Catheter Securement Systems for Peripherally Inserted and Nontunneled Central Vascular Access Devices: Clinical Evaluation of a Novel Sutureless Device

Securement to Prevent Noncuffed Central Venous Catheter Dislodgement in Pediatrics: The SECURED Superiority Randomized Clinical Trial

Importance

Catheter dislodgement is a common complication for children with tunneled or peripherally inserted noncuffed central venous catheters (CVCs). A subcutaneous anchor securement system (SASS) may reduce this risk compared with traditional adhesive securement.

Objective

To compare dislodgement of noncuffed CVCs secured with SASS with dislodgement of noncuffed CVCs secured with sutureless securement devices (SSDs).

Design, Setting, and Participants

The SECURED (Securing Central Venous Catheters to Prevent Dislodegment) trial was a pragmatic, multicenter, superiority randomized clinical trial with an internal pilot and was conducted from August 5, 2020, to August 30, 2022, at 2 Australian quaternary pediatric hospitals. Data analysis was performed in January 2023. Patients aged 0 to 18 years requiring a noncuffed CVC (≥3F catheter) were eligible for inclusion. Follow-up duration was 8 weeks or until device removal.

Interventions

Patients were randomly assigned 1:1 to receive an SASS or SSD, stratified by hospital and catheter type. Only 1 catheter was studied per patient.

Main Outcomes and Measures

The primary outcome was dislodgement (partial or total), defined as movement of the catheter tip by greater than 1 cm (change in external catheter length) at any point during catheter dwell. Dislodgement, reported as a risk ratio (RR), was estimated using a generalized linear model with binomial family and log link. Secondary outcomes were reported as incidence rate ratios and were analyzed using Poission regression. Outcomes reported as mean differences (MDs) were analyzed using linear regression.

Results

Of 310 randomized patients, 175 patients (56.5%) were male and median (IQR) patient age was 48 (16-120) months. A total of 307 patients had a catheter device inserted, of which 153 (49.8%) were SASS and 154 (50.2%) were SSD, and were included in the intention-to-treat (ITT) analysis. Device dislodgement was lower with SASS (8 dislodgements in 153 patients [5.2%]) compared with SSD (35 dislodgements in 154 patients [22.7%]) (RR, 0.23; 95% CI, 0.11-0.48; P < .001). The per-protocol analysis was consistent with the ITT analysis. Partial dislodgement accounted for most dislodgement events, including 6 partial dislodgements in the SASS group (3.9%) and 30 partial dislodgements in the SSD group (19.5%) (RR, 0.18; 95% CI, 0.08-0.42). This contributed to fewer complications during dwell in the SASS group (37 reported complications [24.2%]) vs the SSD group (60 reported complications [39.0%]) (RR, 0.62; 95% CI, 0.44-0.87). Staff reported greater difficulty removing devices anchored with SASS vs SSD (mean [SD], 29.1 [31.3] vs 5.3 [17.0], respectively; MD, 23.8; 95% CI, 16.7-31.0). However, use of SASS resulted in reduced per-participant health care costs of A$36.60 (95% credible interval, 4.25-68.95; US $24.36; 95% credible interval, 2.83-45.89).

Conclusions and Relevance

In the SECURED trial, noncuffed CVCs secured with SASS had fewer dislodgements compared with SSDs, with a lower cost per patient and an acceptable safety profile. Future efforts should be directed at SASS implementation at the health service level.

Trial Registration

anzctr.org.au Identifier: ACTRN12620000783921.

The First Use of a Midline Catheter in Outpatient Pain Management

Midline catheters (MCs) are used to deliver intravenous therapy lasting over 5 days to patients in hospitals. However, the constant development of home and outpatient care is challenging medical teams to provide effective and safe planned therapy to patients under such conditions. We describe the first time an MC was used in outpatient pain management in Poland. A 60-year-old man presented to the Pain Management Clinic with a history of RCC of the left kidney and lumbar back pain radiating to the left knee joint. The person whose case is described below had poor peripheral veins. He intravenously received lidocaine for 10 days via a midline catheter with a good response.

A Primer and Literature Review on Internal and External Retention Mechanisms for Catheter Fixation

Although catheters are commonplace in hospital settings, there is scarce literature discussing the internal and external retention mechanisms used to aid in catheter fixation. Additionally, exact definitions and detailed information on internal and external retention mechanisms are almost non-existent in the literature.

This article serves three primary purposes. The first purpose is to define internal and external catheter retention mechanisms, describe how they work, and provide examples of each that are routinely used in healthcare settings. The second goal of this paper is to provide a literature review comparing various aspects of the different types of internal and external catheter retention mechanisms discussed in the paper, including performance variance and the advantages and disadvantages of each. The third aim of this article is to provide a brief overview of catheter dislodgment, including the rates at which this occurs, the problems that can arise, and the best treatment option when this does occur.

Guidelines of the Italian Association of Pediatric Hematology and Oncology for the management of the central venous access devices in pediatric patients with onco-hematological disease

INTRODUCTION

Central venous accesses devices (CVADs) have a fundamental importance for diagnostic and therapeutic purposes in pediatric onco-hematological patients. The treatment of pediatric onco-hematological diseases is complex and requires the use of integrated multimodal therapies. Long-lasting and safe central venous access is therefore a cornerstone for any successful treatment.

