Central venous catheter exit site dressings: Balancing patients' needs, nurses' experiences and the research evidence

Background/Aims: Many patients undergoing life-preserving haemodialysis are exposed to additional risks because access is via a central venous catheter (CVC). Despite a paucity of evidence, guidelines and policies dictated the use of transparent exit site wound dressings, which was contrary to local nurses’ practice of using an opaque wound dressing. This study aimed to explore nurses’ experiences with three types of CVC exit site dressings in the context of a randomised controlled trial (RCT). Methods: A descriptive exploratory design was used. Transcripts from seven focus groups held with haemodialysis nurses were analysed thematically. Results: Fifteen nurses, with varying haemodialysis experience, provided comments on the ease of applying and removing the dressings, problems encountered with the dressings, which dressing types they thought best or worst, and the value of having a specific work practice instruction developed for the RCT. It was clear that, although no dressing type was perfect, the opaque dressing was the best given the properties of the dressings, the patients’ preferences, and the humid climate. Conclusion: The perspectives voiced by the focus group participants support the need to modify the local health service’s policy, in line with revised state and national guidelines for this type of patient cohort, to allow for individual, contextual and climatic considerations.