Clinical experience of a subcutaneously anchored sutureless system for securing central venous catheters
This article reports the results of three prospective clinical studies conducted in a university hospital regarding the efficacy, safety and cost effectiveness of a subcutaneously anchored sutureless system for securing central venous catheters. The results were favourable to the adoption of such a device, and the analysis of the data allowed the authors to define those categories of patients where the device should have the most benefit: neonates, children, non-compliant older patients with cognitive difficulties, patients with skin abnormalities that may reduce the effectiveness of a skin-adhesive sutureless securement system, patients who are candidates for having a peripherally inserted central catheter (PICC) in place for more than 8 weeks, and any other category of patients with a recognised high risk of catheter dislodgement.
Aspecific device for subcutaneously anchored securement (SAS) of central venous catheters (CVC) was introduced into clinical practice only a few years ago. In the authors' 1500-bed university hospital, clinicians have considered the use of such a device for the purpose of reducing or eliminating the clinical occurrence of catheter dislodgement, an often-neglected complication. In the authors' experience, CVC dislodgement is only partially prevented by current securement strategies: adoption of semipermeable transparent dressings (Tegaderm, 3M; IV 3000, Smith & Nephew); application of cyanoacrylate glue (Hystoacryl, BBraun) on the exit site; consistent use of sutureless devices, either adhesive to the skin (StatLock, BD; Grip-Lok, Zefon International; WingGuard, Centurion Medical Products) or integrated in the transparent dressing (SorbaShield, Centurion). In some patient populations within the authors' hospital (such as in children), partial or total dislodgement of the catheter is the most frequent reason for losing venous access (far more frequent than infection or venous thrombosis or lumen occlusion).
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