I NTEGRATI VE LI TERATURE REVI EWS AND META- ANALYSES

Central venous catheter dressings: a systematic review

Donna Gillies PhD
Head, Research Development Unit, School of Nursing, Family and Community Health, University of Western Sydney, Penrith
South DC, New South Wales, Australia
Elizabeth ORiordan PhD RN MN
Clinical Nurse Consultant, The Childrens Hospital at Westmead, New South Wales, Australia
Debbie Carr RN
Clinical Coordinator, Oncology Treatment Centre, The Childrens Hospital at Westmead, New South Wales, Australia
Ida OBrien RN BHealthSci(Nurs)
Clinical Nurse Consultant, Oncology, The Childrens Hospital at Westmead, New South Wales, Australia
Judy Frost RN MN
Clinical Nurse Consultant, Palliative Care, The Childrens Hospital at Westmead, New South Wales, Australia
and Robbie Gunning RN
Senior Staff Nurse in Paediatric Oncology, Tawah Hospital, Al Ain, United Arab Emirates
Submitted for publication 17 April 2002
Accepted for publication 7 April 2003
Correspondence:
Donna Gillies,
Research Development Unit,
School of Nursing, Family and
Community Health,
University of Western Sydney,
Parramatta Campus, Building ER,
Locked Bag 1797,
Penrith South DC,
NSW 1797,
Australia.
E-mail: d.gillies@uws.edu.au
GI LLI ES D. , O RI ORDAN E. , CARR D. , O BRI EN I . , FROST J . & GUNNI NG R. GI LLI ES D. , O RI ORDAN E. , CARR D. , O BRI EN I . , FROST J . & GUNNI NG R.
( 2003) ( 2003) Journal of Advanced Nursing 44(6), 623632
Central venous catheter dressings: a systematic review
Background. Gauze and tape or transparent polyurethane lm dressings such as
Tegaderm, Opsite or Opsite IV3000 are the most common types of dressing
used to secure central venous catheters (CVCs). Currently, there are no clear
guidelines as to which type of dressing is the most appropriate.
Aims. To identify whether there are any differences between gauze and tape and/or
transparent polyurethane lm dressings in the incidence of CVC-related infection,
catheter-related sepsis, catheter security, tolerance to dressing material, dressing
condition and ease of application in hospitalized patients.
Methods. The Cochrane Controlled Trials Register and Medline, Embase and Can-
cerLit databases were searched to identify any controlled trials comparing the effects of
gauze and tape and/or transparent polyurethane dressings on CVCs. Additional ref-
erences were sought frompublished and non-published literature. Twenty-three studies
were reviewed. Data were extracted independently fromeach paper by two members of
the reviewteamand results compared. Differences were resolved either by consensus or
referral to a third person. Authors were contacted for missing information.
Results. Of the 23 studies reviewed, 15 were excluded. Of the remaining eight, data
were available for meta-analysis from six studies. Of the six included studies, two
compared gauze and tape with Opsite IV3000, two compared Opsite with Opsite
IV3000, one compared Tegaderm with Opsite IV3000, and one compared Tegaderm
with Opsite.
2003 Blackwell Publishing Ltd 623
Conclusions. There was no evidence of any difference in the incidence of infectious
complications between any of the dressing types compared in this review. Each of
these comparisons was based on no more than two studies and all of these studies
reported data from a small patient sample. Therefore it is unlikely that any of these
comparisons would have had sufcient power to detect any differences between
groups.
Keywords: central venous catheter, dressing, infection, contamination, systematic
review, meta-analysis, nursing
Background
The use of tunnelled and non-tunnelled central venous
catheters (CVCs) has become increasingly common in the
hospital setting. The CVCs facilitate venous access, prevent
the trauma associated with repeated venepuncture and allow
the administration of complex treatment regimes, blood
products and intravenous nutritional support. Gauze and
tape or transparent polyurethane lm dressings such as
Tegaderm, Opsite or Opsite IV3000 are the most
common types of dressing used to secure CVCs.
