***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: This r and omized prospect i ve study of all  invasive catheters inserted in our ICU tested the hypothesis that daily dressing changes would reduce the 25 % infection rate associated with these catheters . Significant growth was noted in eight ( 7 % ) of 133 vs. nine ( 6.7 % ) of 135 skin cultures from patients whose dressings and infusion tubings were changed at 24 vs. 72 h , respectively . Catheter tip cultures were positive in six ( 5.9 % ) of 102 vs. eight ( 7.5 % ) of 107 for the 24− and 72-h groups , respectively . Paradoxically , blood cultures were positive in three ( 6.7 % ) of 45 vs. 12 ( 23.1 % ) of 52 from the 24- and 72-h groups , respectively ( p < .03 ) . However , there was no correlation between the positive blood cultures and the organisms cultured from the catheter tips A prospect i ve r and omized clinical trial has been conducted to compare the clinical performance , with prolonged use , of two film-type transparent dressings used over subclavian and jugular single-lumen venous catheters . ' OpSite ' , a traditional dressing with a moderate moisture vapour permeability was compared with a new dressing of high moisture vapour permeability , ' OpSite IV3000 ' . Information was collected daily to assess the nature and incidence of complications , dressing durability and the ease of application and removal .  One hundred and one patients provided two well-matched population s receiving a total of 153 dressings for a total of 780 catheter-days . No differences between the two dressings were noted with respect to the incidence of complications , such as moisture accumulation or lifting , and dressing durability . The low incidence of catheter-related sepsis ( ' OpSite ' group three episodes and ' OpSite IV3000 ' group one episode ) suggests that transparent dressings do not increase this risk . This clinical study demonstrated the new ' OpSite IV3000 ' to be easier to h and le , leading to better application , improved catheter fixation and easy removal Background  Noncuffed , percutaneously inserted central venous catheters ( CVCs ) are widely used and cause at least 250,000 bloodstream infections ( BSIs ) in U.S. hospitals each year . We report a prospect i ve study to determine whether inflammation at the insertion site is predictive of CVC-related BSI . Methods  Percutaneously inserted , noncuffed CVCs inserted into the subclavian , internal jugular , or femoral vein in two r and omized trials during 1998–2000 were prospect ively studied ; most patients were in an intensive care unit . The condition of the insertion site was evaluated daily by research nurses , quantifying pain ( 0 , 1 ) , erythema ( 0–2 ) , swelling ( 0 , 1 ) , and purulence ( 0 , 1 ) ; the lowest possible overall inflammation score was 0 and the highest was 5 . CVC-related BSI was confirmed in each case by demonstrating concordance between isolates from the catheter segment and from blood cultures by restriction-fragment DNA subtyping . Results Among 1,263 CVCs prospect ively studied , 333 ( 26.3 % ) were colonized at removal ; of these , 35 catheters ( 2.7 % ) caused BSIs ( 5.9 per 1000 CVC days ) . BSIs were caused by coagulase-negative staphylococci ( n = 27 ) , enterococci ( n = 4 ) , enteric Gram-negative bacilli ( n = 3 ) , or C and ida ( n = 1 ) . Most insertion sites showed little or no inflammation at the time of removal . There were no significant differences among mean scores for each inflammatory variable examined or overall score among colonized CVCs ( 0.1 ± 0.1 ) , catheters causing CVC-related BSI ( 0.2 ± 0.4 ) , and noncolonized CVCs ( 0.1 ± 0.1 ) . The sensitivity of local inflammation for diagnosis of CVC-related BSI was dismal ( 0–3 % ) . Conclusion Local inflammation is uncommon with infected CVCs , probably because most catheter-associated infections are currently caused by coagulase-negative staphylococci , a pathogen that incites little local or systemic inflammation . Whereas overt inflammation of the insertion site should raise suspicion of CVC-related BSI caused by Staphylococcus aureus or Gram-negative bacilli , especially if the patient has fever or other signs of sepsis , in general , site appearance can not be relied on to identify catheter colonization or CVC-related BSI Objective : Major catheter-related infection includes catheter-related bloodstream infections and clinical sepsis without bloodstream infection resolving after catheter removal with a positive quantitative tip culture .  