The appropriate frequency of dressing for percutaneous central venous catheters in preventing catheter-related blood stream infection in NICU

Abstract

Su et al. recently compared the effects of regular dressing group (RD) versus non-regular dressing group (ND) on complications of percutaneous central venous catheters (PCVCs).1Su L.T. Huang H.C. Liu Y.C. Chang H.Y. Ou-Yang M.C. Chen C.C. et al.The appropriate frequency of dressing for percutaneous central venous catheters in preventing catheter-related blood stream infection in NICU–A randomized controlled trial.Pediatr Neonatol. 2021; 62: 292-297Abstract Full Text Full Text PDF Scopus (2) Google Scholar In this study involving 162 neonates, the authors observed that, compared with ND (0‰ versus 2.0‰, p = 0.048), RD significantly reduced the incidence of catheter-related blood stream infection (CRBSI). The authors made commendable efforts and provided significant evidence for the care of neonatal PCVCs. However, several issues are worthy of further discussion. First, as described in Table 1, there was a significant difference in the location of PCVCs between the two groups. Apparently, the proportion of inguinal area implantation in RD group was significantly higher than that in ND group (7.1% versus 1%, p = 0.035). Meanwhile, prior research has revealed that PCVCs implanted through the inguinal area are associated with lower complications than those implanted through the jugular vein.2Vegunta R.K. Loethen P. Wallace L.J. Albert V.L. Pearl R.H. Differences in the outcome of surgically placed long-term central venous catheters in neonates: neck vs groin placement.J Pediatr Surg. 2005; 40: 47-51Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar Under such circumstances, it is impossible to determine whether the reduction of CRBSI is caused by different interventions (RD or ND) or different PCVC implantation sites (neck or groin placement). Thus, when exploring the impact of RD or ND on PCVC related complications, it is essential to balance the baseline characteristics of the two groups. Second, the purpose of this study was to compare the effects of RD versus ND on PCVCs related complications. However, the specific implementation steps and detailed definition of RD were not given in this study. The description of “Regular dressing group (RD) changed dressings every week regularly and additionally if blood oozing was visible” has a strong subjectivity and could be regarded as being inappropriate. It is unclear whether clinicians or nurses need to change dressings, and whether the dressings need to be changed every day or every week. Since the description is vague, it might lead to lesser repeatability of this study. Third, it should be emphasized that heparin infusion is a significant strategy to prevent catheter occlusion and thrombosis, which has been confirmed by previous literature.3Shah P.S. Shah V.S. Continuous heparin infusion to prevent thrombosis and catheter occlusion in neonates with peripherally placed percutaneous central venous catheters.Cochrane Database Syst Rev. 2008; CD002772Google Scholar,4Shah P.S. Kalyn A. Satodia P. Dunn M.S. Parvez B. Daneman A. et al.A randomized, controlled trial of heparin versus placebo infusion to prolong the usability of peripherally placed percutaneous central venous catheters (PCVCs) in neonates: the HIP (Heparin Infusion for PCVC) study.Pediatrics. 2007; 119: e284-e291Crossref PubMed Scopus (72) Google Scholar However, this study did not provide information on heparin infusion between the two groups. Thus, it is unclear whether there is any difference in the proportion of heparin infusion between the two groups. A clear description of the proportion of heparin infusion used in the two groups would be helpful for readers to interpret this study. None.