Tropical wound dressing protocols for haemodialysis central venous catheter exit sites: a cross-over randomised controlled trial

McArdle, Joleen (2015) Tropical wound dressing protocols for haemodialysis central venous catheter exit sites: a cross-over randomised controlled trial. Masters (Research) thesis, James Cook University.

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Abstract

Background: Exit sites of central venous catheters (CVC), often used to deliver haemodialysis, require meticulous care. Staff in a large regional North Queensland Renal Service found the recommended transparent dressing inappropriate because moisture build-up was thought to increase likelihood of infection or dressings not remaining intact. The use of an opaque dressing (used by the Renal Service) contradicted the State-wide infection control guidelines recommended at the time of the study. Minimal published evidence regarding CVC dressings in a tropical location was available when a literature review was undertaken.

Aim: To identify the most effective and safe dressing protocol for haemodialysis CVC exit sites in a tropical region. The null hypothesis was: There is no difference in effectiveness with the use of a transparent or combination dressing compared to an opaque dressing on CVC exit sites for patients undergoing haemodialysis in the tropics. Effectiveness was measured by intactness of dressings between haemodialysis episodes and by local (CVC exit site) and systemic infections.

Methods: Patients attending a regional North Queensland Renal Service with CVC access consented to participate in the prospective randomised, crossover trial (n=37). Five units from the Townsville Renal Service were included in the study. These units were located up to 900km from the central acute dialysis unit at the Townsville Hospital. Participants were randomly assigned to a specific sequence of transparent, opaque and combination dressings. Each dressing was used for six weeks then substituted in rotation. During dialysis, CVC sites were assessed by nurses for clinical signs of infection and dressing intactness.

Results: Numerous adverse reactions to the combination dressing early in the trial necessitated its removal from the rotation. Eight patients received only one type of dressing during the trial. The final sample size was 26 participants. The majority of the sample were Aboriginal and Torres strait Islander people (n=21). Statistical analysis was undertaken using Wilcoxon signed rank tests to evaluate the difference in the primary outcomes of intactness and infection between the opaque and transparent dressing. There were no statistical differences between intactness of the opaque and transparent dressing types (z=0.386, p=<0.700) or infection (z=-0.454, p=<0.650).

Implications for Clinical Practice: This pilot study generated evidence regarding CVC dressings in tropical climate. The study also provided evidence for a unique population given the high number of Aboriginal and Torres Strait Islander Peoples. The study underlined the challenges of conducting a clinical trial. Combination dressing may not be suitable for the tropics due to the large number of reactions. Nurses in this setting can safely select either an opaque or transparent dressing until the study is replicated in other geographical locations with a larger sample size.

Item ID: 47601
Item Type: Thesis (Masters (Research))
Keywords: central venous catheters, evidence-based practice, focus groups, haemodialysis access, haemodialysis, infection, intravascular device dressings, nursing, patient comfort, renal, tropical weather, wound care
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Additional Information:

Publications arising from this thesis are available from the Related URLs field. The publications are:

Chapter 2: McArdle, Joleen, and Gardner, Anne (2009) A literature review of central venous catheter dressings: implications for haemodialysis in the tropics. Healthcare Infection, 14 (4). pp. 139-146.

Smyth, Wendy, McArdle, Joleen, and Gardner, Anne (2016) Central venous catheter exit site dressings: balancing patients' needs, nurses' experiences and the research evidence. Wound Practice and Research, 24 (1). pp. 41-46.

Smyth, Wendy, McArdle, Joleen, and Gardner, Anne (2015) Which dressing? Qualitative aspects of a randomised controlled trial of wound dressings. Annals of the Australasian College of Tropical Medicine, 17 (1). p. 11.

Hughes, Kim, Gardner, Anne, and McArdle, Joleen (2011) Audit of factors associated with the intactness of central venous catheter exit site dressings for northern Australian haemodialysis patients. Renal Society of Australasia Journal, 7 (3). pp. 108-114.

Date Deposited: 30 Mar 2017 04:25
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1110 Nursing > 111099 Nursing not elsewhere classified @ 100%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920210 Nursing @ 100%
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