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10352-03_JIN3002-Gorski.qxd 3/7/07 12:54 PM Page 87 Speaking of Standards . . . • • • • • • • • • • • • • • Standard 44: Dressings Lisa A. Gorski, MS, APRN,BC, CRNI©, FAAN Standard 44.1: A sterile dressing shall be applied and maintained on access devices. Guidelines for prevention of catheter-related infections.3 Advantages to the TSM dressing include the abilities to visualize the insertion site on an ongoing basis and maintain costeffectiveness because of less frequent changes. A weekly home or outpatient visit for site care and dressing change is cost-effective and convenient for the patient who requires long-term vascular access. The patient also can easily check Standard 44.2: The dressing the catheter insertion site every day and report any changes, shall be changed at established such as redness or drainage. intervals and immediately if the Gauze dressings are an appropriate choice for the patient integrity becomes compromised.1 who experiences site drainage, perspires excessively, or has As every infusion nurse knows, a sensitivity reaction to TSM dressings. Use a gauze dress- maintaining a clean, dry, and oc- ing on a freshly placed access device when there is bleeding clusive dressing is important for for the first 24 hours or so. Often, a transparent dressing is protecting the catheter insertion placed over the gauze dressing to secure the gauze dress- site and reducing the risk for infection. Dressing changes are ing. Use of gauze under a TSM dressing is not an uncommon performed at the time of placement and subsequently in con- practice, and there is often a misconception, especially junction with regular site care, which includes site assess- among non-infusion nurses, that the dressing is then a TSM ment and skin disinfection before placement of the fresh dressing and is changed every 7 days. If gauze is used under dressing. the TSM dressing, it is considered a gauze dressing and is Dressing choices include the transparent semipermeable changed every 48 hours. This practice is clearly addressed membrane (TSM) dressing or a simple gauze dressing. The under the Practice Criteria of Standard 44. The infusion research supporting the choice of dressing is limited. The ev- nurse’s knowledge of the INS Standards of Practice is im- idence does not support one choice over another. In a sys- portant in ensuring that organizational policies address this tematic review of controlled trials that compared the effects issue and provide ongoing education of nursing staff about of gauze and tape versus transparent dressings, there was rationale for practice and dressing change frequency when no evidence of difference in the incidence of infectious com- both types of dressings are used. plications between dressing types. The studies were from Another potential misunderstanding about dressing small samples, however, and there was a high level of uncer- change frequency may result when a gauze dressing is used tainty regarding risk for infection related to type of dressing. under the wings or extension tubing of a noncoring needle in- The authors stress the need for more research. serted into a port and then a TSM dressing is placed to cover 2 Based on this research, choose the dressing based on the entire site. This is common practice. In the 2006 Stan- patient preference and needs. The Practice Guidelines under dards of Practice, the Standards of Practice Review Commit- the INS Standard recommend changing the TSM dressing at tee added an additional practice guideline recommendation least every 7 days and changing gauze dressings every under Standard 45, “Implanted Ports and Pumps.”1 In this 48 hours. In the event of drainage, site tenderness, other signs case, as long as the gauze does not obscure or cover the of infection, or loss of dressing integrity, the dressing should catheter-skin insertion site, it is not considered a gauze dress- be changed sooner, allowing the opportunity to closely as- ing. The TSM dressing is then changed at least every 7 days, sess, cleanse, and disinfect the site. These guidelines are which is addressed under Practice Criteria 45 on page S46 in in line with the Centers for Disease Control and Prevention the Standards. Vol. 30, No. 2, March/April 2007 87 10352-03_JIN3002-Gorski.qxd 3/7/07 12:54 PM Page 88 Finally, antiseptic dressings, such as the chlorhexidineimpregnated foam dressing, are being used more often as consideration and evaluation of antiseptic-impregnated dressings.1 research supports their benefits. A small, round disc is placed around the catheter at the exit site, covered with a R E F E R E N C E S transparent dressing, and changed every 7 days according 1. Infusion Nurses Society. Infusion nursing standards of practice. J Infus Nurs. 2006;29(1S):S1-S92. 2. Gillies D, O’Riordan L, Carr D, et al. Gauze and tape and transparent polyurethane dressings for central venous catheters. Cochrane Database Syst Rev. 2003;4:CD003827. 3. Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections. MMWR. 2002; (RR-10):51. 4. Ho KM, Litton E. Use of chlorhexidine-impregnated dressing to prevent vascular and epidural catheter colonization and infection: a meta-analysis. J Antimicrob Chemother. 2006;58(2):281-287. to the manufacturer’s recommendations. In a meta-analysis published in 2006, chlorhexidine-impregnated dressings were found to be effective in reducing bacterial colonization at both vascular and epidural sites and were identified with a trend toward catheter-related bloodstream or central nervous system–related infections.4 Under INS Standard 56, “Infection,” the Practice Criteria recommend evaluation of technology to control infusion-related infections, including 88 Journal of Infusion Nursing