The impetus for this review came from questions raised by
oncology nurses at The Childrens Hospital at Westmead
(CHW) about the management of CVCs. In particular, they
were interested in investigating whether there was any
difference between gauze and tape and transparent polyur-
ethane lm dressings when used on CVCs. There are no clear
guidelines as to the most appropriate type of dressing to be
used or the frequency with which dressings should be
changed. Currently at CHW, CVCs are dressed daily with
gauze and tape. Clinical experience and feedback from
parents indicated that gauze and tape might not be the most
appropriate dressing to use for all children. To meet the
varying needs of children with CVCs it is important that any
alternative dressings do not compromise the childs safety or
the security of the CVC. This systematic review was therefore
undertaken to assist staff in determining the most appropriate
dressing for CVCs.
The incidence of catheter-related infection ranges from 4 to
18% (Elliott & Tebbs 1998), and is one of the most
frequently cited complications associated with CVCs
(Polderman & Girbes 2002, Webster et al. 2003). Most
catheter-related infections appear to result from the migra-
tion of microorganisms from the insertion site into the
cutaneous catheter tract, resulting in colonization of the tip
(Bjornson et al. 1982, Snydman et al. 1982, Kelsey & Gosling
1984). As some dressings may be more conducive to the
growth of microorganisms, the type of dressing applied to the
catheter insertion site may inuence the incidence of catheter-
related infections (Schwartz-Fulton et al. 1981, Callahan &
Wesorick 1987, Maki 1992, Treston-Aurand et al. 1997).
Traditionally, the CVC site was dressed with dry gauze and
tape. In the early 1980s this gave way to transparent
polyurethane lm dressings, notably Opsite, Tegaderm and
more recently Opsite IV3000. Although there are substantial
differences between the various transparent polyurethane lm
dressings (Thomas 1988) potential advantages of these
dressings include improved security of the catheter, visibility
of the wound site, provision of an effective barrier to
microorganisms and less frequent dressing changes. How-
ever, there is concern that these dressings have the potential
to increase skin surface humidity, which may result in
increased colonization of the site and therefore an increased
risk of catheter-related infection (Conly et al. 1989, Dicker-
son et al. 1989, Wille et al. 1993).
The most appropriate dressing regime remains one of the
most actively researched and controversial areas of CVC
management. Studies that have compared the use of gauze
and tape with transparent polyurethane lm dressings have
reported contradictory ndings regarding the risk of infec-
tious outcomes. Some studies have found that the use of
transparent polyurethane lm dressings increases the risk of
catheter-related infections (Powell et al. 1982, Conly et al.
1989, Dickerson et al. 1989), whereas others have shown
that there is no difference (Curtas & Grant 1981, McCredie
et al. 1984, Petrosino et al. 1988, Young et al. 1988, Brandt
et al. 1996, Reynolds et al. 1997).
A meta-analysis that compared the effect of dressing type
for peripheral and central catheters (Hoffmann et al. 1992)
found that the risk of catheter tip infections (but not sepsis)
was signicantly increased with transparent CVC dressings
compared with gauze and tape. However, this analysis of
seven studies included two that had major confounding
variables (Powell et al. 1982, Andersen et al. 1986). In
addition, one study allocated patients based on where they
were nursed (Young et al. 1988) and incorrect sample
D. Gillies et al.
624 2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 44(6), 623632
numbers may have been used for one study (Conly et al.
1989). Therefore, there were several factors that could have
biased the results of this meta-analysis. The apparent lack of
clear evidence regarding the most appropriate dressing for
CVCs established the need to undertake this systematic
review.
The review
Aims
To identify whether there were any differences between
gauze and tape and/or transparent polyurethane lm
dressings in the incidence of CVC-related infection, cath-
eter-related sepsis, catheter security, tolerance to dressing
material, dressing condition and ease of application in
hospitalized patients.
