title: Dressing and securement for central venous access devices (CVADs): A Cochrane systematic review.
abstract: OBJECTIVE
  To compare the available dressing and securement devices for central venous access devices (CVADs).
  
  
  METHODS
  Systematic review of randomised controlled trials.
  
  
  METHODS
  Cochrane Wounds Group Specialised Register, the Cochrane Central Register of Controlled Trials, the Database of Abstracts of Reviews and of Effects, NHS Economic Evaluation Database, Ovid MEDLINE, CINAHL, EMBASE, clinical trial registries and reference lists of identified trials.
  
  
  METHODS
  Studies evaluated the effects of dressing and securement devices for CVADs. All types of CVADs were included. Outcome measures were CVAD-related bloodstream infection, CVAD tip colonisation, entry and exit site infection, skin colonisation, skin irritation, failed CVAD securement, dressing condition and mortality. We used standard methodological approaches as expected by The Cochrane Collaboration.
  
  
  RESULTS
  We included 22 studies involving 7436 participants comparing nine different types of securement device or dressing. All included studies were at unclear or high risk of performance bias due to the different appearances of the dressings and securement devices. It is unclear whether there is a difference in the rate of CVAD-related bloodstream infection between securement with gauze and tape and standard polyurethane (RR 0.64, 95% CI 0.26 to 1.63, low quality evidence), or between chlorhexidine gluconate-impregnated dressings and standard polyurethane (RR 0.65, 95% CI 0.40 to 1.05, moderate quality evidence). There is high quality evidence that medication-impregnated dressings reduce the incidence of CVAD-related bloodstream infection relative to all other dressing types (RR 0.60, 95% CI 0.39 to 0.93). There is moderate quality evidence that chlorhexidine gluconate-impregnated dressings reduce the frequency of CVAD-related bloodstream infection per 1000 patient days compared with standard polyurethane dressings (RR 0.51, 95% CI 0.33 to 0.78). There is moderate quality evidence that catheter tip colonisation is reduced with chlorhexidine gluconate-impregnated dressings compared with standard polyurethane dressings (RR 0.58, 95% CI 0.47 to 0.73), but the relative effects of gauze and tape and standard polyurethane are unclear (RR 0.95, 95% CI 0.51 to 1.77, very low quality evidence).
  
  
  CONCLUSIONS
  Medication-impregnated dressing products reduce the incidence of CVAD-related bloodstream infection relative to all other dressing types. There is some evidence that chlorhexidine gluconate-impregnated dressings, relative to standard polyurethane dressings, reduce CVAD-related bloodstream infection for the outcomes of frequency of infection per 1000 patient days, risk of catheter tip colonisation and possibly risk of CVAD-related bloodstream infection. Most studies were conducted in intensive care unit settings. More, high quality research is needed regarding the relative effects of dressing and securement products for CVADs.
authors.affiliation: Alliance for Vascular Access Teaching and Research (AVATAR), NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Brisbane, Australia. Electronic address: a.ullman@griffith.edu.au.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Ullman
authors.affiliation: Alliance for Vascular Access Teaching and Research (AVATAR), NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
authors.forename: Marie L
authors.initials: ML
authors.lastname: Cooke
authors.affiliation: Alliance for Vascular Access Teaching and Research (AVATAR), NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, Australia.
authors.forename: Marion
authors.initials: M
authors.lastname: Mitchell
authors.affiliation: Alliance for Vascular Access Teaching and Research (AVATAR), NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
authors.forename: Frances
authors.initials: F
authors.lastname: Lin
authors.affiliation: Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Brisbane, Australia; The University of Queensland, School of Nursing, Midwifery and Social Work, Brisbane, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: New
authors.affiliation: Alliance for Vascular Access Teaching and Research (AVATAR), NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, South Brisbane, Australia.
authors.forename: Debbie A
authors.initials: DA
authors.lastname: Long
authors.affiliation: Centre for Applied Health Economics, Menzies Health Institute Queensland, School of Medicine, Griffith University, Meadowbrook, Australia.
authors.forename: Gabor
authors.initials: G
authors.lastname: Mihala
authors.affiliation: Alliance for Vascular Access Teaching and Research (AVATAR), NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors.forename: Claire M
authors.initials: CM
authors.lastname: Rickard
mesh_terms: D001458:Bandages; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D006801:Humans; D016032:Randomized Controlled Trials as Topic
keywords: Catheter-related infections; Central venous catheters; Evidence-based practice; Occlusive dressings; Vascular access devices