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PICC securement devices

Is anyone using a securement device for PICCs other than Statlock?  We are looking at the Bone by Nexus Medical;  Grip-Lok by Baxter; WingGuard by Centurion as well as the Statlock. 

I know this is somewhat of a philosophical discussion, but I'm hoping someone has some answers for us.  Our PICC department is one of the few(I hear)who still sutures.  Our original PICC nurse was trained at M.D. Anderson in Houston, TX...where they still suture their PICCs.  A nurse in the I.V. dept there told me they had done an in-house study that showed no increase in infection and fewer PICCs pulled out with suturing.  So...we learned to suture from the very beginning.  We are good at it and have very few patient complaints and very few inflamed sutures.  We also have few infections.  The PICC nurses don't do the dressing changes here.  They are done by the staff nurses.

  Our new infection control person and our new clinical services nurse quote INS standards and now say we must use a securement device and stop suturing.  Our biggest concern is that the infection rate will go up and more PICCs become malpositioned or pulled out due the manipulation of the line during dressing changes.

    I've done a lot of research in the literature on this subject.  The only actual study I see comparing suture to securement devices is the one done by Yamamoto et al. reported in the 2002 ; 13:77-81 Journal of Vascular Interventional Radiology....funded by the way by Venetec who makes Statlock.

  Other articles I read..including the one in Journal of Infusion Nursing quote that one article.  The CDC MMWR of 2002 states that no recommendation can be made regarding sutureless securement devices...the Yamamoto study is "underpowered" and basically, more study needs to be done.

  I'd like to know why INS standards prefers sutureless securement devices rather than having them as an option to suturing.  This is so huge and is going to effect our practice here so much.  It seems to me that the Statlock "people" are the ones pushing securement devices.  I can really understand why PICC nurses who used to use steri strips or sterile tape for securement prefer the device. 

  I've asked if we could do an in-house study, but the powers that be seem pretty set that we are definitely going to securement devices.  Do none of you have problems with "pistoning" on the catheter during statlock changes? 

Daphne Broadhurst
Tanya, our facility
Tanya, our facility converted from steristrips to Statlock for PICCs about a year ago, after the anaesthetists brought these devices in for the jugular & subclavian lines. There is a bit of a learning curve to these devices & despite inservices by the rep & our educators we are still seeing more catheter dislodgement than we ought to (although notably less than with the steristrips). There is a fair bit of manipulation required with this securement device & I suspect that the dislodgement may be in many cases due to user error. I should clarify that it is all clinical nurses at the bedside who are responsible for PICC care- I'm sure the #'s would be lower if we had a team dedicated to PICC care.

Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada

lynncrni
I was on the INS standards

I was on the INS standards committee for this revision. We felt that the data for using a manufactured catheter stabilization device was powerful enough to make the statements that we did. I would agree that more outcome data is needed for all types of central venous catheters and that the majority of the data is on PIVs. However, I would disagree that these studies were funded by the manufacturer. Most start-up companies such as Venetec do not have the resources to spend lots of dollars on clinical research. At best, they may provide some product for the clinical study but this is a very small fraction of the actual cost of doing a study. I have no knowledge of what Venete's involvement was with the Yamamoto study but I have my doubts that they were influential in the outcomes published. In 2005 Venetec was acquired by Bard Medical. 

There are 2 other compelling reasons to stop using sutures for all CVCs and these were strongly considered in the INS committee's decision. One is the position paper from OSHA calling for the elimination of sutures for all medical catheters due to the risk of needlestick injury. The second is the fact that sutures are known to grow biofilm, thus increasing the risk of catheter-related infections.

Just like all other product changes, there will be a learning curve but I believe it is very correct to make this change. Lynn 

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Cindy Schrum
Cindy Schrum RN CRNI No

Cindy Schrum RN CRNI

No problems with pistoning.  We had a much cleaner site because the entire catheter can be cleaned.  No blood goobers under the suture wings.  Patients were very happy with them.  Stat-lock isn't the only securement device out there.  Centurion has a very nice dressing I saw at AVA.  When properly applied, it secures the catheter better than the stat-lock and removes in one piece.  It was great!  Look around at all options!

Cindy Schrum RN CRNI

lynncrni
Cindy, can you be more
Cindy, can you be more specific about this product? Just curious. As you know dressings were removed from the list of catheter stabilization devices in the 2006 standards. Thanks, Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

CGC-PICC
Picc securement

Our team continues to suture despite the additional risks to the health care worker.  We have been addressing the minimal amount of evidence based practice studies on this issue.. Our current BSI rate for 2009 was 0.03%...fantasic, however the the unspoken risk has affected 4 out of 5 team members.  Only one has converted to hep C but that risk is much to high.  Families, lifestyles and continued work in the health field has been altered forever.  We would love to stop placing 6 unnecessary needle punctures in our patients and reduce our risk for injury.

We also need  studies compairing BSI, injury and dislodged devices.

 

Cindy Clinkenbeared RN, VA-BC

Beth George
We use the SorbaView Shield

We use the SorbaView Shield securement dressing as well.   We like it because it is a one step application, less manipulation of the PICC and holds very well. 

 

 

Beth George, CRNI, VA-BC
Nurse Clinician/Vascular Access
UAB Medicine
Birmingham, AL

PICCNurse
PICC Securement Devices

TNaumna - After looking at these dates, I hope I’m not too late to post to your question.

Centurion’s SORBAVIEW SHIELD is a stabilization “system” built into the SorbaView Dressing. Using this dialog in their marketing materials, one could say its two products in one.

I know of a homecare pharmacy using this product with success. The reality is that not all practice settings can afford the cost of adding stabilization devices on top of a dressing change kits. Homecare & LTC facilities have to be creative. This product offers a reliable, safe, cost efficient option.

I teach nurses in homecare and LTC. I ask them to consider removing sutures and am forced to instruct then how to secure catheters using the sterile tape/steri-strips in the dressing change kit! YES, the old fashion way!!! We see too many irritations at the suture site after the patient has left the hospital. I too have sutured because the hospital I worked in had MDs who insisted on the use of sutures. They were only concerned with the line not falling out. They never saw the site afterward. Pustules near an insertion site at not good. And as Lynn mentioned, biofilm grows on sutures. One last thing to consider, lines can be pulled out, dislodged, or whatever by confused patients regardless if they were sutured, STATLocked, or glued in place.  

Please let us know what your facility decides. I’m interested in what others are doing. Thanks!

D. Melton

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