Intravascular catheter migration: A cross-sectional and health-economic comparison of adhesive and subcutaneous engineered stabilisation devices for intravascular device securement

Abstract

The Infusional Services Team at a large cancer centre in Belfast, Northern Ireland, performed a cross-sectional analysis of two catheter securement technologies to address an area of frequent, but underestimated concern – peripherally inserted central catheter migration and dislodgement. Healthcare practitioner and patient feedback, along with economic impact, were assessed. The costs associated with catheter replacement during the adhesive device group study period were calculated using an average cost per insertion, based on material costs required for the procedure. Other factors were the replacement cost of the adhesive engineered securement device with each dressing change. In the subcutaneous securement group, the material costs were adjusted for use of the subcutaneous device as it remained in situ for the duration of the catheters’ dwell time. This review found that subcutaneous securement offers both patient and facilities a safe, effective and economical alternative for device securement with patients who are unable to tolerate or have successful securement with adhesive securement devices. The use of subcutaneous devices provided for reduced risks for peripherally inserted central catheters in terms of dislodgement, migration or malposition, alleviating the potential risks to develop catheter-related thrombosis and device-related infection.

GAVeCeLT-WoCoVA Consensus on subcutaneously anchored securement devices for the securement of venous catheters: Current evidence and recommendations for future research

“…An additional paper, 9 published online during the revision of the present document, was later forwarded to the panelists. Answers from the individual experts on each specific question were combined together in a narrative form, leading to a number of final statements with a proper degree of Consensus from the whole working group.…”

“…Another bias of the few published studies is the very small number of patients (in most cases, 30-50) in each trial. However, at the time of the revision of the present document, a new clinical study was published 9 -a prospective observational study with a retrospective control groupwhere SAS was used in more than 1000 patients, with maximal efficacy (no dislodgment). The results of this large study are consistent with the results of all the clinical studies on SAS which have been published or presented in international conferences as posters or oral presentations in the last few years.…”

“…Although SAS are currently used in clinical practice, clinical studies are few and there are not yet clear evidence-based recommendations about their use in terms of effectiveness, safety, and cost-effectiveness. 1 The effectiveness of SAS in reducing the risk of dislodgement has been addressed in a few clinical studies published in peer-reviewed journals [2][3][4][5][6][7][8][9] and in many unpublished studies presented at international conferences as posters or oral presentations. All these studies have apparently confirmed the efficacy of the device.…”

“…Although, some concern exists around the safety of SAS, that is, the possibility of adverse effects such as allergy, pain at placement or at removal, skin injury, and infection; this topic has also been addressed in the literature, 3,7,8 though not systematically, so that there are no clear data about the actual incidence of adverse effects and about the possible strategies for preventing them. Finally, cost-effectiveness of SAS has been specifically addressed in a few studies, 5,8,9 which all concluded in favor of SAS. Still, considering the not irrelevant cost of the device, it appears that the actual costeffectiveness may vary in different populations of patients, as it is dependent on the percentage risk of dislodgement as well as on the scheduled duration of the venous access.…”

Catheter securement impact on PICC-related CLABSI: A university hospital perspective

“…The study by McParlan found the use of SESDs provided an average cost savings per patient (€81.92/US$93.41), lower complications, and served as a safe and affordable alternative to PICC securement. 30 Financial savings by mitigating the risks of CLABSIs are additionally a benefit to the economic health care burden. Performing CER at all levels benefit the patient population for increasing transferability of practice with theoretical, practical, and future implications to practice.…”