title: Comparison of two different time interval protocols for central venous catheter dressing in bone marrow transplant patients: results of a randomized, multicenter study. The Italian Nurse Bone Marrow Transplant Group (GITMO).
abstract: OBJECTIVE
  Care of central venous catheter (CVC) in patients undergoing bone marrow transplantation (BMT) raises significant problems related to the high risk of local infections due to the immunodeficient status, which in itself is a predisposing factor for systemic blood-stream infections. Although frequent changes of CVC dressing might theoretically reduce the incidence of infections, they are also accompanied by significant skin toxicity and patient discomfort. No study has yet addressed these points. The objective of this study was to compare two different time interval protocols for CVC dressing in order to assess the effects on local infections and toxicity.
  
  
  METHODS
  In a multicenter study, 399 bone marrow transplant (BMT) patients with a tunneled CVC (Group A, 230 pts) or a non-tunneled one (Group B, 169 pts) were randomly allocated to receive CVC dressing changes every 5 or 10 days, if belonging to Group A, or 2 or 5 days, if in Group B. Transparent, impermeable polyurethane dressings were used for all patients. The rate of local infections at the site of CVC insertion was assessed by microbiological 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. Patients (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 local skin toxicity. Longer intervals were accompanied by a reduction in costs.
  
  
  CONCLUSIONS
  The results of this study demonstrate that the increase in time interval between CVC dressing changes in BMT patients did not raise the risk of local infections, while significantly reducing patient discomfort and costs.
authors.affiliation: Bone Marrow Transplant Unit, Division of Hematology, Azienda Ospedaliera Careggi, 50134 Florence, Italy. a.vannucchi@dcf.unifi.it
authors.forename: R
authors.initials: R
authors.lastname: Laura
authors.forename: M
authors.initials: M
authors.lastname: Degl'Innocenti
authors.forename: M
authors.initials: M
authors.lastname: Mocali
authors.forename: F
authors.initials: F
authors.lastname: Alberani
authors.forename: S
authors.initials: S
authors.lastname: Boschi
authors.forename: A
authors.initials: A
authors.lastname: Giraudi
authors.forename: M T
authors.initials: MT
authors.lastname: Arnaud
authors.forename: R
authors.initials: R
authors.lastname: Zucchinali
authors.forename: M G
authors.initials: MG
authors.lastname: Paris
authors.forename: R
authors.initials: R
authors.lastname: Dallara
authors.forename: S
authors.initials: S
authors.lastname: Thaler
authors.forename: G
authors.initials: G
authors.lastname: Perobelli
authors.forename: S
authors.initials: S
authors.lastname: Parfazi
authors.forename: T
authors.initials: T
authors.lastname: De Lazzer
authors.forename: G
authors.initials: G
authors.lastname: Peron
mesh_terms: D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000191:economics; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000191:economics / Q000379:methods*; D003365:Costs and Cost Analysis; D003872:Dermatitis / Q000209:etiology; D005076:Exanthema / Q000209:etiology; D006801:Humans; D017053:Infection Control / Q000379:methods; D007239:Infections / Q000209:etiology; D013997:Time Factors