highly acceptable to bedside clinicians and can be incorporated into clinical practice.”

The research is set to be translated into practice through in-house education sessions, adoption into local policies and guidelines and presentations at local, national and international conferences.