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 tosecure a peripheral intravenous (IV) catheter, and youll hear only slightvariations on a theme. While techniques differ some between institutions, standardpractice involves using adhesive tape and a sterile occlusive dressing. Thisgeneral method is so widely used that any outsider would assume it works quitewell.

Discerning nurses know otherwise. Tape securement is fraughtwith problems and dangers, for patients and clinicians. Tapes inadequaciescan lead to complications such as phlebitis, infiltration, migration, anddislodgment that cause patients discomfort and harm.1 Tape is also associatedwith high IV restart rates that expose healthcare workers (HCWs) tosharps-injury risk and possible infection with life-threatening illnesses, suchas HIV or hepatitis B or C.2 In addition, these frequent IV restarts consumetime that nurses really dont have due to their patient care and paperworkresponsibilities. Unscheduled IV restarts increase use of costly materials,especially when expensive safety catheters are used.

Although implementation isnt 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 adimension, providing longer dwell times, improved outcomes, and better use ofnurses time.

The Occupational Health and Safety Administration (OSHA) hasalso recognized the value of securement devices. Its new document, FactSheet: Securing Medical Catheters, describes the sharps injury risk that tapesecurement poses to HCWs, and notes that adhesive anchors another term for catheter securement devices canreduce or eliminate injury risk.3 The fact sheet concludes that, used in placeof tape, adhesive anchors create improved catheter stability. That in turndecreases catheter migration, dislodgment, and the necessity of reinsertion with its associated needlestick risk.4

Our Experience with Catheter-Securement Devices

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

The securement device consists of a precision-molded retainerthat has been engineered to provide a tight grip around the catheter hub. The IV Ultra model snap-fits over the push-tab of the catheterhub to secure it. The retainer is integrated onto an adhesive anchoring pad. In addition to holding catheters better than tape does, theanchors superior securement prevents micro-movements and pistoning thatOSHA 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 ayear after switching from a protocol requiring IV restarts after 72 hours, toone requiring restarts after 96 hours. Under the old protocol, only 8 percent to15 percent of our IV placements were even lasting the full 72 hours. Once the96-hour regimen was put in place, the situation deteriorated to the point thatnearly every catheter needed to be restarted before 96 hours.

Our administration had hoped the new 96-hour protocol wouldenable us to reduce nursing payroll. Instead, personnel costs and overtime payrose and morale plunged. Even with our experienced IV team, nurses wereunder 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 ourrespiratory patients, whose peripheral IVs normally have the highest failurerate. The results astounded us.

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

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

The precision-engineered securement device also proved fastand easy to apply. You can think of the application method by remembering thefour Ps: prep, press, peel, and place. As with any device, of course, youlearn some tricks when using it that are helpful supplements to the instructionsthe company provides. Heres the method weve found that works the best forStatLock IV Ultra:

Prep: After youve done your IVstick, connected the tubing, and disposed of the stylette, use alcohol todegrease the skin on both sides of the catheter hub. Be sure to cover the fullarea where the pads will go, so theyll adhere properly. If clinicallyindicated, 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 thepush-tab points upwards. Its very important not to squeeze the retainerclosed; press the retainer over the catheter hub so it captures the push-tab.

Peel: Pinch the devices retainerso that it fits tightly around the catheter hub, and then peel away the paperbacking on the adhesive pads, one side at a time.

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

The removal process is even easier. Think of the two Ds:dissolve and disengage.

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

Disengage: Disengage the catheterfrom the devices retainer. It will lift up easily if you do this as thedirections say. Never pull up on the pad with force, because that will causediscomfort to the patient and skin tears in patients with fragile skin.

Bonnie Trottier is manager of the IV therapy department atHolmes Regional Medical Center in Melbourne, Fla.