“Sticking it to Them” – Application of a Tissue Adhesive to Secure and Stabilize Peripherally Inserted Central Catheters
Joan Ralph Webber, DNP, APRN, CNS, OCN, CRNI®
Oncology/Hematology Clinical Nurse Specialist
Mayo Clinic Arizona
With the advent and popularity in peripherally inserted central catheter (PICC) use, reflected in clinical benefits, a growing body of evidence suggested they may also have significant consequences. PICC migration from the optimal position due to unsatisfactory securement may be avoided if stabilization was optimal. Novel securement devices have shown effectiveness; however, each device has had its challenges. There is a recognized need to recommend a securement method that is cost-effective yet provides securement and stabilization as defined. The intention of this quantitative, causal-comparative, descriptive design was to describe the underpinning ideologies involved needed to evaluate the relationship existed between tissue adhesive applied at the PICC insertion site and the migration of the catheter.
The study demonstrated a PICC migration rate reduction from 19.35% to 0% with continued use over the next year having a 1.4% migration rate representing a 93% sustained reduction in migration. During the study, an incidental observation was recognized where the intervention group demonstrated no CLABSI’s for 5 consecutive quarters vs the non-intervention group range of 0-5 CLABSI per quarter where the intervention group added SecurePortIV® tissue adhesive and eliminated the use of a chlorhexidine disc and an engineered securement device.
Evaluation of a Novel Medical Adhesive on Exit Site Following Pediatric PICC Insertion
Dayna Holt MSN, RN, CRNI®, CPN, VA-BC™
Vascular Access Nurse Specialist
Rady Children's Hospital - San Diego, CA
ePoster, AVA 2019 Annual Scientific Meeting
The purpose of the evaluation was to evaluate an FDA approved medical tissue adhesive for the impact on insertion site bleeding and unplanned dressing changes following pediatric PICC insertion. The tissue adhesive performed well, was easy to use and well-tolerated by patients. Use of the medical adhesive as a catheter site sealant and securement "device" is very promising and may reduce supply and staffing costs related to the 89% reduction in unplanned dressing changes. In addition, there are several advantages of the decreased post-insertion bleeding. The reduced bleeding allows the dressing to remain intact for 7 days reducing the risk for infection associated with multiple dressing changes. The reduced bleeding has the potential to reduce catheter dislodgements (75% observed reduction) and in turn reduce catheter replacement procedures, complication risks, and the associated costs. Lastly, the reduced bleeding can improve the patient experience with reduced pain/discomfort/stress resulting in increased patient and family satisfaction.
Peripheral Related Intravenous Catheter Efficiency: PRICE
Jennifer Thompson, BSN, RN, EMT-P, VA-BC™
Vascular Access Manager
Texas Health Huguley Hospital Fort Worth South
The insertion of a peripheral intravenous catheter (PIV) is the most common invasive surgical procedure performed world-wide with the highest failure rate. There are many known contributing factors for this high PIV failure rate. Some of which are catheter dislodgement, poor dressing integrity, infection, phlebitis, and mechanical failure. Many hospital systems have adopted the policy of removing PIVs only when clinically indicated but have failed to implement the necessary changes to ensure maximum dwell time. The question remained that if we do our best to mitigate the contributing factors for the PIV failure rate will the PIV dwell time improve? By improving the adherence of the dressing, adding microbial protection at the insertion site, and securing the catheter under the dressing we were able to significantly increase the dwell time of PIVs. Standardizing PIV insertion, care, and maintenance will improve a PIVs dwell time while improving our patient's hospital experience. Not all catheters are created equal, but shouldn't they all be treated equal? It may take time, money, and resources initially but aren't our patients’ vessels worth the PRICE! The evaluation demonstrated a reduced PIV dressing disruption rate from 70% to 18% (a 74% reduction) when tissue adhesive was added to the dressing protocol and a 87% completion of therapy rate was achieved. A cost analysis estimates that the use of Tissue Adhesive will save the hospital $407k in total costs of which $204k are direct material supply costs.
Tissue Adhesive for Vascular Access – A Personal Perspective!
Sara Hale, BSN, RN
Vascular Access Team
Dayton Children's Hospital
SecurePortIV®, the first tissue adhesive approved for vascular access, is one of the newest and most exciting new products designed to improve outcomes for your patients. Dayton Children’s conducted a late 2018 SecurePortIV® Catheter Securement Adhesive trial on NICU and pediatric patients where the trial was targeting reduced PICC catheter migration, reduced PICC insertion site bleeding and oozing and sealing the insertion site to reduce to risk for infection. The trial was successful, and the product was implemented for house wide PICC in March 2019. Since the time of adoption, there have been zero CLABSI’s which is significantly less than the prior occurrence rate of about 1 per month.