METHODS

The aim of this work is to define pediatric guidelines about the management of CVADs in onco-hematology. A panel of experts belonging to the working groups on Infections and Supportive Therapy, Surgery and Nursing of the Italian Pediatric Hematology Oncology Association (AIEOP) revised the scientific literature systematically, scored the level of evidence and prepared these guidelines. The content of the following guidelines was approved by the Scientific Board of AIEOP.

RESULTS AND CONCLUSIONS

Important innovations have been developed recently in the field of CVADs, leading to new insertion methods, new materials and new strategy in the overall management of the device, especially in the adult population. These guidelines recommend how to apply these innovations in the pediatric population, and are directed to all physicians, nurses and health personnel active in the daily management of CVADs. Their aim is to update the knowledge on CVAD and improve the standard of care in pediatric patients with malignancies.

Long-term vascular access in differently resourced settings: a review of indications, devices, techniques, and complications

Central venous access is frequently essential for the management of many acute and chronic conditions in children. Millions of central venous access devices (CVADs) are placed each year. In this review article, we discuss the indications for long-term vascular access, the types of devices available, the state of the art of central venous cannulation and device placement, and the complications of long-term central venous access. We pay a special attention to the challenges of, and options for long-term central venous access, also those in developing countries, with limited financial, human, and material resources.

Universal adhesive vascular access securement with Grip-Lok devices

The use of sutureless, adhesive securement devices in vascular access has become recommended as best practice, because they are a cost-effective, reliable solution. After a vascular access device has been inserted, catheter securement is one of the most important aspects of care and maintenance. The Grip-Lok® range offers secure, comfortable adhesive securement for all types of vascular access devices. The products use hypoallergenic medical adhesive, which reduces the risk of skin irritation and provides a reliable, adaptable alternative to suturing.

2018 Infectious Diseases Society of America Clinical Practice Guideline for the Management of Outpatient Parenteral Antimicrobial Therapy

A panel of experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2004 clinical practice guideline on outpatient parenteral antimicrobial therapy (OPAT) [1]. This guideline is intended to provide insight for healthcare professionals who prescribe and oversee the provision of OPAT. It considers various patient features, infusion catheter issues, monitoring questions, and antimicrobial stewardship concerns. It does not offer recommendations on the treatment of specific infections. The reader is referred to disease- or organism-specific guidelines for such support.

A Comparative Study of Blood Sampling From Venipuncture and Short Peripheral Catheters in Pediatric Inpatients

This prospective, comparative study examined blood test results, hemolysis rates, and patient perceptions related to 2 blood sampling methods in pediatric inpatients (N = 95). Blood specimens were drawn via venipuncture and a short peripheral catheter used for fluid administration. Results revealed no significant differences in potassium and glucose levels. No clinically significant difference in hemoglobin was noted. Hemolysis rates were 4% for venipuncture samples and 15% when drawn from peripheral catheters. One catheter became occluded after a blood draw. Patients/parents rated distress and dissatisfaction with venipuncture as significantly greater compared with short peripheral catheter blood sampling (P < .001).

[Case report on deviant care measures of a PICC line on a palliative patient]

A PICC line is a peripheral, through a vein inserted, central venous catheter. There are different engineered stabilisation devices - some are with and some without a sutural. This is an individual case-report which only looks at one concrete fixing system with an adhesive plate (StatLock®).In an internet search on 12/2017 the usual care-recommendation refers mainly to a document of Charité - Universitätsmedizin Berlin (04/2014). It is recommended to change the adhesive plate and the plaster every seven days. Also irrigations during the change of the adhesive plate and after each use of the PICC line are recommended. This procedure also includes the take off and new fixation of the adhesive plate as well as the disinfection and cleaning of the skin and the fixation of the plaster.This case report looked at a 65 years old masculine, cachectic, palliative patient with a metastasizing prostate cancer in a weak condition. He was able to move within his residential area. He had no cognitive or psychological impairment.The installation of the PICC line on the left upper arm was done in 04/2017. When the patient came to our mobile palliative team one of the lines was used for pain therapy with a PCA-pump. The second line was irrigated with 10 ml NaCl by his wife daily.At the beginning the adhesive plate was changed every 14 days. Because of skin irritations and pain during the change of the bandage the patient decided at the 10.8.2017 to do no more further changes of the adhesive plate.The adhesive plate was controlled through the transparent plaster and the transparent plaster was changed for the first time on the 20.10.2017 without removing the adhesive plate. The change of the adhesive plate itself was done on the 13.12.2017 without any complications.In this described case there were no complications even after more than 4 months (20 weeks) although there was no change of the adhesive plate during this time.It is suggested to individualize the interval of the change of the adhesive plate for palliative patient even more. Larger studies could give more detailed guidelines for an extend change interval. Thereby the comfort and the safety of the patient should be more important than the economic aspects (less effort and smaller costs because of the extended intervals of change).

Prevention of Central Line-Associated Bloodstream Infections

Central venous catheters (CVCs) are commonly used in critically ill patients and offer several advantages to peripheral intravenous access. However, indwelling CVCs have the potential to lead to bloodstream infections, with the risk increasing with an array of characteristics, such as catheter choice, catheter location, insertion technique, and catheter maintenance. Evidence-based guidelines have led to a significant reduction in the incidence of bloodstream infections associated with CVCs. The combination of guideline implementation and newer technologies has the potential to further reduce morbidity and mortality from infections related to CVCs.