This evidence-based practice project aimed to implement and evaluate the outcomes of the application of cyanoacrylate tissue adhesive at the insertion sites of peripheral intravenous catheters to increase dwell time and functional longevity. Over 90% of hospitalized patients have a PIVC, resulting in almost two billion PIVC placements each year (Helm et al., 2015). Patients report PIVC placement is painful and even traumatic. Failure rate of PIVCs is 35-69%, with accidental dislodgement as a common cause (Helm, 2015; Bahl et al., 2021). Research suggests tissue adhesive applied at insertion sites can effectively secure PIVCs and may reduce risk of infection from bacteria, fungus, and yeast (Rickard et al., 2018; Nicholson & Hill, 2019). The Infusion Nurses Society Standards (2021) support the application of tissue adhesive to reduce PIVC dislodgement, restarts, and infection. Tissue adhesive may be the missing link in nurses’ persistent efforts to optimally secure PIVCs, increase dwell time, and provide continuity of intravenous treatment. However, in 2022, tissue adhesive had not been well-integrated into policies or practices in a Midwestern health care system. Furthermore, little is known about the effect of tissue adhesive on PIVC dwell time in patients who were “difficult sticks” and had venous depletion.
In the target hospital, vascular access (VA) nurses placed PIVCs on patients who were assessed as being “difficult sticks.” Patients qualified for this project if VA nurses placed a 2.5-inch PIVC, 20- or 22-gauge data, in the upper extremity. Data were extracted from medical records in 2018, before tissue adhesive was available in-house, and again in 2021, after VA nurses started applying tissue adhesive. Cyanoacrylate tissue adhesive is approved by the Food and Drug Administration for use with all vascular access devices. Dwell time was the number of days from insertion of the PIVC to the time of discontinuation, which was when the a) IV infiltrated, leaked, or stopped functioning; b) patient discharged or died; or c) PIVC was no longer needed.
Data from 2018 revealed an average dwell time of 4.02 days (n = 272). In 2021, the dwell time for PIVCs with tissue adhesive was 4.9 days (n = 299). Tissue adhesive increased the longevity of PIVCs by 18.6%, almost three-fourths of a day. The average dwell time in both years was longer than the average dwell time of PIVCs reported in multiple studies as 1.25-3.5 days. Data for this project did not reveal any adverse effects of the tissue adhesive. The expertise of VA nurses may have influenced the results, as VA nurses used ultrasound to identify optimal vein location, selected the optimal diameter of catheters, and stabilized all PIVCs with and without tissue adhesive in a secure manner.
In this project, tissue adhesive increased the dwell time of PIVCs in patients with venous depletion. Medical-surgical nurses can advocate for implementing this evidence-based practice to reduce dislodgment and painful restarts. Strategies for implementation can include sharing evidence on the use of tissue adhesive to increase comfort for patients, avoid interruptions in therapies, and save nurses’ time.
Evidence-based references 1. Bahl, A., Gibson, S. M., Jankowski, D., & Chen, N. W. (2021). Short peripheral intravenous catheter securement with cyanoacrylate glue compared to conventional dressing: A randomized controlled trial. The journal of vascular access, 11297298211024037. 2. Carr, P. J., Rippey, J. C., Cooke, M. L., Higgins, N. S., Trevenen, M., Foale, A., & Rickard, C. M. (2018). From insertion to removal: A multicenter survival analysis of an admitted cohort with peripheral intravenous catheters inserted in the emergency department. Infection Control & Hospital Epidemiology, 39(10), 1216-1221. 3. Gorski, L.A., Hadaway, L., Hagle, M.E., Broadhurst, D., Clare, S., Kleidon, T.,…Alexander, M. (2021). Infusion Therapy Standards of Practice, 8th Edition. J Infus Nurs, 44(1S Suppl 1), S1-S224. 4. Helm, R. E., Klausner, J. D., Klemperer, J. D., Flint, L. M., & Huang, E. (2015). Accepted but unacceptable: peripheral IV catheter failure. Journal of Infusion Nursing, 38(3), 189-203. 5. Marsh, N., Webster, J., Ullman, A. J., Mihala, G., Cooke, M., Chopra, V., & Rickard, C. M. (2020). Peripheral intravenous catheter non‐infectious complications in adults: A systematic review and meta‐analysis. Journal of Advanced Nursing, 76(12), 3346-3362. 6. Nicholson, J., & Hill, J. (2019). Cyanoacrylate tissue adhesive: a new tool for the vascular access toolbox. British Journal of Nursing, 28(19), S22-S28. 7. Rickard, C. M., Marsh, N., Webster, J., Runnegar, N., Larsen, E., McGrail, M. R., ... & Playford, E. G. (2018). Dressings and securements for the prevention of peripheral intravenous catheter failure in adults (SAVE): a pragmatic, randomized controlled, superiority trial. The Lancet, 392(10145), 419-430.