Devices and dressings to secure peripheral venous catheters to prevent complications

Nicole Marsh, Joan Webster, Gabor Mihala, Claire M Rickard, Nicole Marsh, Joan Webster, Gabor Mihala, Claire M Rickard

Abstract

Background: A peripheral venous catheter (PVC) is typically used for short-term delivery of intravascular fluids and medications. It is an essential element of modern medicine and the most frequent invasive procedure performed in hospitals. However, PVCs often fail before intravenous treatment is completed: this can occur because the device is not adequately attached to the skin, allowing the PVC to fall out, leading to complications such as phlebitis (irritation or inflammation to the vein wall), infiltration (fluid leaking into surrounding tissues) or occlusion (blockage). An inadequately secured PVC also increases the risk of catheter-related bloodstream infection (CRBSI), as the pistoning action (moving back and forth in the vein) of the catheter can allow migration of organisms along the catheter and into the bloodstream. Despite the many dressings and securement devices available, the impact of different securement techniques for increasing PVC dwell time is still unclear; there is a need to provide guidance for clinicians by reviewing current studies systematically.

Objectives: To assess the effects of PVC dressings and securement devices on the incidence of PVC failure.

Search methods: We searched the following electronic databases to identify reports of relevant randomised controlled trials (RCTs): the Cochrane Wounds Group Register (searched 08 April 2015): The Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), Ovid MEDLINE (1946 to March 7 2015); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, March 7 2015); Ovid EMBASE (1974 to March 7 2015); and EBSCO CINAHL (1982 to March 8 2015).

Selection criteria: RCTs or cluster RCTs comparing different dressings or securement devices for the stabilisation of PVCs. Cross-over trials were ineligible for inclusion, unless data for the first treatment period could be obtained.

Data collection and analysis: Two review authors independently selected studies, assessed trial quality and extracted data. We contacted study authors for missing information. We used standard methodological procedures expected by Cochrane.

Main results: We included six RCTs (1539 participants) in this review. Trial sizes ranged from 50 to 703 participants. These six trials made four comparisons, namely: transparent dressings versus gauze; bordered transparent dressings versus a securement device; bordered transparent dressings versus tape; and transparent dressing versus sticking plaster. There is very low quality evidence of fewer catheter dislodgements or accidental removals with transparent dressings compared with gauze (two studies, 278 participants, RR 0.40; 95% CI 0.17 to 0.92, P = 0.03%). The relative effects of transparent dressings and gauze on phlebitis (RR 0.89; 95% CI 0.47 to 1.68) and infiltration (RR 0.80; 95% CI 0.48 to 1.33) are unclear. The relative effects on PVC failure of a bordered transparent dressing and a securement device have been assessed in only one small study and these were unclear. There was very low quality evidence from the same single study of less frequent dislodgement or accidental catheter removal with bordered transparent dressings than securement devices (RR 0.14, 95% CI 0.03 to 0.63) but more phlebitis with bordered dressings (RR 8.11, 95% CI 1.03 to 64.02) (very low quality evidence). A small single study compared bordered transparent dressings with tape and found very low quality evidence of more PVC failure with the bordered dressing (RR 1.84, 95% CI 1.08 to 3.11) but the relative effects on dislodgement were not clear (very low quality evidence). The relative effects of transparent dressings and a sticking plaster have only been compared in one small study and are unclear. More high quality RCTs are required to determine the relative effects of alternative PVC dressings and securement devices.

Authors' conclusions: It is not clear if any one dressing or securement device is better than any other in securing peripheral venous catheters. There is a need for further, independent high quality trials to evaluate the many traditional as well as the newer, high use products. Given the large cost differences between some different dressings and securement devices, future trials should include a robust cost-effectiveness analysis.

Conflict of interest statement

There was no manufacturer funding or involvement in the conception or undertaking of this review. Nicole Marsh and Claire Rickard's departments have received funding to provide educational lectures, unrestricted research grants‐in‐aid, an unrestricted PhD scholarship for Claire Rickard's student, and contract research from BD Medical Australia Ltd (a company that makes peripheral intravenous devices but not dressings). Nicole Marsh and Claire Rickard's departments have received an unrestricted research grant‐in‐aid from Centurion (a maker of PVC dressings none of which are included in this review). Claire Rickard has received funding to her department to provide independent educational lectures for: 3M (a company that makes PVC dressings some of which are included in this review); and for Carefusion (companies that distribute PVC dressings, none of which are included in this review).

Gabor Mihala and Joan Webster: nothing to declare

Figures

1
1
Flow diagram of included and excluded studies
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
1.1. Analysis
1.1. Analysis
Comparison 1 Transparent dressing versus gauze, Outcome 1 Dislodgement/accidental removal.
1.2. Analysis
1.2. Analysis
Comparison 1 Transparent dressing versus gauze, Outcome 2 Phlebitis.
1.3. Analysis
1.3. Analysis
Comparison 1 Transparent dressing versus gauze, Outcome 3 Infliltration.
2.1. Analysis
2.1. Analysis
Comparison 2 Bordered transparent dressing versus securement device, Outcome 1 PVC failure.
2.2. Analysis
2.2. Analysis
Comparison 2 Bordered transparent dressing versus securement device, Outcome 2 Dislodgement/accidental removal.
2.3. Analysis
2.3. Analysis
Comparison 2 Bordered transparent dressing versus securement device, Outcome 3 Phlebitis.
2.4. Analysis
2.4. Analysis
Comparison 2 Bordered transparent dressing versus securement device, Outcome 4 Infiltration.
3.1. Analysis
3.1. Analysis
Comparison 3 Bordered transparent dressing versus tape, Outcome 1 PVC failure.
3.2. Analysis
3.2. Analysis
Comparison 3 Bordered transparent dressing versus tape, Outcome 2 Dislodgement/accidental removal.
4.1. Analysis
4.1. Analysis
Comparison 4 Transparent dressing versus sticking plaster, Outcome 1 Dislodgement/accidental removal.
4.2. Analysis
4.2. Analysis
Comparison 4 Transparent dressing versus sticking plaster, Outcome 2 Phlebitis.
4.3. Analysis
4.3. Analysis
Comparison 4 Transparent dressing versus sticking plaster, Outcome 3 Infliltration.
4.4. Analysis
4.4. Analysis
Comparison 4 Transparent dressing versus sticking plaster, Outcome 4 Occlusion.

References

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