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Peripheral Vascular Access Device Stabilization

In the past transparent membrane dressings and tape were considered acceptable methods of securing a peripheral I.V. catheter after insertion. New data shows that peripheral catheter failure rates are high, in the range of 35-50%, and transparent film dressings and tape are no longer encouraged for use as securement.1  New Infusion Nurse Society standards state we should consider the use of Engineered Stabilization Devices (ESDs). Peripheral I.V. catheter failure due to poor securement are costly to our healthcare system, costly to nursing time and most importantly costly to the patient. Studies have found that the use of ESDs do add cost and complexity to IV care, but in the long run clinical and cost benefits are reported from stabilization and securement.

All vascular access devices should be stabilized to prevent VAD complications such as device movement (or pistoning in the vessel) that may cause phlebitis, or cause the introduction of microorganisms into the vessel, infiltration, unintentional catheter removal and/or dislodgement causing loss of venous access. The methods used to stabilize a device should not interfere with the assessment or monitoring of the site and should not impede vascular circulation or delivery of the prescribed therapy. It is preferable to consider the use of an engineered stabilization device (ESD) to stabilize and secure VADs. The decision about the most appropriate methods for VAD stabilization and securement involve assessment of the patient. Consider the patient's age, skin turgor and integrity, previous adhesive skin injury, and/or drainage at the insertion site. The use of transparent membrane dressing and tape is not adequate for peripheral cannula securement.

For peripheral catheter securement, consider several options:
• Use of a peripheral catheter with an engineered stabilization device on the hub with a bordered polyurethane securement dressing
• Use of a standard round hub peripheral catheter in combination with an adhesive ESD
• Cyanoacrylate tissue adhesive, a medical sterile super-glue, and a standard transparent dressing

Never use rolled bandages with or without elastic properties to secure any type of VAD because they do not adequately secure the device, obscure visualization of the site, may impede detection of complications and impair circulation or the flow of the infusion.  Some skin disorders may contradict the use of any type of medical adhesive, such as pediatric epidermolysis bullosa, or toxic epidermal necrolysis. In these types of situations a tubular gauze mesh could be considered.
Assess the integrity of the ESD with each dressing change and change the ESD according to the manufacturer’s recommendations. Remove ESDs during the dressing change to allow antiseptic skin cleansing to occur and apply a new ESD.

Be aware of medical adhesive related skin injury (MARSI) associated with the use of adhesive type ESDs. You may refer to MARSI in the complications section of this course for more information.

You may view our Guide to Peripheral Catheter Stabilization Devices, by clicking on the link.  You will find all of our Resources and printable posters on the website under Resource Library.

Resources
1. Accepted but Unacceptable: Peripheral IV Catheter Failure, Journal of Infusion Nursing, Volume 30 Number 3 May/June 2015
Robert E. Helm , MD Jeffrey D. Klausner , MD, MPH John D. Klemperer , MD Lori M. Flint , BSN, RN, CCRN Emily Huang , BA
2.  Infusion Therapy Standards of Practice, Journal of Infusion Nursing, January February 2016- Volume 39, Number 1S

Visit our Infusion Campus, a virtual online campus with continuing education courses for nurses in IV therapy and infusion education. 

Don’t forget to also stop by our Resource Library where you will find tons of infusion related printable posters, to remind you of the latest infusion practices and guidelines.

Pedagogy blog written by Capra Dalton, RN,CEO. 

Capra has more than 28 years of experience in infusion therapy and the instruction of licensed nurses in infusion therapy continuing education. Her experience comes from multiple infusion settings: acute care, ambulatory infusion centers, home infusion, long term care continuing education provider, and long term care pharmacy quality assurance consultant.  
Posted: 8/30/2016 5:05:17 PM
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