Transparent Polyurethane Peripheral IV Dressings
January 1, 1998 3 minutes read
Transparent Polyurethane Peripheral IV Dressings
ABSTRACT & COMMENTARY
Synopsis: Peripheral IV catheter sites covered with transparent polyurethane dressings (TPD) were dislodged less frequently than those dressed with gauze dressings. There were no differences in the rates of phlebitis or infiltration between the two types of dressings.
Source: Tripepi-Bova KA, et al. Am J Crit Care 1997; 6(5):377-381.
The iv catheter is the therapeutic common denominator among patients in the critical care unit. Catheters may be actively used to deliver fluids, blood, medications, or nutrition, or may just "be there" in case of emergency. In either case, this intervention may cause adverse effects such as infection or phlebitis. All hospitals have policies and procedures to standardize IV catheter care in order to minimize iatrogenic contributions to these adverse effects. Tripepi-Bova and colleagues worked at an institution whose policies and procedures were changed based on the results of a 1992 meta-analysis of 14 studies that compared infection rates between gauze dressings and TPD. Gauze dressings for central venous catheters were favored by the meta-analysis, with less infectious complications. The findings of the meta-analysis were generalized to all IV catheters at this institution. The nursing staff thought TPD for peripheral IV sites were clinically preferable, citing improved observation of the site and superior anchoring of the catheter. Tripepi-Bova et al felt that the evidence for gauze dressings on peripheral IV sites in the meta-analysis was less conclusive and so designed a study to test their bias; the frequencies of phlebitis, infiltration, and catheter dislodgement using TPD vs. gauze dressings were compared.
All adult patients admitted to any of six specialty ICUs were eligible for enrollment in this non-blinded, randomized, controlled trial. A patient could only be enrolled once. All nursing personnel attended mandatory sessions to ensure standardized techniques in catheter insertion, monitoring, and maintenance. In an 18-month period, 229 patients were enrolled, with 47% of them randomized to the TPD group and 53% randomized to the gauze dressing group.
The patients in the TPD group had a significantly lower rate of catheter dislodgement as compared to those in the gauze dressing group, an outcome not evaluated in the previous meta-analysis. There were no significant differences in the rates of infiltration or phlebitis in this study, although the actual rates in the TPD group were lower than those with gauze dressings. Infiltration and phlebitis frequency by dressing type were variable in the meta-analysis. In this study, no routine cultures of the catheter tip were done.
COMMENT BY DOREEN M. ANARDI, RN
Meta-analyses of smaller randomized, controlled trials are being used more frequently in order to make treatment or procedural decisions about medical therapies. While this process can improve use and understanding of research data, any application of the results of meta-analyses in the clinical arena must be done with care. Tripepi-Bova et al had a preference, reviewed the literature, and analyzed the meta-analysis. They recognized that the existing data for gauze peripheral IV catheter dressings were not strong and probably varied by institutionpossibly based on the TPD product used. They also recognized that an important outcome, catheter dislodgement, was not tested. Restarting IV catheters is distressful for the patient and time-consuming for the nursing staff. The positive finding for this outcome, improved observation of the site, and no significant difference in phlebitis or infiltration tipped the scales and enabled this research group to use the scientific process and change hospital policy and procedure.
Significant differences between gauze dressings and transparent polyurethane dressings (TPD) for peripheral IVs include:
a. a higher mortality from sepsis in patients with gauze dressings.
b. more frequent need for replacement of the IV with gauze dressings.
c. a higher rate of phlebitis with the TPD dressings.
d. a higher rate of pulmonary embolism with the gauze dressings .
e. none of the above.
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