Abstract
Proper fixation of central venous catheters (CVCs) is an integral part of safety to avoid dislodgement and malfunction. However, the effectiveness of different CVC securement sutures is unknown. Analysis of maximum dislodgement forces for CVCs from three different manufacturers using four different suture techniques in an in vitro tensile loading experiment: 1. "clamp only", 2. "clamp and compression suture", 3. "finger trap" and 4. "complete", i.e., "clamp + compression suture + finger trap". Twenty-five tests were performed for each of the three CVC models and four securement suture techniques (n = 300 test runs). The primary cause of catheter dislodgement was sliding through the clamp in techniques 1 and 2. In contrast, rupture of the suture was the predominant cause for dislodgement in techniques 2 and 3. Median (IQR 25-75%) dislodgement forces were 26.0 (16.6) N in technique 1, 26.5 (18.8) N in technique 2, 76.7 (18.7) N in technique 3, and 84.8 (11.8) N in technique 4. Post-hoc analysis demonstrated significant differences (P < .001) between all pairwise combinations of techniques except technique 1 vs. 2 (P = .98). "Finger trap" fixation at the segmentation site considerably increases forces required for dislodgement compared to clamp-based approaches.
Highlights
Central venous catheterization is a common procedure to provide safe administration of vasoactive agents, fluid resuscitation, hemodialysis, and hemodynamic monitoring [1,2]
The primary aim of this study was to compare the stability of four different suture techniques, each applied to central venous catheters (CVCs) models from three different manufacturers
Catheter dislodgement is a frequent complication after central venous catheterization [12]
Summary
Central venous catheterization is a common procedure to provide safe administration of vasoactive agents, fluid resuscitation, hemodialysis, and hemodynamic monitoring [1,2]. Recommendations have been published regarding CVC placement [3,4,5]. The effectiveness of different CVC fixation sutures is unknown [6]. Sutureless CVC fixation devices have recently become increasingly popular because of their less invasive nature and potentially greater patient comfort [7,8,9,10,11]. CVC fixation with sutures is still widely used and mandatory in high-risk patients (i.e., burns). Due to individual experiences of the authors CVC dislodgements are rare when utilizing a “finger trap”-based fixation and more common when relying on the “clamp only” but until now, experimental data that support these observations are not available
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