Removal of Chlorhexidine Gluconate-Impregnated Dressings Due to Skin Irritation in Patients Under Hematopoietic Stem Cell Transplantation

Topic Significance & Study Purpose/Background/Rationale 

Describe reasons for removing chlorhexidine gluconate-impregnated dressings (CHXGID), due to skin irritation, in hematopoietic stem cell transplantation (HSCT). 

Methods, Intervention, & Analysis

Patients treated with allogeneic or autologous HSCT and using CHXGID on the site of insertion of central venous catheters (CVCs) were prospectively studied. For 45 days, dressings were daily monitored to detect possible signs and symptoms of skin irritation. Dressings were removed according to the extension and severity of the lesions. Patients daily estimated their pain in a Numerical Rating Scale, from 0 to 10, with 0 meaning “no pain” and 10 “severe pain”. Tolerance to the dressing was assessed daily by the following question: “How do you feel about using this dressing?” with three options of answers: “Confortable”, “Bearable” or “Unbearable”.

Findings & Interpretation

A total of 25 patients were evaluated from November 2013 to June 2014.

Table 1 – Description of the amount of interruptions in the use of CHXGID and of the skin reactions presented.

6 dressings removed
4 definitively	2 temporarily
2- excoriated vesicles and skin loss 1- skin loss 1- erythematous plaque and excoriation	1 - microvesicles on skin in contact with chlorhexidine gel 1 - superficial skin desquamation

All patients, except for one, presented lesions on the skin in contact with the Medipore high adhesion tape. Skin recovered four days later, on average. The dressing was considered comfortable by four patients, and bearable by two. The median intensity of pain reported during dressing replacement was 6 (0 to 8.5). Five patients presented the skin lesions during the neutropenia period and one presented the lesions after neutrophil engraftment.

Discussion & Implications 

Although poorly reported, the development of skin lesions while in use of CHXGID is a frequent problem in HSCT. Thus, the nurse must be alert to early detect signs and symptoms of skin irritation caused by the dressing and interrupt its use until recovery of skin integrity. In these patients, rupture of the cutaneous barrier is a concern, mainly due to their immunological vulnerability.