Infection Control Today: Case Study

How to Secure a Peripheral IV Catheter
By Bonnie Trottier, RN, CRNI

Ask most nurses what is the best way to secure a peripheral intravenous (IV) catheter, and you’ll hear only slight variations on a theme. While techniques differ some between institutions, standard practice involves using adhesive tape and a sterile occlusive dressing. This general method is so widely used that any outsider would assume it works quite well.

Discerning nurses know otherwise. Tape securement is fraught with problems and dangers, for patients and clinicians. Tape’s inadequacies can lead to complications such as phlebitis, infiltration, migration, and dislodgment that cause patients discomfort and harm.¹ Tape is also associated with high IV restart rates that expose healthcare workers (HCWs) to sharps-injury risk and possible infection with life-threatening illnesses, such as HIV or hepatitis B or C.² In addition, these frequent IV restarts consume time that nurses really don’t have due to their patient care and paperwork responsibilities. Unscheduled IV restarts increase use of costly materials, especially when expensive safety catheters are used.

Although implementation isn’t as widespread as it should be, effective catheter-securement devices have been available for several years. These well-engineered devices far outperform tape in every a dimension, providing longer dwell times, improved outcomes, and better use of nurse’s time.

The Occupational Health and Safety Administration (OSHA) has also recognized the value of securement devices. Its new document, “Fact Sheet: Securing Medical Catheters,” describes the sharps injury risk that tape securement poses to HCWs, and notes that “adhesive anchors” — another term for catheter securement devices — can reduce or eliminate injury risk.³ The fact sheet concludes that, used in place of tape, adhesive anchors create “improved catheter stability.” That in turn decreases “catheter migration, dislodgment, and the necessity of reinsertion with its associated needlestick risk.”⁴

My employer, Health-First, a three-hospital healthcare system based in Rockledge, Fla., has been using the StatLock IV Ultra catheter securement device to secure peripheral IV catheters since late 2003. We adopted the device after it proved itself in a rigorous clinical trial that compared StatLock to tape and another kind of securement device. We also use a smaller version, the StatLock IV Ultra Pediatric, for pediatric patients.

The securement device consists of a precision-molded retainer that has been engineered to provide a tight grip around the catheter hub. The IV Ultra model snap-fits over the push-tab of the catheter hub to secure it. The retainer is integrated onto an adhesive anchoring pad. In addition to holding catheters better than tape does, the anchor’s superior securement prevents micro-movements and “pistoning” that OSHA and others implicate as the cause of complications that lead to unplanned restarts.^5-7

We made the decision to trial the securement device about a year after switching from a protocol requiring IV restarts after 72 hours, to one requiring restarts after 96 hours. Under the old protocol, only 8 percent to 15 percent of our IV placements were even lasting the full 72 hours. Once the 96-hour regimen was put in place, the situation deteriorated to the point that nearly every catheter needed to be restarted before 96 hours.

Our administration had hoped the new 96-hour protocol would enable us to reduce nursing payroll. Instead, personnel costs and overtime pay rose — and morale plunged. Even with our experienced IV team, nurses were under constant pressure to keep up with the restart load. They were having a hard time fitting in routine patient care, paperwork, and even meal breaks. After studying the research, we hoped that the securement device would reverse this problem.^8-12

We trialed the device at two of our hospitals, and on our respiratory patients, whose peripheral IVs normally have the highest failure rate. The results astounded us.

In the securement device phase of the trial, more than 50 percent of our IVs stayed in place through the fourth day. Recall that with taping, as few as 8 percent of our placements were making it through the third day. The overall unplanned restart rate for the device was only 21 percent, a 70 percent improvement over the tape phase of the trial.

One recently published study reported similar results. In this research, involving an IV team at a large VA healthcare system, the device reduced unscheduled restarts by 63 percent, as well as total complications by 42 percent.¹³

The precision-engineered securement device also proved fast and easy to apply. You can think of the application method by remembering the four P’s: prep, press, peel, and place. As with any device, of course, you learn some tricks when using it that are helpful supplements to the instructions the company provides. Here’s the method we’ve found that works the best for StatLock IV Ultra:

Prep: After you’ve done your IV stick, connected the tubing, and disposed of the stylette, use alcohol to degrease the skin on both sides of the catheter hub. Be sure to cover the full area where the pads will go, so they’ll adhere properly. If clinically indicated, follow-up with skin prep to enhance skin protection and adherence. Wait 10 to 15 seconds, or until site is “paper dry.”

Press: Align the catheter so the push-tab points upwards. It’s very important not to squeeze the retainer closed; press the retainer over the catheter hub so it captures the push-tab.

Peel: Pinch the device’s retainer so that it fits tightly around the catheter hub, and then peel away the paper backing on the adhesive pads, one side at a time.

Place: Place each pad on the patient’s skin after the backing is peeled. As an option, you can apply a sterile adhesive strip over the extension set tubing to form a J-loop, as we do; indeed, a sterile strip comes with the device for that purpose. If your institution’s policy requires it, you can then add a sterile occlusive dressing to the insertion site, which is something we do at Health-First.

The removal process is even easier. Think of the two D’s: dissolve and disengage.

Dissolve: The adhesive dissolves in alcohol, so use a generous amount to loosen the edge of the pad.

Disengage: Disengage the catheter from the device’s retainer. It will lift up easily if you do this as the directions say. Never pull up on the pad with force, because that will cause discomfort to the patient and skin tears in patients with fragile skin.