Friday, 9 September 2016

Skin Glue to Secure ED Inserted Peripheral IV’s

Believe it or not, skin glue has been studied for securing central venous catheters, epidurals and arterial lines. I must have missed the memo...

Can we glue peripheral IV’s in the ED?

This randomized controlled trial out of Caboolture Hospital in Queensland tried to answer the question. They enrolled 360 adult patients in the ED who were thought to require admission to hospital. They excluded patients who were agitated or had a high likelihood of removing their IV’s.

A study nurse took down the existing IV dressing and patients were randomized to glue vs. standard care. The glue group got 1 drop of cyanoacrylate (Histoacryl) at the IV insertion site and 1 drop under the catheter hub.

The primary outcome was IV failure at 48 hours defined as dislodgement, occlusion, infection, or phlebitis.

Results? The glue group failed 17% of the time and standard care 27%. Thus an absolute difference of 10% or number needed to treat of 10. Not too bad.

Remember that this study enrolled all comers. It did not focus on the high risk IV’s and excluded agitated patients which probably would have demonstrated a greater treatment effect.

Of course no study is perfect and there were some limitations. In addition, small studies can’t make great claims about safety. Nevertheless, I imagine it should be fine.

I would encourage people to view the associated video referenced by the manuscript. It shows the gluing technique and demonstrates the strength of bond very soon after. To me, this seems to have face validity. Who needs evidence... they could have just shown me the video!

There are some questions that remain.

Is it cost effective? It may not be but if used indiscriminately. But perhaps a targeted approach would make it more so.

Can we use other forms of cyanoacrylate such as Dermabond? The authors used Hisoacryl which has a pretty clever dropper so other applicators may get different results.

What should we take away for now?

I think a common sense approach is warranted. Although not specifically studied, I would imagine that we could identify “at risk” IV’s and use glue when thought needed. We would need to ensure that downstream health care providers are aware the IV has been secured with glue and educate inpatient teams about removal. Once again, there is a handy glue removal video.

I would imagine we will get more real world ED experience and studies over time.

Is there nothing glue can’t do?  


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