Insertion site dressings are a major mean to reduce catheter infections by the extraluminal route . However , the importance of dressing disruptions in the occurrence of major catheter-related infection has never been studied in a large cohort of patients . Design : A secondary analysis of a r and omized multicenter trial was performed in order to determine the importance of dressing disruption on the risk for development of catheter-related bloodstream infection . Measurements and Main Results : Among 1,419 patients ( 3,275 arterial or central -vein catheters ) included , we identified 296 colonized catheters , 29 major catheter-related infections , and 23 catheter-related bloodstream infections . Of the 11,036 dressings changes , 7,347 ( 67 % ) were performed before the planned date because of soiling or undressing . Dressing disruption occurred more frequently in patients with higher Sequential Organ Failure Assessment scores  and in patients receiving renal replacement therapies ; it was less frequent in males and patients admitted for coma . Subclavian access protected from dressing disruption . Dressing cost ( especially staff cost ) was inversely related to the rate of disruption . The number of dressing disruptions  was related to increased risk for colonization of the skin around the catheter at removal ( p < .0001 ) . The risk of major catheter-related infection and catheter-related bloodstream infection increased by more than three-fold after the second dressing disruption and by more than ten-fold if the final dressing was disrupted , independently of other risk factors of infection . Conclusion : Disruption of catheter dressings was common and was an important risk factor for catheter-related infections . These data support the preferential use of the subclavian insertion site and enhanced efforts to reduce dressing disruption in postinsertion bundles of care Thirty-two consecutive patients with haematological disorders , in need of a permanent central venous catheter ( CVC ) were r and omly allocated to have their CVC b and ages ( Tegaderm ) changed once ( OAW , n = 20 ) or twice ( TAW , n = 19 ) a week . The two r and omization arms were balanced in respect of age , sex , and underlying disease . The exit site of the CVC was inspected daily through the transparent b and age and erythema was noted . If severe erythema occurred , daily wet gauze dressings were applied . Sample s for bacterial cultures were taken from the exit site of the CVC at every change of b and ages . There was no difference in complications leading to removal of the CVC between the two groups ( 7/20 OAW vs. 7/19 TAW ) or in CVC survival-time ( P = 0.4 ) . However , the OAW group had more positive CVC tip cultures ( OAW 11/14 vs. TAW 2/9 ; P < 0.05 ) and a tendency to : ( i ) more extra dressings ( P = 0.08 ) ; ( ii ) more cultures from the exit skin site showing high numbers of colony forming units ( P = 0.07 ) ; ( iii ) shorter time to first exit site infection ( P = 0.09 ) ; and ( iv ) more Gram-positive septicaemias ( P = 0.08 ) . Both clinical and bacteriological data in this study indicate that changing transparent polyurethane CVC b and ages twice a week is superior to once a week PURPOSE Peripherally inserted central catheters ( PICCs ) are frequently used to deliver outpatient courses of intravenous therapy . However , the rates and risks of complication for this device have not been well-studied . Our objective was to determine the incidence and risk factors of PICC-related complications with a 1-year prospect i ve observational study . PATIENTS AND METHODS All PICCs inserted in adult and pediatric patients at Memorial Sloan-Kettering Cancer Center ( MSKCC ) were followed prospect ively . The device insertion team , inpatient nurses , and various home-care companies and outside institutions collected longitudinal data . RESULTS Three hundred fifty-one PICCs were inserted during the study period and followed for a total of 10,562 catheter-days ( median placement , 15 days ; range , 1 to 487 days ) . Two hundred five PICCs ( 58 % ) were managed by home-care companies and outside institutions , and 146 PICCs ( 42 % ) were managed exclusively at MSKCC . For these 205 PICCs , 131 nurses from 74 home-care companies and institutions