To conduct subgroup analysis of the data for adults and
children.
Design
The methods of this review were based on those of the
Cochrane Collaboration (Clarke & Oxman 2000). This
required the development by the review group of a protocol
in which the selection criteria for the inclusion of studies and
methods of the review were dened.
Search strategy
Prior to conducting this review the Cochrane Database of
Systematic Reviews (CDSR) and the Database of Abstracts of
Reviews of Effectiveness (DARE) were searched to identify
whether any systematic reviews pertaining to this topic had
been published. The search of the DARE database identied
the Hoffmann et al. (1992) meta-analysis which examined
the infection risks associated with the use of transparent
dressings on peripheral and central catheters. However, as
previously discussed, the data used for this analysis may have
resulted in biased ndings. In addition, new studies had been
published subsequent to this meta-analysis and this data also
needed to be included.
The Cochrane Controlled Trials Register (up to March
2000) was searched using terms relating to CVC dressings to
identify any relevant randomized controlled trials. The
databases Medline (1966May 2000), CINAHL (1982
March 2000) and CancerLit (1995April 2000) were also
searched using a topic search strategy designed to identify
references that contained textwords or subject headings
relevant to the topic of CVC dressings. Specicity of this
topic search was increased by combining the results of this
search with the results from a modied version of the
Cochrane Randomised Controlled Trial Search Strategy. No
references were generated from searches of Medline 1966
1975, which probably reects that transparent polyurethane
lm dressings only started to be used to secure CVCs in the
late 1970s and early 1980s.
Searches of the Ovid databases using the names of authors
known to have published on the topic were also conducted.
Bibliographies of papers from which data was extracted,
published reviews, relevant conference proceedings and any
product information were also checked for references. Based
on the selection criteria, titles and/or abstracts of potentially
relevant references were independently assessed by three
reviewers as to whether they were suitable for review. Any
disagreement regarding the selection of studies was resolved
through consensus. Full copies of references thought to be
suitable for review were obtained for data extraction.
Selection criteria
All randomized or systematically allocated controlled trials
investigating the effects of CVC dressings, gauze and tape,
and transparent polyurethane lm, on the incidence of CVC-
related infection, catheter-related sepsis, catheter security,
skin condition, dressing condition and ease of application, in
hospitalized patients, were selected for review. The selection
criteria for papers to be included are discussed below.
Types of participants
Studies included should concern patients in an acute care
setting with a CVC. A CVC can be tunnelled or non-tun-
nelled, the tip of which is in the superior vena cava. Generally
the cephalic, subclavian or external jugular veins are used.
Tunnelled catheters have a dacron cuff just inside the exit
site.
Types of intervention
To be included, studies should focus on gauze and tape
compared with transparent polyurethane lm, or one trans-
parent polyurethane lm compared with another, as dressings
for CVCs. Transparent polyurethane lm dressings are de-
ned as dressings composed of a thin polyurethane mem-
brane coated with a layer of acrylic adhesive.
Types of outcome measures
Based on the protocol for this review the reported outcomes
were classied as quantitative or qualitative.
Data for the following quantitative outcomes were collec-
ted for this review:
Integrative literature reviews and meta-analyses Central venous catheter dressings
2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 44(6), 623632 625
Catheter colonization: positive semiquantitative or quan-
titative culture from a CVC (CDC 2002).
Site colonization: any positive cultures of the exit site or
skin around the exit site.
Catheter-related sepsis: isolation of the same organ
ism from a semiquantitative or quantitative culture of a
catheter segment and from separate percutaneous
blood cultures, with no other identiable source of infec-
tion.
As the methods used to measure these outcomes have
acceptable validity and reliability, these data were collected
even when the measures of validity and reliability were not
stated.
Data for the following qualitatively assessed outcomes
were only collected from included studies if the denitions
used were shown to be reliable.
