Document Type

Dissertation

Degree

Doctor of Philosophy

Major

Nursing

Date of Defense

12-14-2011

Graduate Advisor

Dawn Lee Garzon, PhD, CPNP, FAANP

Committee

Dr. Loyd Richardson

Dr. Jean Bachman

Dr. Margaret Barton-Burke

Abstract

This study is an experimental design with randomization comparing the use of standard gauze dressings (SGD) to transparent adhesive dressings (TAD) to cover chest tube insertion sites in post-operative patients who have undergone cardio-thoracic surgery. The study was conducted in a 400 bed, tertiary non-academic teaching hospital in the Midwestern United States. Seventy-nine patients were enrolled in the study; 39 received TAD and 40 received SGD. The non-inferiority margin was set at 15% in keeping with current recommendations (Kaul & Diamond, 2006). The TAD was found to be not inferior to the SGD with regards to the proportional differences in the occurrence of skin irritation (0.024 (95% CI -0.1, 0.15), the proportional differences in occurrence of skin tears (0.024(95% CI -0.08, 0.14), and the proportional difference in cost per dressing change 0.018 (95% CI -0.008, 0.046). The proportional difference in the number of dressing changes required per chest tube day exceeded the 15% non-inferiority margin. It is important to note however that the increased margin favored the TAD by 20% as compared to the SGD (SGD0.51-TAD 0.31). Mann-Whitney test was used to evaluate differences in cost per dressing type U=118, p 001, and number of dressing changes required by dressing type U=601, p=.01. Both results favored the TAD. Kendall’s tau correlation revealed that the costs were significantly greater in patients who received SGD τ (79), p<.001. Skin irritation was measured using a color scale and skin tears were measured using the Payne-Martin skin tear assessment tool. Patients did not differ by dressing type in the development of skin irritation (U = 763, p= .693), or development of skin tears (U = 761.5, p = .584). Based on these findings use of TAD can be recommended as not inferior to the current practice of using gauze and tape. Further study is needed to evaluate whether this non-inferiority is maintained in patients who require chest tubes for longer periods of time.

OCLC Number

773697215

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Nursing Commons

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