Abstract
BackgroundExtracorporeal membrane oxygenation (ECMO), an invasive mechanical therapy, provides cardio-respiratory support to critically ill patients when maximal conventional support has failed. ECMO is delivered via large-bore cannulae which must be effectively secured to avoid complications including cannula migration, dislodgement and accidental decannulation. Growing evidence suggests tissue adhesive (TA) may be a practical and safe method to secure vascular access devices, but little evidence exists pertaining to securement of ECMO cannulae. The aim of this study was to determine the safety and efficacy of two TA formulations (2-octyl cyanoacrylate and n-butyl-2-octyl cyanoacrylate) for use in peripherally inserted ECMO cannula securement, and compare TA securement to ‘standard’ securement methods.MethodsThis in vitro project assessed: (1) the tensile strength and flexibility of TA formulations compared to ‘standard’ ECMO cannula securement using a porcine skin model, and (2) the chemical resistance of the polyurethane ECMO cannulae to TA. An Instron 5567 Universal Testing System was used for strength testing in both experiments.ResultsSecurement with sutures and n-butyl-2-octyl cyanoacrylate both significantly increased the force required to dislodge the cannula compared to a transparent polyurethane dressing (p = 0.006 and p = 0.003, respectively) and 2-octyl cyanoacrylate (p = 0.023 and p = 0.013, respectively). Suture securement provided increased flexibility compared to TA securement (p < 0.0001), and there was no statistically significant difference in flexibility between 2-octyl cyanoacrylate and n-butyl-2-octyl cyanoacrylate (p = 0.774). The resistance strength of cannula polyurethane was not weakened after exposure to either TA formulation after 60 min compared to control.ConclusionsTissue adhesive appears to be a promising adjunct method of ECMO cannula insertion site securement. Tissue adhesive securement with n-butyl-2-octyl cyanoacrylate may provide comparable securement strength to a single polypropylene drain stitch, and, when used as an adjunct securement method, may minimise the risks associated with suture securement. However, further clinical research is still needed in this area.
Highlights
Extracorporeal membrane oxygenation (ECMO), an invasive mechanical therapy, provides cardio-respiratory support to critically ill patients when maximal conventional support has failed
ECMO therapy is delivered via large-bore cannulae [1], and the success of the therapy is, in part, reliant on adequate dressing securement of these cannulae. Both at the insertion site and along the length of the cannula, may reduce the significant clinical risk posed by cannula migration, dislodgement or complete decannulation, which can lead to potentially devastating patient outcomes
Securement testing Securement with sutures (34.35 N, standard deviations (SD) 8.02) and n-butyl-2-octyl cyanoacrylate tissue adhesive (TA) (35.51 N, SD 5.96) both significantly increased the force required to dislodge the cannula compared to a PU dressing alone (16.66 N, SD 5.56) (p = 0.006, p = 0.003, respectively)
Summary
Extracorporeal membrane oxygenation (ECMO), an invasive mechanical therapy, provides cardio-respiratory support to critically ill patients when maximal conventional support has failed. ECMO therapy is delivered via large-bore cannulae [1], and the success of the therapy is, in part, reliant on adequate dressing securement of these cannulae Effective securement, both at the insertion site and along the length of the cannula, may reduce the significant clinical risk posed by cannula migration, dislodgement or complete decannulation, which can lead to potentially devastating patient outcomes. Cannula dislodgement may lead to catastrophic patient consequences due to loss of ECMO support, air entrainment and massive blood loss [5], and can be life-threatening [3] To prevent these complications, clinical practice guidelines from the Extracorporeal Life Support Organisation state that ECMO cannulae must be effectively secured to the skin in at least two locations, with fixation and positioning of the cannulae checked at frequent intervals [6]
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