Exit-site infection: erythema, tenderness, induration, or
purulence at the catheter exit site.
Tunnel infection: erythema, tenderness, induration, or
purulence in the tissue overlying the catheter.
Catheter security: as dened by authors of any included
studies.
Skin condition/irritation: as dened by authors of any
included studies.
Dressing condition/durability: as dened by authors of any
included studies.
Ease of application: as dened by authors of any included
studies.
Data collection and analysis
A data extraction form was developed and piloted by all
members of the review team on a mixed set of articles. Data
were extracted from each selected paper independently by
two members of the review group and each pair then met to
compare the results. If differences were identied, they were
resolved either by consensus or by referral to a third member
of the team. If data were missing, efforts were made to
contact the authors.
Outcome data were only collected when they were repor-
ted for a patient sample (i.e. where the sample number
represented the number of patients per group). In many cases,
outcome data were reported for a sample number which
represented the number of dressings or lines per group. These
data could not be used as they represented multiple samples
from the same patient and could result in biased reporting
and inaccurate statistical conclusions. When data from a non-
patient sample were given for a valid and reliable outcome,
attempts were made to contact authors to obtain the data for
the patient sample.
Results
Excluded studies
Of the 23 studies reviewed, 15 were excluded (Table 1). Five
of these had major confounding variables, at least one
Table 1 Excluded studies
Study Reason
Andersen et al. (1986) Only the gauze and tape group had Nobecutan (veried with authors)
Berggren et al. (1995) Reliability was not shown for outcomes. No further data regarding validity
and reliability could be obtained
Dickerson et al. (1989) Denition of outcomes unclear. No further data could be obtained
Keenlyside (1993) Conventional dressing was not dened. No further information could be obtained
McCredie et al. (1984), Lawson et al. (1986)* Gauze and tape was compared with gauze and Tegaderm
Little and Palmer (1998) Dry sterile dressing was not dened. Only the dry sterile dressing group had
povidoneiodine ointment.
D.G. Maki (unpublished letter) Methodology unclear. No further data could be obtained
Nehme and Trigger (1984) Only the gauze and tape group had povidoneiodine ointment
Powell et al. (1982) Only the gauze and tape group had povidoneiodine ointment
Powell et al. (1984), Powell et al. (1985)* Denition of catheter-related sepsis and catheter colonization differed from the
review protocol
Ricard et al. (1985) Some catheters appear to be peripherally inserted. No further information could be
obtained to conrm
Shivnan et al. (1991) No useable data was reported. No further information could be obtained
Thomas (1977) Methodology unclear. No further information could be obtained
Wheeler et al. (1988) Historical controls
Young et al. (1988) Convenience allocation used
*Duplicate publication of same study.
D. Gillies et al.
626 2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 44(6), 623632
dressing was not dened in two studies, the denition of
outcomes was either unclear or did not agree with the study
protocol in three studies, and two studies were not randomly
or alternately allocated. Four studies were excluded because
there was inadequate information on their methodology.
Despite efforts to contact authors for additional information,
no further data could be obtained.
Quality of included studies
Eight of the 23 studies initially selected for review were
included in the analysis (Tables 2 and 3). Seven of these
studies used random allocation and one used alternate
allocation. None of the randomly allocation studies was
described adequately to allow a decision about the quality
of the randomization process to be made. Seven of the eight
included studies stated that blinding was used; however,
there was insufcient information in any of these to
conclude whether adequate blinding was used. The study
by Petrosino et al. (1988) was not blinded and, although
Neufeld (1991) stated that the observer was not aware
which coloured tab was indicative of dressing types, the
observer may have been aware of which dressing type was
which. Confounding factors were reported in three of the
studies (Conly et al. 1989, Neufeld 1991, Wille et al. 1993;
see Tables 2 and 3).
