Optimal Dressing, Securement of Peripheral IV Catheters Not Yet Found
Until an optimal dressing and securement strategy is confirmed, cost will continue to be the main factor that determines product choice in peripheral IV catheters.
Current peripheral intravenous catheter (PIVC) dressing and securement strategies, including tissue adhesive with polyurethane dressing, bordered polyurethane dressing, and using a securement device with polyurethane dressing, are not superior to standard low-cost polyurethane dressing with regard to the risk for PIVC failure, according to study results published in The Lancet.
Patients admitted to 2 Australian hospitals who required a PIVC for >24 hours were randomly assigned to either tissue adhesive with polyurethane (n=446), bordered polyurethane (n=454), a securement device with polyurethane (n=453), or polyurethane (n=454). All-cause PIVC failure comprised the primary outcome, which was a composite of occlusion, infection (primary bloodstream infection or local infection), phlebitis, and complete dislodgement. The treatments were administered in an unblinded fashion; however, infections were adjudicated by a blinded physician.
A total of 163 (38%) patients who received tissue adhesive with polyurethane experienced PIVC failure (absolute risk difference, –4.5%; 95% CI –11.1 to 2.1%; P =.19). PIVC failure was also observed in 169 (40%) patients in the group with bordered polyurethane (absolute risk difference, −2.7%; 95% CI, –9.3 to 3.9%; P =.44), 176 (41%) patients in the securement device with polyurethane arm (absolute risk difference –1.2%; 95% CI, –7.9% to 5.4%; P =.73), and 180 (43%) patients in the polyurethane group.
Skin adverse events were also observed in the tissue adhesive with polyurethane group (n=17), bordered polyurethane group (n=2), securement device with polyurethane group (n=8), and polyurethane (n=7) group. There was no significant difference between the groups with regard to total costs.
A limitation of the cost analysis was the lack of available data on costs incurred after patient discharge.
Until an optimal method for dressing and securement of PIVCs is found, the study investigators suggested that “cost should be the main consideration with regard to product choice.”
Disclosures: Dr Rickard's employer has received on her behalf research and unrestricted educational grants from 3M, Adhezion, Bard, Baxter, B Braun, BD Medical, Centurion Medical Products, Entrotech, and Medtronic, as well as consultancy fees from 3M, Bard, B Braun, BD Medical, and ResQDevices. Dr Larsen's employer has received on her behalf consultancy fees from 3M. Dr Marsh's employer has received on her behalf research and unrestricted educational grants from 3M, BD Medical, Centurion, and Entrotech.
Rickard CM, Marsh N, Webster J, et al. Dressings and securements for the prevention of peripheral intravenous catheter failure in adults (SAVE): a pragmatic, randomised controlled, superiority trial [published online July 26, 2018]. Lancet. doi:10.1016/S0140-6736(18)31380-1