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Based on evidence from the company, the External Assessment Centre and expert advice, the Committee was satisfied that Tegaderm CHG would not involve significant changes to current care pathways and the use of existing care bundles. Timsit et al. (2012) reported a large multicentre randomised controlled trial, based in 12 intensive care units in France, involving 1,879 patients and 4,163 intravascular catheters (2,201 arterial and 1,962 central venous catheters). Patients needing intravascular access were randomised to 1 of 3 groups: Tegaderm CHG (938 patients), standard dressing (Tegaderm transparent film dressing; 476 patients) or highly‑adhesive dressing (Tegaderm HP transparent film dressing; 465 patients). Assessors were blinded to dressing type. Patients had their skin prepared with povidone‑iodine in alcohol or 0.5% chlorhexidine in alcohol. Dressings were replaced after 24 hours and then every 3 to 7 days depending on the centre, or as needed if there was leaking or soiling. The study follow‑up period was 48 hours after discharge from the intensive care unit.
Cheyne Child Development: while you wait leaflet - Pre-School Age (Kensington and Chelsea and Westminster children) Cheyne Child Development: while you wait leaflet - Pre-School Age (Hammersmith and Fulham children) The Committee noted that the study evidence was largely from intensive care units in France that followed different skin preparation guidelines and that may have had more severely ill patients than those generally found in the UK. The Committee considered that this evidence was nevertheless generalisable to the UK, based on advice from experts and the External Assessment Centre and on the knowledge of its members. Using Tegaderm CHG instead of a standard dressing does not need any special additional training. At the topic selection phase, the Committee received expert advice that confirmed that minimal additional training would be needed.
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Advice provided during evaluation from 3 experts with experience of using both Tegaderm CHG and standard dressings was that, in general, clinician experience of applying and removing Tegaderm CHG was similar to standard dressings. There was 1 expert who stated that it takes longer to remove Tegaderm CHG and that there may be a few incorrect applications at first. The remaining 2 experts stated that the time taken to apply or remove the dressing is the same or similar for both Tegaderm CHG and standard dressings. The end of the central line can be taped out of the way when your child has a bath, please ensure that the end does not get submerged in the bath. Some families find it useful to place the bung in a plastic bag, using cling film or a sandwich bag and also tap the line(s) over the shoulders during bath time. The External Assessment Centre carried out a further literature search to identify all prospective comparative studies including at least 2 of the 3 dressing types in the scope: Tegaderm CHG, a semipermeable transparent (standard) dressing and a chlorhexidine gluconate (CHG)‑impregnated dressing. This search returned 1,755 records of which 4 were considered relevant. Of the 4 studies identified, 2 involved Tegaderm. One of the 2 studies involving Tegaderm was presented by the company (Timsit et al. 2012); the other was identified by the company as an ongoing study (Karpanen et al. 2014) with interim results published after the company's submission of evidence. The External Assessment Centre considered the Timsit et al. (2012) study to be relevant to the decision problem despite the fact that both the intervention and control groups were not swabbed with 2% CHG in alcohol as specified in the decision problem. The other 2 studies (Timsit et al. 2009 and Roberts et al. 1998) compared a CHG‑impregnated sponge dressing (Biopatch, Johnson and Johnson) against standard dressings, and were included by the External Assessment Centre to provide an indirect comparison between Tegaderm CHG and a CHG‑impregnated dressing. DISCLOSURES: None of the authors have a financial interest in any of the products, devices, or drugs mentioned in this manuscript. The end should not be dangling down by the nappy/groin area, if they do get soiled, the bionector (caps) at the end of the line will need to be changed and the line should be cleaned thoroughly.
NHS Clinical Evaluation Team 2018. Clinical Review: Intravenous Vapour Permeable Film Dressings (IV Films) - Part One Securing Peripheral Cannulae in Adults (PVAD). UK. Williamson DM, Sherman KP, Shakespeare DT. The use of semipermeable dressings in fingertip injuries. J Hand Surg Br. 1987;12(1):125–126.The External Assessment Centre found that the company's search of the MAUDE and MHRA systems accurately reported, in detail, the adverse events for Tegaderm CHG. Overall, it considered the company's search for adverse events to be robust. Richardson MC. Royal Society of Medicine Services International Congress and Symposium, Series No. 179, Harlow, Essex, UK: Royal Society of Medicine Services Limited; 1991:29-33.
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