Haffejee A A, Moodley J, Pillay K, Singh B, Thomson S, Bhamjee A
Department of Surgery, University of Natal, Durban.
S Afr J Surg. 1991 Dec;29(4):142-6.
Catheter-related sepsis still remains one of the most frequent and serious complication of total parenteral nutrition. Strategies for preventing contamination of central venous lines have focused on decreasing the number of micro-organisms around the exit site and inhibiting their entry into the catheter wound. This prospective study compares a new occlusive hydrocolloid dressing (Visiband; Convatec Squibb) with that of a polyurethane film dressing for nutritional catheters. Dressings were changed either on day 3 or day 5 after application. Swab smears of the catheter exit site at each dressing change were stained by Gram's method before inoculation onto a blood agar plate, a chocolate agar plate and a MacConkey agar plate. Significantly less colonisation occurred under the former dressing at day 3 and day 5 dressing changes. In addition, the polyurethane film dressing was associated with a significant increase in skin colonisation (P = 0.04) and the number of positive Gram-stain microbes if left unchanged for 5 days (P = 0.0018). Staphylococcus aureus catheter-related sepsis occurred in 1 patient on day 18 in the polyurethane film dressing group. In addition, Candida albicans colonisation was confined to patients with the polyurethane film dressing. While the type of dressing applied to the catheter exit site may influence the incidence of catheter colonisation and infection, it must be emphasised that strict adherence to aseptic technique during catheter insertion and manipulation of the dressing is vital in the prevention of catheter-related sepsis during total parenteral nutrition.
