Abstract:
Background: Central venous catheters are essential in paediatric intensive care but are associated with catheter-related bloodstream infections (CRBSIs) and skin complications. Chlorhexidine gluconate (CHG)-impregnated dressings may reduce infection risk; however, concerns remain regarding their dermatological safety in vulnerable paediatric populations.
Aim: To evaluate the dermatological safety of CHG-impregnated dressings in critically ill paediatric patients requiring central venous catheters and to explore their impact on catheter-related outcomes.
Study design: A single-blind, prospective randomised clinical trial was conducted in a tertiary paediatric intensive care unit. Within routine clinical practice, patients were randomly assigned to receive either a conventional transparent dressing or a dressing incorporating a 2% CHG gel pad. The primary outcome was the occurrence of tegumentary alterations at the catheter insertion site. Secondary outcomes included CRBSI incidence and catheter maintenance variables.
Results: Skin alterations were identified in 14.0% of patients, with no significant differences between groups (16.8% vs. 11.2%; p = 0.202). However, dermatological alterations occurred at a significantly younger age in the CHG group (6.5 ± 4.8 vs. 46.0 ± 43.2 months; p = 0.003), with a similar pattern for pruritus. Multivariable analysis showed a significant interaction between dressing type and age, indicating age-dependent dermatological responses. CHG dressings were associated with fewer dressing changes and longer intervals between replacements. CRBSI incidence was lower in the CHG group (2.4% vs. 18.4%; p < 0.001), although this was a secondary outcome.
Conclusions: CHG-impregnated dressings showed an acceptable dermatological safety profile. Their use was associated with improved catheter-related outcomes, although skin reactions occurred at younger ages.
Relevance to clinical practice: CHG dressings may support safer catheter management but require careful dermatological monitoring in infants. These findings may help inform dressing selection and catheter care strategies in paediatric intensive care settings where infection prevention and skin integrity must be balanced.
Reference:Portero-Prados FJ, Pabón-Carrasco M, Ponce-Blandón JA. Dermatological Safety of Chlorhexidine-Impregnated Dressings in Paediatric Intensive Care: A Randomised Clinical Trial. Nurs Crit Care. 2026 Jul;31(4):e70554. doi: 10.1111/nicc.70554. PMID: 42360019; PMCID: PMC13307245.