hen anesthesiologists place catheters, we give little thought to how the catheter securement will affect the function and potential complications of that catheter outside the operating room. Yet studies have shown that the particular form of securement — tape, suture or a manufactured catheter stabilization device — can have a significant effect on catheter-associated complications.

Catheter securement/stabilization remains one of the more neglected areas of medical inquiry, so it is not surprising that physicians may be unaware of advances in this area. Evidence is accumulating to support one method — manufactured catheter stabilization devices — over traditional securement techniques of tape and suture. The devices are available for all the types of catheters we commonly place — peripheral I.V.s (PIVs), arterial lines and central venous catheters.

The Centers for Disease Control and Prevention and, more recently, the Infusion Nurses Society (INS) have cited this evidence base.^1,2 The Occupational Safety and Health Administration (OSHA) also relied upon this published research in revising its Bloodborne Pathogen Standard and issuing its fact sheet on securing medical catheters.^3,4 Those studies point to some of the most attractive attributes of the devices: their ability to minimize unplanned catheter restarts and complications such as phlebitis and infiltration while also reducing the risk of sharps injury for physicians and other health care workers. From a cost standpoint, when downstream costs are considered along with the initial material expense, stabilization devices also may confer an advantage.

Devices Reduce Restarts and Complications
Anesthesiologists are becoming more aware that the things we do in the perioperative period have long-term implications for our patients’ welfare, e.g., beta-blockade, glucose control and preventing line infections. I expect this awareness ultimately to lead to greater usage of catheter stabilization devices.

A study published in the peer-reviewed Journal of Infusion Nursing (JIN) compiled data from product trials conducted in 83 different hospitals.⁵ The study, which encompassed 10,164 patients, compared tape securement to a particular brand of manufactured stabilization device, examining their effectiveness with PIVs. In the study, use of the stabilization device reduced restarts by 76 percent in the first three days of I.V. therapy. Restarts not only inconvenience patients but also cause them distress from repeated venipunctures.

The study also examined the stabilization device’s impact on catheter-related complications. The complication rate with tape was 47.6 percent. When the device was used, the rate dropped to a mere 16 percent, a 67-percent reduction. Reducing complications means fewer I.V. extravasations, premature dislodgements and catheter restarts. Anesthesiologists usually tape-secure the PIV catheters they place, so I believe the JIN study’s results will apply.

A look at the physics of tape securement versus device stabilization shows why the device approach is more logical. When catheters are taped in place, the catheter is sandwiched between the tape and the skin. Any force applied to the catheter, for example, pulling on the I.V. tubing or arterial line tubing, can cause the catheter to move. The catheter thus creates a wedge that undermines the tape’s adhesion.

In contrast, properly designed stabilization devices raise the catheter off the skin. For example the devices mentioned in this article fit the catheter in a precision-molded plastic retainer that holds it tightly in place. The retainer is attached to an anchor pad that provides a large, uniform adhesive surface. Adhesion is further enhanced by a skin preparation pad that comes with the device. From an engineering standpoint, this is a far superior approach to tape.

Devices and Needlestick Safety
The evidence base establishes that catheter stabilization devices help to minimize needlestick injuries. For instance, in research conducted at the Children’s Hospital of Philadelphia and the Hospital of the University of Pennsylvania, the device, when compared to suture securement, eliminated sharps injuries to health care workers in both studies.⁶

The Children’s Hospital study compared device stabilization to suture securement in children with short-term central venous catheters.6 The University of Pennsylvania study compared device stabilization versus suture securement of peripherally inserted central catheter (PICC) lines in adults.⁷ In both studies, securement-related needlestick injuries related to catheter securement occurred in the suture group at a 2-percent rate.

The ability of the device to prevent needlesticks with catheter types that are normally suture-secured is intuitively obvious. With no medical sharp involved, the device provides perfect protection. In the case of catheters that would otherwise be tape-secured, the device also helps to prevent needlesticks by reducing catheter restarts and increasing catheter dwell times.

Reducing Costs
No one at any leadership level in health care can ignore pressures to reduce costs these days, so the financial performance of the device is a crucial aspect of its value. Use of the device does add some upfront cost, but when the overall costs are considered, the cost-effectiveness of the device becomes clear. Another study at the Children’s Hospital of Philadelphia compared PICC stabilization with the device to securement with sterile threaded tape in a pediatric patient population.6 The device increased placement costs, though not to a statistically significant degree. It did, however, significantly reduce the cost of maintaining the PICC line and the complication costs associated with the catheter. Maintenance costs were $7.83 for threaded tape and $3.07 for the device. The spread was even greater for complication costs: $328.68 for tape versus $71.11 for the device on average per catheter.

These differences are not hard to explain. Restarts require more nursing time and consume materials. Complications lead to additional treatment costs.

The pediatric PICC study also revealed physicians’ preference for the device over other securement methods. Doctors found it faster to apply than suture and liked it better overall.

The Infusion Nurses Society, a leading infusion-safety organization, promulgated new standards last year that state a preference for the use of a manufactured catheter stabilization device instead of tape or suture. OSHA, with its charge to protect workers, focuses on the needlestick safety issue and requires all U.S. hospitals to annually evaluate their means of catheter securement and to consider adopting stabilization devices.

Introducing a practice change is usually difficult, and we often do not have enough information to make an informed decision. In this case, several studies suggest that there is a better way to secure catheters. These catheter stabilization devices appear to improve care by reducing patient complications, reducing the risk of needlestick injury for the health care provider and thus saving money in the long run. I suspect that we will abandon tape and suture for these devices in the near future.

References:
1. Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections. MMWR. 2002; (RR: 10):51.
2. Infusion nursing standards of practice. J Infus Nurs. 2006; 29(1S):S44-S62.
3. Bloodborne pathogens. 1910.1030. Toxic and Hazardous Substances. Occupational Safety and Health Standards. Code of Federal Regulations, Ch. 29.
4. Occupational Safety and Health Administration. U.S. Department of Labor. OSHA Fact Sheet: Securing Medical Catheters.
5. Schears GJ. Summary of product trials for 10,164 patients. J Infus Nurs. 2006; 29(4):225-229.
6. Frey AM, Schears GJ. Why are we stuck on tape and suture? J Infus Nurs. 2006; 29(1):34-38.
7. Yamamoto AJ, Solomon JA, Soulen MC, et al. Sutureless securement device reduces complications of peripherally inserted central venous catheters. J Vasc Interven Radiol. 2002; 13(1):77-81.

Gregory J. Schears, M.D., is Consultant Anesthesiologist and Assistant Professor of Anesthesia and Pediatrics, Mayo Clinic, Rochester, Minnesota.