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|Newsletter: Securing a Central Venous Access Device|
Securing a Central Venous Access Device
Mary T. Tessier, RN, Vascular Access Specialist
For those who live with a central venous access device (CVAD), daily care and maintenance is an issue. Keeping lines clean and secure is critically important for avoiding infection and preserving the lines. When the line moves back and forth, it can introduce bacteria beneath the skin and into the bloodstream. Improved stability can help prevent infections from occurring. Yet anyone who has had a
peripherally inserted central catheter (PICC), port, tunneled catheter or nontunneled catheter knows the difficulties in maintaining security and comfort, and the major complication that losing a CVAD can pose.
Several products have been manufactured to provide securement of needles and tubing. Not every one is right for every patient. Trial and error become the norm as patients try to find what works best for them. Here we introduce you to some options to secure your line.
Statlock® (Bard Access) is a stabilization device for PICC lines. It is latex free, and intended to prevent movement and/or dislodgement of the catheter. As with most devices, however, it does not anchor the length of the catheter, which can become cumbersome, heavy, and a potential threat. Occupations, children, pets, and just daily maneuvering can cause dislodgement of the catheter if it gets tangled during daily activities or during sleep.
I have had patients use a long tube sock with the foot cut off to hel
p provide more security of the line. Wearing long-sleeved shirts also provides another measure of security to prevent the line from catching on objects. Other patients purchase “fish net” tubular bandaging (such as Surgilast® or Surgitube® [both Derma Sciences], or Curad® Elastic Net) from medical supply stores. These can provide added comfort and an additional safeguard.
Grip-Lok® (TIDI) is another securement device available for purchase. Grip-Lok is a universal securement device. It is available in multiple sizes for different purposes (PIV, PICC, CVL). The product is latex free.
SecurAcath® (Interrad Medical) is fairly new to the market. It is placed at the same time a PICC or CVAD is inserted. The SecurAcath is comprised of an anchor-type piece and a cover. First the small anchor is placed directly under the skin and the catheter is placed in a groove, then the device cover (the orange portion in the photo) is snapped on to grip the catheter.
The device helps prevent migration and dislodgement while allowing for 360-degree cleaning around the insertion site. One of the benefits of the device is that it does not need to be removed weekly with dressing changes. The device is placed and can be left in for the duration of the catheter.
SorbaView Shield® (Centurion) combines a dressing or covering with securement—a stabilization device embedded in the dressing. It can be placed over any type of CVAD (PICC, tunneled or untunneled catheter, or accessed port). It has a large window for visualization and is designed to stay in place for comfort and security.
Then we look at tape. Yup—good, old-fashioned tape. Taping the catheter tubing can preserve lines and provide added confidence in patients. Tape can be an excellent securement, but it can also be detrimental to fragile skin. The constant application and removal of tape can irritate and/or tear skin. Open areas around insertion sites are difficult to heal and can increase the chances of developing infection.
Superglue? Sometimes it seems like the only answer, but obviously it is not a realistic one. Sutures? To prevent needle stick injuries and increased risk of infection, the Centers for Disease Control (CDC) and Occupational Safety and Health Administration (OSHA) recommend that lines not be sutured in. Many practitioners, however, continue to suture devices in place, placing themselves and the patient at risk.
Tubing can be bothersome and pose a risk of accidental dislodgement due to the weight of the tubing/filter. Some patients find that making a tube top of stretchy mesh stockinette helps. Another method of securing the tubing is to coil the tubing around on itself close to the insertion site and tape it in place. The drawback of this is removing tape frequently may damage or tear skin. Changing the site of attachment frequently and using a removable skin adherent (such as Medco Sports Stik-It®) will help maintain skin integrity.
So what is the answer? Your best resource is your vascular access specialist. Discussion forums and conversations with other users is also beneficial. Taking advantage of every resource available cuts down on the guesswork. Sharing your experiences will help others with the same issues. But remember: different measures work for different people. What works for one person may be a nightmare for another person. Continued product development is under way, and until someone develops a product that provides securement, comfort, and safety for all, it is trial and error.
Editor’s note: If the catheter tubing comes out of the insertion site, do not push the tubing back in. Contact your health care professional.
LifelineLetter, July/August 2015