Peripheral Extracorporeal Membrane Oygenation Cannula Dressing and Securement Practices Across Australia and New Zealand

Abstract

Introduction: Extracorporeal membrane oxygenation (ECMO) is a highly invasive method of cardiac and/or pulmonary support for critically ill patients where conventional therapies have failed. Along with other factors, ECMO success relies on effective placement and securement of large-bore cannulae used in therapy delivery. Effective dressing and securement of ECMO cannulae and associated circuitry plays an important role in preventing infection and accidental dislodgement. Limited data exists regarding ECMO cannula dressing and securement practice across Australia and New Zealand. Study Objectives: To determine ECMO cannula dressing and securement practices, and adherence to local guidelines. Methods: Prospective cross-sectional study of adult and paediatric patients receiving ECMO in 11 Australian and New Zealand intensive care units. Results: Dressing and securement practices for 290 cannulae from 127 patients are described. Over half (56%) of cannulae were sutured at the insertion site. Ninety percent of all cannulae were covered with a transparent semi-permeable dressing, however, only 11% of these dressings contained chlorhexidine gluconate (CHG) or had a CHG-impregnated disk underneath. Circuit tubing was secured typically by two fixation points (60%), however two backflow cannulae had no securement along the tubing length. Most frequently, circuit tubing was secured with a sutureless securement device only (33%), followed by a securement combination of sutures plus clipping or taping to a fixed object (13%). One in four cannulae and circuits (24%) were not dressed and secured in accordance with local hospital policy. Conclusions: The use of transparent semi-permeable dressings at ECMO cannula insertion sites is common practice however use of CHG-containing dressings/disks, demonstrated to reduce bloodstream infection rates in central lines, is rare. Further investigation is warranted to determine the role of CHG-impregnated dressings/disks in reducing ECMO cannula-related infections. Cannula and circuit securement practices vary indicating a lack of standardisation due to an evidence gap in this area.