Central venous catheters are critical to patient care across acute, paediatric, neonatal and oncology settings. However, despite careful insertion and maintenance protocols, complications related to catheter securement remain a persistent risk. Suboptimal securement can contribute to catheter migration, dislodgement, insertion site trauma and infection, all of which can impact patient safety, clinician workload and overall cost of care[1], [2].
This article explores the key risks associated with commonly used CVC securement methods and considers how subcutaneously anchored securement devices, may support risk mitigation strategies across clinical practice.
Risks Associated with Traditional CVC Securement
Catheter Migration and Dislodgement
Catheter migration and accidental dislodgement are well recognised complications associated with both sutured and adhesive securement methods. Sutures do not prevent micromovement at the insertion site, while adhesive securement devices are vulnerable to failure from moisture, perspiration and repeated dressing changes.1,2
In paediatric patients, unintentional catheter dislodgement can have particularly serious consequences. The SECURED randomised clinical trial demonstrated that non‑cuffed CVCs secured with a subcutaneous anchor device were significantly less likely to dislodge compared with those secured using adhesive securement devices[3]
Infection Risk and Dressing Disruption
Securement plays an important role in infection prevention by maintaining catheter stability and protecting the integrity of the insertion site dressing. Catheter movement can lead to dressing failure, increased insertion site manipulation and a higher likelihood of microbial ingress.2
Skin Integrity and Unplanned Clinical Intervention
Frequent replacement of adhesive securement devices can increase the risk of medical adhesive‑related skin injury, particularly in patients with fragile or compromised skin such as neonates, oncology patients and the critically ill.1,[4]
Securement failure may also result in unplanned catheter removals, reinsertion procedures and additional imaging, all of which place additional burden on patients and clinical teams.
The Role of Subcutaneous Anchor Securement in Risk Mitigation
Enhanced Mechanical Stability
Subcutaneously anchored securement devices stabilise the catheter at the point of entry using small blunt anchors positioned beneath the skin. This method directly addresses catheter micromovement, significantly improving mechanical stability compared with surface‑based securement.1,[5]
High securement success rates and low migration rates have been reported across adult, paediatric and neonatal populations when subcutaneous anchor devices are used for both PICCs and CVCs.[6], [7]
Reduced Dressing Manipulation and Infection Exposure
By stabilising the catheter independently of the dressing, subcutaneous securement allows the dressing to function primarily as a protective barrier rather than a fixation tool. This separation of roles supports improved dressing durability and may reduce cumulative insertion site exposure over the catheter dwell time.1,[8]
The NICE Medical Technology Guidance review concluded that subcutaneous securement devices provide effective catheter stabilisation while supporting infection prevention goals and reducing the number of unplanned catheter removals[9]
Consistency Over the Full Catheter Dwell Time
Unlike adhesive securement devices that require routine replacement, subcutaneous anchor systems are designed to remain in place for the entire catheter dwell time. The SecurAstaP randomised trial demonstrated a significant reduction in nursing time associated with dressing changes when using a subcutaneous securement device, without an increase in catheter complications.[10]
Reducing repeated manipulation at the insertion site may contribute to improved catheter stability and more predictable care pathways.
Conclusion
Central venous catheter securement is a critical component of vascular access risk mitigation. Evidence from multiple clinical studies demonstrates that subcutaneously anchored securement devices reduce catheter movement, lower dislodgement risk and support infection prevention strategies when compared with traditional securement methods.
Incorporating securement choice into vascular access decision‑making offers an important opportunity to improve patient safety, reduce complications and enhance clinical efficiency across care settings.
References
[1] Pittiruti M et al. Clinical experience of a subcutaneously anchored sutureless system for securing central venous catheters. Journal of Vascular Access. 2012. [nice.org.uk]
[2] Bell JA et al. Systematic review of the safety and efficacy of central vascular access device securement. 2016. [securacath.com]
[3] Kleidon TM et al. Securement to prevent non‑cuffed central venous catheter dislodgement in paediatrics: The SECURED superiority randomised clinical trial. JAMA Pediatrics. 2024. [avatargroup.org.au]
[4] Brescia F, Pittiruti M, Scoppettuolo G, Celentano D, Marche B. Subcutaneously anchored securement for peripherally inserted central catheters: immediate, early and late complications. J Vasc Access. 2014;15(4):282–287.
[5] Crocoli A, D’Andrea V, Pittiruti M. Safety and effectiveness of subcutaneously anchored securement for tunneled central catheters in oncological paediatric patients: a retrospective study. J Vasc Access. 2018;19(6):564–570.
[6] D’Andrea V, Pittiruti M, Annetta MG, Crocoli A, D’Onofrio D. Securement of central venous catheters by subcutaneously anchored sutureless devices in neonates. J Vasc Access. 2018;19(6):558–563.
[7] Hawes M, McCormick C, Gilbert G. A retrospective study of subcutaneous anchor securement systems in oncology patients. J Assoc Vasc Access. 2019;24(3):24–30.
[8] McParlan D. Intravascular catheter migration: a cross‑sectional and health‑economic comparison of adhesive and subcutaneous engineered stabilisation devices for intravascular device securement. J Assoc Vasc Access. 2016;21(1):33–40.
[9] National Institute for Health and Care Excellence (NICE). SecurAcath for securing percutaneous catheters. Medical Technologies Guidance HTG440. London: NICE; 2017. Updated 2022.
[10] Goossens GA, Grumiaux N, Janssens C, Jérôme M, Fieuws S, Moons P, et al. Securement with SecurAcath versus StatLock for peripherally inserted central catheters (SecurAstaP): a randomised open trial. BMJ Open. 2018;8:e016058.