Tissue Adhesive for Vascular Access – The Journey to Adoption
Paula Lamagna, BSN, RN, VA-BC™, CPUI
Clinical Nurse Educator, IV Therapy
Boston Children's Hospital
Melissa Stebel, MSN, CNS, CEN, CPEN, VA-BC
Vascular Access Specialist
Rady Children's Hospital San Diego
Rebecca Stevens, BSN, RN, VA-BC™
Vascular Access Nurse/Educator Glens Falls Hospital
Tissue Adhesives for vascular access is one of the newest and most exciting new tools for your vascular access toolbox. Studies have confirmed its effectiveness. In this presentation, three vascular access experts share their first-hand experiences with bringing SecurePortIV® tissue adhesive into their facilities and the positive results they continue to observe.
Case studies are presented by Paul Lamagna (Boston Children’s, MA) where the use of SecurePortIV® adhesive helped to maintain lines in challenging patients through to completion of therapy including one Steven Johnson Syndrome patient where the product was used to overcome challenges associated with skin sloughing as a result of the condition. Melissa Stebel (Rady Children’s, CA) presented data demonstrating an 89% reduction in unplanned PICC dressing changes and a 75% reduction in PICC dislodgements. Rebecca Stevens (Glens Falls Hospital, NY) explained how her team used to IOWA Model to demonstrate a 83% reduction in unscheduled dressing changes from 29% to 5%. Insertion site bleeding was reduced from 40% to 4%, dressing non-adherence was reduced 42% to 8% and since the time of SecurePortIV® tissue adhesive implementation, CLABSI occurrence was reduced to zero in the first 8 months.
Our Future is Now Sealed
Darcy Doellman, MSN, RN, CRNI®, VA-BC™
Cincinnati Children's Hospital
Matt Ostroff, MSN, APN
Vascular Access Coordinator/Lead Clinician
St Joseph’s University Medical Center
A growing body of evidence reveals several purposes and favorable outcomes when tissue adhesives are used with both peripheral and central VADs. This presentation reviews the evidence and shares clinical experience with tissue adhesive used at the VAD insertion site. The KOL presenters share their experiences with tissue adhesive and the interim results of an ongoing randomized controlled clinical trial are presented. The presented data supports prior studies that have demonstrated improved dwell times and a reduction in certain types of PIV catheter failures associated with the use of tissue adhesive.
Ultrasound Guided Peripherally Inserted Central Catheter Insertion with Peel Away Introducer in Neonates
Anna Liang, NP
Vascular Access Provider
UCSF Benioff Children's Hospital Oakland
Pam Koch, RN
UCSF Benioff Children's Hospital Oakland
Carolyn Lund, MS, FAAN
Neonatal Clinical Nurse Specialist
UCSF Benioff Children's Hospital Oakland
This presentation describes how one level-one neonatal intensive care unit (NICU) placing ultrasound guided 1.4 and 1.9 French (Fr) PICC using the peel away introducer technique and the outcomes. The success rate was 92% (36/39) & the median weight was 3.0 (range: 1.1 - 4.6) kg. Repositioning immediately after imaging was common and only 6 (16.7%) did not require adjustment. No line infections occurred and 31 lines (86%) lasted for the intended therapy.
“Catheter adhesive” is discussed as a key component of the PICC insertion and maintenance bundle. UCSF Benioff Children’s Hospital Oakland began using SecurePortIV® Catheter Securement Adhesive in early 2018 shortly after the product received 510k clearance for market release.
Adding the Catheter into Your Bundle
Sarah Capalla, MSN, RN, CCRN-K, CNRN
Director of Patient Care
Loma Linda University Medical Center
Jennifer Kooiman Mohr, MSN, RN-BC
Nursing Education Specialist: Nursing Operations Support Float Pool, SOS, VAT, Medical Surgical Short Stay
University of Wisconsin Hospital (UW Health)
Infection prevention is a key component to vascular access and each of us is challenged to prevent patient harm. At what point should a catheter with protected technology become part of the insertion bundle? This presentation reviews the experience of two large teaching hospitals that implemented a bundle including the Arrowg+ard Blue Advance™ Peripherally Inserted Central Catheter. Both hospitals will share their need and experience with protected technology as part of the bundle.
IV catheter use tissue adhesive (SecurePortIV®) is presented by Sarah Capalla as a key component of the Loma Linda IV catheter insertion and maintenance bundles for all IV catheters. Loma Linda became the first hospital in the US to adopt SecurePortIV® Catheter Securement Adhesive for all catheter types in mid 2018, shortly after the product received 510k clearance for market release.
Translating Vascular Access: An Experience with Veterinary Medicine
Christopher Ensign, MSN, RN, CNL, CRNI®
Clinical Coordinator Vascular Access
Amita Health Hinsdale Hospital
Vascular access is a skill that is not only important to the human side of medicine, but to the animal side as well. Interactions between veterinarians and physicians have deepened knowledge about cardiology such as Takotsubo syndrome in humans and capture myopathy in animals. Vascular Access collaboration between disciplines is a new forefront that can yield great benefit to both sides and embrace the One Health and Zoobiquity movements. The discussed use of “Line tissue adhesive” is the first known use of SecurePortIV® Catheter Securement Adhesive to secure and seal an IV catheter on a pangolin or any other zoo animal.