Although efforts were made to contact study authors for
information, no outcome data were available for two of the
eight included studies (Table 2). In the study by Freiberger
et al. (1992) there was no signicant difference in the
incidence of site colonization when gauze and tape was
compared with Tegaderm. However the authors concluded
that there was probably inadequate power in this study of 60
patients to have shown a signicant difference. Conly et al.
(1989) reported a signicantly higher incidence of catheter
colonization and catheter-related sepsis and higher level of
site colonization when CVCs were dressed with Opsite
compared with gauze and tape. However, signicant con-
founding in the Opsite group may have affected these results
(see Table 2). Also, these analyses did not appear to be based
on sample numbers which represented patients, which may
have resulted in inaccurate statistical conclusions. For exam-
ple the incidence of catheter-related sepsis was given as 0 of
34 for the gauze and tape group and seven of 42 for the
Opsite group, although there were 37 patients in each group.
Therefore the seven in the Opsite group may have represented
multiple samples from one or more patients with catheter-
related sepsis. Although considerable efforts were made to
contact study authors for patient data these could not be
obtained.
A summary of the included studies with available data is
given in Table 3. Two of these compared gauze and tape with
Opsite IV3000, two compared Opsite with Opsite IV3000,
one compared Tegaderm with Opsite IV3000, and one
compared Tegaderm with Opsite.
Data were collected at two time intervals in the study by
Petrosino et al. (1988). However, only the data collected at 7
10 days were used in this review, as the patient dropout at
30 days was 46%. In addition, data from the gauze and tape
group could not be used from the Petrosino study as
povidoneiodine ointment was only used with this group.
Attempts were made to obtain exit site colonization data from
the Petrosino study authors, but these were unsuccessful.
For each comparison (gauze and tape compared with
Opsite IV3000, Opsite with Opsite IV3000, Tegaderm with
Opsite IV3000 and Tegaderm with Opsite) results are given
as odds ratios and risk difference for the dichotomous
variables of catheter-related sepsis, exit-site infection, tunnel
infection and site colonization (Table 4). Weighted mean
difference is shown for the continuous variables, site colon-
ization (as the mean number of colony-forming units) and
number of dressings changed per day.
Gauze and tape vs. Opsite IV3000
There was no signicant difference in the incidence of
catheter-related sepsis when gauze and tape was compared
with Opsite IV3000. The data for this analysis were pooled
from the studies by Ha gerstro m et al. (1994) and Brandt et al.
(1996), giving a total sample number of 115. As there was
signicant heterogeneity between these studies, a Random
Effects model was used to calculate the odds ratio and risk
difference for this comparison.
There was no signicant difference in the incidence of exit
site infection or tunnel infection when gauze and tape was
compared with Opsite IV3000. All the data for this compar-
ison came from the study by Brandt et al. (1996), which had a
total sample number of 101.
Opsite vs. Opsite IV3000
There was no signicant difference in the incidence of
catheter-related sepsis when Opsite was compared with
Opsite IV3000. All data for this analysis were from the
study by Wille et al. (1993), which had a total sample number
of 101.
There was no signicant difference in the incidence of site
colonization when Opsite was compared with Opsite
IV3000. However, there was a small but signicant differ-
ence in the mean number of dressings changed per day
Integrative literature reviews and meta-analyses Central venous catheter dressings
2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 44(6), 623632 627
Table 2 Included studies (Data not available)
Authors Patients Setting Interventions Outcomes Exclusions Comments Days in study
Conly et al.
(1989)
Patients (medical,
surgical, paediatric,
ICU) who had a
CVC inserted for
any purpose for
at least 3 days
University hospital,
Canada
Random
allocation: G &
T (/2 days)
Opsite (/2 days)
Site colonization,
catheter
colonization,
catheter-related
sepsis
Those who
had a catheter
<72 hours and
patients who
received catheters
for short-term
haemodynamic
monitoring
Outcome data was not
reported per patient
group. No further
data could be
obtained.
