Securing peripheral intravenous catheters with skin glue in the emergency department leads to lower failure rates, according to a new randomized trial.
“We put in IV lines frequently, usually unaware of how unreliable they are and the impact this can have on patients,” said lead author Dr. Simon Bugden from Caboolture Hospital in Queensland, Australia.
“It’s an area where we can easily improve the quality of our service,” he told Reuters Health by email. “Using skin glue with IV lines, selectively for patients who are admitted to hospital, will improve the quality of their care and experience. If you are placing an IV line in a patient that is diaphoretic or moving around a lot, it is safe to add some skin glue to help maintain its patency and longevity.”
Peripheral IV catheters have a failure of 33 percent to 69 percent, Dr. Bugden and colleagues note in Annals of Emergency Medicine.
Medical-grade skin glue has been studied previously as a novel method for fixation; according to the new paper it is associated with reduction in failure rate and may have antimicrobial properties.
To learn more, the researchers conducted a non-blinded, two-arm, randomized trial comparing standard peripheral IV catheter securement with standard securement plus cyanoacrylate glue (Histoacryl; B Braun, Melsungen, Germany) at the skin insertion site and under the catheter hub.
The team analyzed data from 179 participants in the skin-glue group and 190 in standard-care group. The former had a 48-hour failure rate of 17 percent, versus 27 percent in the standard care group (p=0.02); the skin-glue group also had less failure secondary to dislodgement (7 percent versus 14 percent), though this difference was only borderline significant.
No participants developed infections and there were no differences between the groups for failure secondary to occlusion or phlebitis.
“IV lines are so common,” Dr. Bugden said. “Yet they fail at an appalling rate, causing more pain and cost when they need to be re-inserted. Would you buy something from the shopping mall, knowing there was a one in three chance it would break in the next two days? Medicine needs to become more reliable, because the unreliability causes more pain and costs. This study has been part of the way we are trying to improve the care and health of our community, trying to make a meaningful improvement for our patients,” Dr. Bugden added.
The study was funded by the Queensland Emergency Medicine Research Foundation and the School of Medicine at the University of Queensland.