Short peripheral intravenous catheter securement with cyanoacrylate glue compared to conventional dressing: A randomized controlled trial.

Abstract

BACKGROUND\nShort peripheral intravenous catheters (PIVCs) fail prior to completion of therapy in up to 63% of hospitalizations. This unacceptably high rate of failure has become the norm for the most common invasive procedure in all of medicine. Securement strategies may improve PIVC survival.\n\n\nMETHODS\nWe conducted a prospective, single-site, parallel, two-arm randomized controlled investigation with a primary outcome of catheter failure comparing securement with standard semi-permeable dressing and clear tape (SPD) to standard semipermeable dressing and clear tape with cyanoacrylate glue (SPD + CG). Adult emergency department patients with a short PIVC and anticipated hospital duration ⩾ 48\u2009h were enrolled and followed until IV failure or completion of therapy for up to 7\u2009days. Secondary outcomes included complications and cost comparisons between groups. Primary outcome was assessed by intention to treat and per protocol analyses.\n\n\nFINDINGS\n350 patients were enrolled between November 2019 and October 2020. PIVC survival for SPD + CG was similar to SPD group with the absolute risk difference of IV failure in the intention-to-treat (-5.8%, p\u2009=\u20090.065) population and improved in the per protocol (-8.1%, p\u2009=\u20090.04) population, respectively. Kaplan-Meier survival analysis indicated there was a significant benefit of the SPD + CG at greater than 2\u2009days of hospitalization (p\u2009=\u20090.04). Prior to 48\u2009h, there was no survival enhancement to either group (p\u2009=\u20090.98) in the intention to treat population. In a multivariable analysis with piecewise Cox regression, when the IV was functional greater than 48\u2009h, the risk of IV failure in the SPD\u2009+\u2009CG was 43% less than the SPD group (adjusted hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.34 to 0.97; p\u2009=\u20090.04). Cumulative cost related to IV during hospitalization was similar between groups with a lower incremental rescue cost in the SPD + CG group.\n\n\nINTERPRETATION\nSPD combined with cyanoacrylate glue provides similar benefit to patients compared to SPD alone and potentially improves short PIVC survival when the IV was inserted >48\u2009h. As this strategy is cost neutral, it could be considered in admitted patients, particularly those with longer anticipated hospital durations.