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Central venous access device-associated skin impairment : a pilot study comparing dressing to no-dressing in adult allogeneic stem cell transplant recipients

University of British Columbia

Central venous access device (CVAD) associated skin impairment (CASI) is common in adult allogeneic hematopoietic stem cell (HSCT) recipients, with symptoms ranging from mild erythema to ulceration. Not applying a dressing (no-dressing) to embedded tunneled CVAD (T-CVAD) exit sites may decrease CASI without increased risk of CVAD-related bloodstream infection (CRBSI), but evidence is lacking. This pilot study assessed the feasibility of conducting a large-scale longitudinal randomized controlled trial (RCT) comparing CASI and CRBSI between dressing and no-dressing in adult outpatient allogeneic HSCT recipients. Twenty-four participants were enrolled. Eligible participants had embedded T-CVADs, were within 35 to 60 days of transplant, and had achieved neutrophil engraftment. A modified Eastern Cooperative Oncology Group (ECOG) Skin Toxicity Scale was used to grade CASI at baseline and weekly for 6 weeks. The groups were compared using a two-way ANOVA for CASI episodes and a Fisher’s exact test for CASI episodes > grade 1 and bloodstream infection. There was a statistically significant finding of fewer CASI episodes for the no-dressing group, and a statistically significant relationship between type of exit site care and CASI > grade 1. Results of the statistical tests are estimates due to the small sample size. The major feasibility challenges were fewer eligible patients than expected and a high participation refusal rate (58%). The Modified ECOG Skin Toxicity Scale performed well; however, further testing is recommended. The study findings support the need for a RCT comparing CASI and CRBSI between dressing and no-dressing in the adult outpatient allogeneic HSCT setting.

Text

2019-10-22

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/72031

Nursing

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/