A literature review of central venous catheter dressings: implications for haemodialysis in the tropics

Queensland Health guidelines for central venous catheter (CVC) exit site management recommend using transparent dressings. However, the appropriateness of these dressings in tropical climates has been challenged in a regional haemodialysis unit due to perceived difficulties with moisture accumulation between haemodialysis sessions. This paper aims to reviewthe literature on best dressing practice in reducing incidence of catheter-related infections in patients receiving haemodialysis through a CVC, and will explore the evidence specifically related to tropical climates. Electronic database searches were conducted using the specific search terms: central venous catheter; haemodialysis; tropics; exit site; dressing; transparent; Primapore, IV3000; sepsis. Some 152 articles were initially retrieved. Of these, 135 articles did not specifically relate to exit site dressings, leaving 11 review and six research articles that were included in the literature review. Exit site dressing articles predominantly compared gauze with transparent dressings. The evidence of a causal relationship between transparent dressings and risk of catheter-related bloodstream infections was inconclusive, although transparent dressings may increase the risk of catheter tip colonisation and promote moisture and bacterial proliferation on peripheral cannulation sites. No articles addressed CVC management in the tropics. There was limited evidence to suggest infection rateswere higher using transparent compared with non-transparent (gauze) dressings. No studies were found that investigated the effectiveness of either dressing type, or an appropriate dressing protocol, for the tropics. Further research is required to determine the most effective dressing type for use on haemodialysis CVC exit sites in the tropics.