1424 Prospective randomized trial to study the best time interval between catheter (KT) dressing

High dose chemotherapy followed by bone marrow transplantation (BMT) is often complicated by toxidermia. The presence of the KT dressing increases the intensity of cutaneous lesions at its implantation site. Until 1990 we used to change systematically KT dressing every 4 days. Taking into account the role of these changes, we wondered whether in increasing the time lapse between each KT dressing it would be possible to decrease the cutaneous complications without infectious side effects. To answer this question a prospective randomized trial testing two intervals between KT dressings was undertaken. Eligible patients were randomly assigned either to group 1 (4 days) or group 2 (15 days). They were followed up during hospitalization for BMT. KT dressing was checked every day and changed early if one or several of these features was observed: dirty compresses, unsticking dressing, perfusion or KT problems, positive bacteriologic contacts. At each occasion of changing the KT dressing cutaneous lesions were quoted according to a toxicity grading. Between July 1990 and April 1993, 112 children entered this study. 1064 dressings were performed during the study. 56 children were treated with 4 days interval, 56 with 15 days interval. Median age, underlaying disease, conditioning regimens, were not different between the two groups. 86% of group 2 children (15 days) experienced a local cutaneous toxicity of grade  or = 2. No difference was observed between the two groups according to incidence of local and systemic documented infections, duration of fever, incidence of positive contacts. However, in group 2, the median observed interval between KT dressing was 8 days essentially because of premature unsticking of the dressing.