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revisiting securement devices for PICCs

I just read all entries in the forum related to securement devices.  Our team still sutures, but we are considering changing to a securement device.  We've held off on changing for two reasons:  1) our PICCs stay secure!  We have essentially NO migration and with suture under the dressing and a StatLock outside the dressing, even a good tug on the line doesn't pull it out.  We don't usually have any problems with the suture sites.  2) the nurses on the units change the dressings...and we fear for our lines if they're not sutured in.

Do your PICC teams do all the dressing changes, if not, do the other nurses have trouble changing the securement device?

 I've been reading the literature...including CDC which mentions, but only mildly recommends using securement devices;  OSHA, which is concerned about needle sticks; Yamamoto et al who has done one study; and Tim Royer whose study was mainly about securement devices for PIV's.  The main author who is quoted re securement devices is Dr. Steve Bierman who as a consultant for BARD and associated with Venetec International who manufacturers StatLock, could have a conflict of interest.  Most of the other literature just quotes Yamamoto's study.

Dr. Maki(who I really respect)also supports use of securement devices, but I find it interesting that one of his reasons for disliking suture securement is that the catheter can "piston" in and out of the skin...which leads to my biggest concern with StatLock(or other devices):

If the original device could stay in place, I'd like it, but how can one keep the catheter from "pistoning" during the device change?  I'd think pistoning could be kept to a minimum, but not totally eliminated, if our PICC nurses did the removing and re-applying, but I'm very concerned about it if our staff nurses are doing the changing.  Please let me know your experiences with these devices...I'm totally conflicted

I share your concerns about
I share your concerns about having all nurses doing dressing changes, but those concerns are not based on the type of stabilization method. I do not think that all nurses should be allowed to change these dressing regardless of what method of stabilization that is being used. I have never liked sutures and we stopped using them in the early days of our PICC placement because they became reddened within a few days. Now we know why - sutures grow biofilm also. This serves as a great source of organisms to infect a PICC. Lynn

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

rivka livni
We started with sutures but
We started with sutures but changed to StatLock within a year. The learning curve of changing the secument device is huge and time consuming, but within 10 dressing changes nurses said they felt very comfortable. The patients who had sutures before told me that the securement devices felt more comfortable since it did not pull on their skin during dressing change. Now I suture only patients that are known to be alergic to the dressings and need only a gauze cover.
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