An Assessment of Intravenous Catheter Insertion Site Dressings

Background: The integrity of intravenous catheter insertion site dressings is considered critical for the prevention of intravascular catheter associated infections.  The use of chlorhexidine gluconate (CHG) containing materials at the insertion site has proven efficacious in reducing central venous catheter  (CVC) associated bacteremia.  To minimize the risk of infection, we assessed the physical integrity of catheter insertion site dressings and compared two CHG containing CVC insertion site dressings.

Objective: 1. Determine the number of catheter insertion site dressings with compromised integrity and 2. Compare the coverage of the CVC insertion sites by a CHG containing sponge and gel dressing.

Methods: Central and peripheral intravenous catheter dressings were assessed over 2 observation periods by 3 trained observers using a standardized data abstraction tool in both ICU and non-ICU units.  Dressings were assessed to determine if the insertion site was adequately covered by the dressing or dressing edges were adherent to the skin.  CVC insertion sites employing a CHG containing sponge (observation period 1) were assessed for appropriate orientation of the sponge and whether the sponge completely contacted the insertion site; sites using a CHG containing gel (observation period 2) were assessed for appropriate coverage of the insertion site by the CHG gel.

Results: In period 1, 281 observations included 104 (37%) CVC and 177 (63%) peripheral dressings.  In period 2, 391 observations included 238 (61%) CVC and 153 (39%) peripheral dressings.  41 of 325 (13%) of CVC and 6 of 311 (2%) of peripheral dressings were not intact; a significant change was not seen between observation periods.  Of the CVC dressings using CHG at the insertion site, 23 of 87 (26%) CHG sponge dressings were either not oriented appropriately or did not completely contact the insertion site; 7 of 183 (4%) CHG gel dressings did not adequately cover the insertion site (p<0.05).

Conclusions: In this observational study, high rates of CVC dressings were not intact and 26% of CHG sponge and 4% of CHG gel dressings did not adequately contact or cover the CVC insertion site.  These findings were unexpected and only characterized after systematic review.   Impact on CVC associated bloodstream infections could not be accurately determined due to confounders.