The traditional method of fixing central venous catheters was suturing, and although this is still used today, the high rate of complications is leading more and more professionals to opt for other safer options. What are the alternatives?
WHAT WILL YOU FIND IN THIS ARTICLE?
- Complications associated with type of central venous catheter fixation
- Suture fixation
- Adhesive fixation
- Subcutaneous fixation system
- Which type of fixation to use?
Want to know more about the different central venous catheter fixation systems? Stay on this page and read the full post.
COMPLICATIONS ASSOCIATED WITH TYPE OF CENTRAL VENOUS CATHETER FIXATION
To avoid complications, the main recommendation is to keep the catheter, dressing and puncture site clean, dry and well secured. However, this is not always the case: according to some studies, between 21% and 71% of dressings are dirty, wet, loose or poorly secured.1
Good fixation and maintenance will help to avoid complications such as phlebitis, catheter-related bloodstream infection, device colonisation, entry and exit site infection, skin colonisation or irritation.
In addition, if the catheter is not well fixed or moves during cleaning, thrombosis may occur and, consequently, occlusions or migration of the catheter may be encountered.
TYPES OF CENTRAL VENOUS CATHETER FIXATION
There are several types of central venous catheter attachments, and each has its own recommendations and best practices for use.
SUTURE FIXATION
The traditional method of fixation of central venous catheters was suturing, and although this is still used today, it is being displaced by other methods that present fewer complications.
In terms of fixation and mainly for short periods of time, it provides stability to the catheter, however, over time, the silk may loosen and we may encounter catheter migration.
This is not the only complication associated with suturing; the rate of catheter-associated infection or bacteraemia is also increased with this method of fixation.
With this system, the health of the professional who fixes the catheter may also be affected, as the CDC estimates that between 600,000 and 800,000 accidental punctures occur each year.
Because of all these complications, the guidelines advise against their use, why are they still used, and are there safer alternatives?
ADHESIVE BONDING
Another type of central venous catheter fixation is adhesive fixation. This is a common and less invasive technique than suturing and has a lower complication rate.
Adhesive devices
The most commonly used adhesive fastening devices are Grip-lock or Stat-lock:
- Grip-lock: this is a Velcro device with a cut-out area where the flaps fit. It is also a flexible device, so it adapts perfectly to any patient’s fixation area. As long as they are well maintained and free of dirt, they can be kept for up to two or three weeks.
- Stat-lock: a device with protruding prongs on which to attach the catheter wings. It is less flexible than the Grip-Lok.
Adhesive fixation devices are a great alternative to suturing, with a complication rate of 21.3% compared to 47.2% associated with suturing.3
However, there are also complications associated with these devices. On the one hand, the passage of time can lead to degradation and loosening of the adhesive, which does not ensure 100% secure fixation.
Strong, moisture-resistant adhesives are also an option. The disadvantage of these devices is that they require specific solvents for easy removal, and incorrect use of solvents can cause skin damage.
Moreover, during maintenance, to ensure optimal cleaning of the insertion site and dressing area, adhesives should be removed from the skin surface.
SUBCUTANEOUS FIXATION SYSTEM
The subcutaneous fixation system or SecurAcath is a relatively new option that allows sutureless and adhesive-free fixation. The catheter is placed inside an orange plastic structure, which is attached to an anchor inserted into the subcutaneous tissues, beyond the skin where the pain receptors are located.
Within 48 to 72 hours after fixation, the anchor heals in place, preventing movement of the catheter.
Immobility favours the recovery of the insertion area and facilitates the formation of new tissue that acts as a protective barrier against bacteria present on the surface. By being fixed at the puncture site, the vascular access device can be gently lifted, allowing thorough cleaning to be performed.
This type of fixation reduces mechanical complications and the number of catheter replacements, thus reducing the risk of interruption of therapy, resulting in cost savings.
WHAT TYPE OF FASTENER TO USE?
Disease Control and Prevention‘s clinical practice guideline on vascular care recommends, as well as other guidelines and studies, the use of sutureless fixation devices. 6
The use of sutureless fixation systems has been shown to reduce the occurrence of catheter-associated infections and the degree of catheter displacement. In addition, these systems are less invasive for the patient, avoiding the risk of bleeding associated with suturing and, therefore, fewer dressing replacements. 6
With regard to adhesive and subcutaneous fixation, each has its advantages and indications, so, as with any procedure, we must adapt to the characteristics of the patient.
However, the subcutaneous fixation system is associated with fewer complications and greater device stability, and does not need to be replaced during the lifetime of the catheter.
There are certain groups of patients who particularly benefit from the use of subcutaneous fixation, such as: neonates, children, uncooperative elderly patients with cognitive difficulties, patients with skin abnormalities, patients who are candidates to carry a PICC line for more than 8 weeks, as well as any other category of patients with a recognised high risk of catheter dislodgement.7
BIBLIOGRAPHY
- Spencer, Timothy. (2018). Securing vascular access devices. The American nurse. 13. 29-31.
- Ullman AJ, Cooke ML, Mitchell M, Lin F, New K, Long DA, Mihala G, Rickard CM. Dressings and securement devices for central venous catheters (CVC). Cochrane Database Syst Rev. 2015 Sep 10;2015(9):CD010367. doi: 10.1002/14651858.CD010367.pub2. PMID: 26358142; PMCID: PMC6457749.
- Molina-Mazón, C., Martín-Cerezo, X., De La Vega, G. D., Asensio-Flores, S., & Adamuz-Tomás, J. (2018). Estudio comparativo sobre fijación de catéter venoso central mediante sutura versus dispositivo adhesivo. Enfermería Intensiva. https://doi.org/10.1016/j.enfi.2017.10.004
- The cyanoacrylate glue for VADs. (s. f.). https://deltamed.pro/en/news/cyanoacrylate-glue-for-vads#:~:text=Cyanoacrylate%20glue%20is%20used%20to,under%20the%20catheter%20connection%20itself
- Ball M, Singh A. Care Of A Central Line. . In: StatPearls . Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564398/
- Molina-Mazón, C., Martín-Cerezo, X., De La Vega, G. D., Asensio-Flores, S., & Adamuz-Tomás, J. (2018). Estudio comparativo sobre fijación de catéter venoso central mediante sutura versus dispositivo adhesivo. Enfermería Intensiva. https://doi.org/10.1016/j.enfi.2017.10.004
- Pittiruti, M., Scoppettuolo, G., Dolcetti, L., Celentano, D., Emoli, A., Marche, B., & Musarò, A. (2019b). Clinical experience of a subcutaneously anchored sutureless system for securing central venous catheters. British journal of nursing, 28(2), S4-S14. https://doi.org/10.12968/bjon.2019.28.2.s4
