Audit of factors associated with the intactness of central venous catheter exit site dressings for northern Australian haemodialysis patients

Background: For people receiving haemodialysis (HD) via a central venous catheter (CVC), a secure dressing is essential to protect the exit site from infection and to stabilise the catheter. A literature review identified the lack of evidence to support the use of any one dressing type in a tropical setting. Renal nurses rely on clinical experience to select the dressing most suitable for the humid conditions in which renal out-patients often live and work.

Aim: To determine the percentage of opaque dressings currently used for CVC exit sites that remained intact between dialysis episodes, and to explore whether altered dressing integrity is associated with specific demographic or clinical characteristics.

Method: A prospective, observational design was used to audit the CVC exit sites of 34 patients at each dialysis presentation over a four-week period. Information about intactness of dressings in relationship to position and type of catheter and assessment of exit sites was collected. Demographics included age, home town and ethnicity.

Results: Of 273 presentations, 107 (39.2%) did not have a fully intact dressing. Non-intact dressings were associated with: position of catheter; presence of sutures; having a wet dressing; and permanent residence greater than 150 kilometres from the dialysis centre. During the four-week audit, five patients developed significant new exit site infections.

Conclusion: The high number of non-intact dressings indicates that further review of clinical practices and dressings used in the tropics is warranted. These findings have informed the design for a randomised controlled trial to compare dressing types.