Confounders: There was
a signicantly higher
proportion of surgical
vs. medical patients,
subclavian vs. jugular
insertion sites, and
males vs. females
in the Opsite group.
There was also a
signicantly lower
proportion that
received steroids in
this group.
Dropouts: 39%
G & T 135 days
Opsite 179 days
Freiberger et al.
(1992)
Patients between
the ages of
019 years with
newly placed CVCs
Oncology and
Bone Marrow
Transplant Unit,
Paediatric
Hospital, USA
Random allocation:
G & T (/Mon,
Wed, Fri)
Tegaderm
(/Mon, Wed, Fri)
Site
colonization
Not stated No data available.
No further data could
be obtained.
Dropouts: Not stated
10 days
CVC, central venous catheter.
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Table 3 Included studies (data available)
Authors Patients Setting Interventions Outcomes Exclusions Comments Days in study
Brandt et al.
(1996)
Patients 18 years
of age who were
to have a tunnelled
CVC inserted
following admission
for an autologous BMT
BMT unit of a
regional oncology
centre, USA
Random allocation:
G & T (/daily)
IV3000 (24/week)
Catheter-related
sepsis
Exit site infection
Tunnel infection
Those with
sepsis within
14 days of
study entry or
with short
term CVCs
Dropouts: 38% G & T 223 days
IV3000 210 days
Ha gerstro m
et al. (1994)
Patients with
dialysis CVCs
Department of
Nephrology Dialysis
Unit, Sweden
Random allocation:
G & T (2/week)
IV3000 (2/week)
Catheter-related
sepsis
Not stated Dropouts:
not stated
3 months
Neufeld (1991) All adult inpatients
who had percutaneous
or tunnelled central
lines in place
for >48 hours
ICU and unspecied
wards, Canada
Random allocation:
Opsite
(/7 days or PRN)
IV3000
(/7 days or PRN)
Site colonization.
No dressings
changed/week
Oncology
and haematology
patients
There was an
additional
change of
dressings at
72 hours in the
Opsite group.
Dropouts: 432%
At least 48 hours
Petrosino et al.
(1988)
Adult oncology
patients with a
newly inserted
tunnelled CVC
Two medical
oncology units at
two acute care
institutions, USA
Random allocation:
Tegaderm
(/7 days or PRN)
Opsite (/7days or PRN)
Exit site
infection
Did not complete
7 days because
of death, exit
site bleeding, cuff
extrusion, catheter
removal, excessive
diaphoresis, dislike
or reaction to
povidone
Dropouts: 21%.
Blinding was
not used
710 days
Reynolds et al.
(1997)
Patients critically ill
with liver disease,
majority having
had liver transplants
Liver ICU, England Alternate allocation:
Tegaderm (/2days)
IV3000 (/2days)
Site
colonization
Not stated Confounders:
None stated.
Dropouts: 25%
56 days
Wille et al.
(1993)
Patients >16 years
of age scheduled to
have a CVC in a
newly created site
A district general
hospital,
The Netherlands
Random allocation:
Opsite (/7days)
IV3000 (/7days)
Catheter-related
sepsis
Not stated Higher proportion
of males in IV3000
group, 28% were
shaved compared
with the Opsite
group (20%).
Dropouts: 114%
120 days
CVC, central venous catheter; BMT, bone marrow transplant.
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(Opsite: 038, Opsite IV3000: 018). All data for these
analyses were from the study by Neufeld (1991), which had a
total sample number of 25.
Tegaderm vs. Opsite IV3000
There was no signicant difference in the incidence of site
colonization or mean number of colony-forming units (cfus)
when Tegaderm was compared with Opsite IV3000. All data
for these analyses were from the study by Reynolds et al.
(1997), which had a total sample number of 75.
Tegaderm vs. Opsite
There was no signicant difference in the incidence of exit
site infection when Tegaderm was compared with Opsite. All
data for this analysis were from the study by Petrosino et al.
