Cutaneous lesions caused by
catheter dressing changes can be serious and generate local
pain in children undergoing high-dose
chemotherapy followed by
bone marrow transplantation. One hundred and thirteen children entered a randomised trial to compare two
catheter dressing change frequencies (15 days vs 4 days). Skin toxicity was classified according to the following scale: grade 0: healthy skin, to grade 4: severe skin toxicity. A qualitative culture of the skin at the
catheter entry site was taken whenever the dressing was changed. Of the 112 evaluable children (56 in each group) 32 developed grade > or = 2 local skin toxicity (eight in the 15-day group and 24 in the 4-day group; P = 0.001). Although higher in the 4-day group, the proportions of children experiencing
pain during and between dressing changes were not statistically different between the two groups. The proportion of patients with one or more positive skin culture(s) at the
catheter entry site during hospitalisation were similar in the two groups (27% in the 15-day group and 23% in the 4-day group) as were the proportions of documented nosocomial
bloodstream infections (11% and 13%; NS). Whereas the planned frequency was maintained in the 4-day group (mean = 4 days, s.d. = 1), it was usually shortened in the 15-day group (mean = 8 days, s.d. = 4), mainly because dressings had loosened. Decreasing the
catheter dressing change frequency proved efficient in reducing cutaneous toxicity without increasing the risk of local and systemic
infection. In our unit,
catheter dressings are changed every 8 days since this analysis.