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A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
Securing Jugular Central Venous Catheters With Dressings Fixed to a Liquid Adhesive to Prevent Dressing Failure in
Nicole Marsh1,2,3, Catherine O'Brien1,3, Emily N Larsen1,3
1Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
Objectives:
Central venous catheters (CVCs) are vital for treating ICU patients. However, up to a quarter of CVCs fail from mechanical or infective complications. Poor securement of CVCs to the skin contributes to catheter failure, particularly CVCs placed in the jugular vein, which are highly vulnerable to pullout forces. This study evaluated the effectiveness of medical liquid adhesive (MLA) for improving jugular CVC dressing adhesion.
Design:
Multisite parallel group, superiority, randomized controlled trial.
Setting:
Four metropolitan Australian ICUs.
Patients:
Eligible patients were 18 years old or older, within 12 hours of jugular CVC insertion, expected to need the CVC for greater than or equal to 72 hours, and remain in ICU for greater than or equal to 24 hours.
Interventions:
Patients were randomly allocated (stratified by hospital and gender) to standard CVC dressings with the application of MLA to skin under the dressing border (intervention) or standard care CVC dressings (control).
Measurements And Main Results:
The primary endpoint was dressing failure within 7 days due to lifting edges. Secondary outcomes included the total number of dressing changes, skin injury, and CVC failure. In total, 160 participants (82 control; 78 intervention) were enrolled. There were 22 (28%) and 41 (50%) cases of premature dressing failure in the intervention and control groups respectively (odds ratio, 0.39; 95% CI, 0.20-0.76; p = 0.005). The intervention group had fewer dressing changes (incidence rate ratio [IRR], 0.74; 95% CI, 0.55-0.99). Time to dressing failure (log-rank test; p = 0.12) and all-cause CVC failure (IRR, 1.44; 95% CI, 0.36-5.79) did not differ between groups. Three skin injuries occurred: one in the intervention (blister) and two in the control (maceration and skin tear) groups.
Conclusions:
MLA is associated with significantly decreased jugular CVC dressing failure and longer dressing dwell, with an acceptable safety profile. MLA should be considered to preserve jugular CVC dressings in ICU.
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