(1988), which had a total sample number of 21.
Discussion
Despite the relatively high number of studies identied as
relevant to this review, few could be included. This was not
because the inclusion criteria were particularly strict. For
example, quasi-randomized trials were included and observ-
ers did not appear to be effectively blinded in any included
study.
The included studies covered dressings of gauze and tape,
Tegaderm, Opsite and Opsite IV3000. The outcomes from
these studies were catheter-related sepsis, exit site infection,
tunnel infection, site colonization and number of dressings
changed per day. However, it is impossible to draw any
conclusions from these studies about the risk of infection
with each of the dressing types. For each outcome reported,
data were from no more than two studies. In addition, the
sample numbers in these studies were quite small, the largest
reporting data from 101 participants. Therefore, all of the
included studies were probably too small to show any
difference in outcomes. In particular, the sample numbers
would have been too low to show any difference in the
incidence of the most clinically important outcome, catheter-
related sepsis. For example, a sample number of approxi-
mately 450 per group would be required for a doubling in the
incidence of catheter-related sepsis to be signicant (where
the incidence in the control group was 005 and power was
08). Clearly this is much higher than the sample numbers of
5060 per group that were obtained for the analyses of
catheter-related sepsis in this review.
Conclusion
There is a high level of uncertainty about the risk of infection
with the CVC dressings included in this review. Therefore, at
this stage it appears that choice of dressing for CVCs can be
based on patient preference. Based on our ndings, policy at
The CHW has been changed to allow the decision to use
gauze and tape or Opsite IV3000 to be based on the
preferences of patients and carers. However, as new data
become available this policy may have to be changed if an
increased risk is found to be associated with any of these
CVC dressings.
Further research is necessary to determine what is the
appropriate dressing to use for CVCs. It is paramount that
any future studies investigating this issue be rigorously
Table 4 Meta-analytic results
Comparison/outcome
No. of
studies
No. of
participants
Odds ratio
(95% CI)
Risk difference
(95% CI)
Weighted mean
difference (95% CI)
G & T

vs. IV3000
Catheter-related sepsis 2 115 115 (003, 4323) 006 (043, 031)
Exit site infection 1 101 232 (040, 1327) 005 (005, 014)
Tunnel infection 1 101 064 (014, 283) 003 (014, 007)
Opsite

vs. IV3000
Catheter-related sepsis 1 101 031 (003,312) 004 (012, 004)
Site colonization (incidence) 1 25 Not estimable 000 (015, 015)
Dressings changed/day 1 25 020* (037, 003)
Tegaderm

vs. IV3000
Site colonization (incidence) 1 75 066 (026, 167) 010 (032, 012)
Site colonization (mean cfus) 1 75 090 (415, 235)
Tegaderm

vs. Opsite
Exit-site infection 1 21 075 (012, 466) 006 (047, 034)
*P < 005.

Treated as the control group in the calculation of results.

D. Gillies et al.
630 2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 44(6), 623632
performed randomized controlled trials. Such studies must
address the quantitative indicators of CVC-related infection,
namely catheter-related sepsis and CVC site colonization.
This is not to say that qualitative assessments of infection
cannot be used, but these must be evaluated for validity and
reliability and the collection of data must be stringently
blinded. For meta-analytic results to be achievable, the data
must also be able to be combined. This can only be achieved
if comparable quantitative outcomes or qualitative scoring
systems are used in future studies.
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What is already known about this topic
Central venous catheters facilitate venous access.
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There may also be differences between dressings in re-
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This paper is a systematic review of trials which com-
pared different central venous catheter dressings.
Although there were a number of studies identied few
of these could contribute to a meta-analysis of the data.
There was no evidence that any of the dressing types in
this review led to an increased risk of infection but this
could be due to a lack of available data.
Based on this systematic review of the available litera-
ture recommendations are made for future research in
this area.
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