Daily Dressing Change Effects on Skin Flora Beneath Subclavian Catheter Dressings During Total Parenteral Nutrition

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Abstract
Septicemia is a persistent problem during total parenteral nutrition (TPN). The skin around the catheter insertion site is one possible source of this infection. In previous studies we showed mechanical cleansing of the skin was more important than the ointment applied; however, alternate day dressing changes did not completely eradicate all skin organisms. The present study was designed to examine the effects of daily dressing changes on the skin flora beneath the subclavian dressing. Fifteen patients receiving TPN were studied for a minimum of 11 days each. The dressing was changed daily and the catheter site cultured immediately. The area was then scrubbed with polyvinylpovidine-iodine, an antibiotic ointment was placed on the catheter insertion site, and a new dressing applied. There were no positive skin or blood cultures in this group during a total study period of 242 patient-days. The control group consisted of 23 patients receiving identical subclavian catheter care but on an alternate rather than daily basis. In the control group there was a 3.5% incidence of positive skin cultures in 530 patient-days. Daily dressing changes eliminated all skin organisms beneath the subclavian dressing during TPN and would be useful in patients who are at high risk for septic complications.