Chlorhexidine gluconate (CHG) infused disks are widely used adjuncts to central venous lines (CVLs), to reduce catheter related bloodstream infections. They are applied at the time of insertion(1) around the catheter entry site. At Middlemore Hospital (MMH), CHG disks are standard practice in burn patients requiring CVLs. Although generally well tolerated, three cases of keloid scaring following CHG disc use have been identified in this cohort.
Methodology:
A retrospective review of patients admitted under the MMH Burns Service who developed dermal injury following CHG disc application.
Cases:
Three patients were identified with adverse skin outcomes associated with CHG disks. All patients had underlying conditions that resulted in deficient skin layers which predisposed them to injury post use. One paediatric patient presented with severe staphylococcal scalded skin syndrome (SSSS) and two adult patients presented with Toxic epidermal necrolysis (TENS). All subsequently developed scarring following recovery. A broader retrospective review of burn unit admissions over the past 20 years is currently underway to determine the prevalence of such complications.
Review:
The literature on CHG disc use in patients with compromised epidermal barriers is limited. Evidence suggests that impaired epidermal integrity and decreased dermo-epidermal cohesion increase the risk of chemical injuries(1,2). A case series from J. Wall et al, Birmingham(2) reported similar complications for patients with chlorhexidine impregnated discs used with SJS/ TENs, prompting and hospital policy change to restrict use.
Conclusion:
Three patients had skin compromising pathology that increased their susceptibility to chlorhexidine dermal necrosis. They required further treatment for keloid scaring post discharge. Careful consideration of alternative CVL dressing strategies is warranted to balance infection prevention with the risk of skin injury in the context of TENs/SSS. A further retrospective study of twenty years of Burns admissions is being completed to assess prevalence.