were contacted for follow-up clinical information . In all , 115 ( 32.8 % ) of 351 PICCs were removed as a result of a complication , for a rate of 10.9 per 1,000 catheter-days . Patients with hematologic malignancy or bone marrow transplant were more likely to develop a complication , whereas those with metastatic disease were less likely . CONCLUSION Complications occur frequently among cancer patients with PICCs , and long-term follow-up is onerous . Despite a high complication rate , the ease of insertion and removal argues for continued PICC use in the cancer population Cutaneous lesions caused by catheter dressing changes can be serious and generate local pain in children undergoing high-dose chemotherapy followed by bone marrow transplantation . One hundred and thirteen children entered a r and omised trial to compare two catheter dressing change frequencies ( 15 days vs 4 days ) . Skin toxicity was classified according to the following scale : grade 0 : healthy skin , to grade 4 : severe skin toxicity . A qualitative culture of the skin at the catheter entry site was taken whenever the dressing was changed . Of the 112 evaluable children ( 56 in each group ) 32 developed grade ⩾2 local skin toxicity ( eight in the 15-day group and 24 in the 4-day group ; P = 0.001 ) . Although higher in the 4-day group , the proportions of children experiencing pain during and between dressing changes were not statistically different between the two groups . The proportion of patients with one or more positive skin culture(s ) at the catheter entry site during hospitalisation were similar in the two groups ( 27 % in the 15-day group and 23 % in the 4-day group ) as were the proportions of documented nosocomial bloodstream infections ( 11 % and 13 % ; NS ) . Whereas the planned frequency was maintained in the 4-day group ( mean = 4 days , s.d . = 1 ) , it was usually shortened in the 15-day group ( mean = 8 days , s.d . = 4 ) , mainly because dressings had loosened . Decreasing the catheter dressing change frequency proved efficient in reducing cutaneous toxicity without increasing the risk of local and systemic infection . In our unit , catheter dressings are changed every 8 days since this analysis BACKGROUND / AIMS To compare the time interval from insertion until development of central venous catheter related bloodstream infection ( CVC-RBSI ) between patients who received non-routine dressing change group ( Group 1 ) and patients who received routine dressing change group ( Group 2 ) . METHODOLOGY Between March 2006 and July 2008 , patients who underwent CVC were r and omly divided into Groups 1 and 2 . Comparative study between the two groups was performed by reference to the incidences of CVC-RBSI from the prospect ively obtained data base . RESULTS One hundred-eighty nine patients underwent 530 CVC insertions . Group 1 had 254 CVCs and Group 2 had 276 CVCs . There were no significant inter-group differences in patient background factors , except for gender . In addition , Group 1 had a shorter duration of catheter insertion than Group 2 . Nevertheless , Group 1 had not only a significantly shorter period from insertion until the development of CVC-RBSI but also a higher frequency of fever than Group 2 . CONCLUSIONS The results of our comparison between non-routine dressing change group and routine dressing change group indicate that routine dressing change can reduce the incidence of CVC-RBSI in patients undergoing CVC insertions BACKGROUND Changing a central venous catheter occlusive dressing on a twice-weekly basis is usually recommended in hemato-oncological patients . A longer interval is believed to give rise to infections . However , frequent dressing changes might cause local cutaneous damage . MATERIAL / METHODS Local cutaneous damage and infections were compared in patients with once-weekly versus twice-weekly changes of central venous catheters occlusive dressings .  This was a prospect i ve , r and omized , multicenter trial . RESULTS Eighty-one patients with acute myeloid leukemia being treated with intensive chemotherapy were enrolled ( twice-weekly group : n=42 , once-weekly group : n=39 ) . They 
    Output:
    
The best available evidence is currently inconclusive regarding whether longer intervals between CVAD dressing changes are associated with more or less catheter-related infection , mortality or pain than shorter intervals