Studies show a third of intravascular catheters fail while troubleshooting and replacing catheters costs the nation about $1 billion each year. Australian researchers now believe they are on the threshold to providing nurses with a simple solution. The answer could lie in a common product already found in our hospitals and in countless homes across the country.
Around 15 million intravenous drips are used in Australian hospitals each year, with most placed in the arms or hand veins of patients.
One in three fail while in use.
Of these, 70 per cent become blocked, 15 per cent become so painful they need to be removed and another 15 per cent simply fall out or are accidentally pulled out, while about one in 1000 patients develops a serious infection in the bloodstream as a result of bacteria entering
through the IV drip.
The most common cause of IV drips failing is inadequate securement, causing micro-motion of the drip and irritation of the vein, which can then swell and become occluded or can push the drip into the surrounding tissue.
Inadequate securement can also lead to bacteria entering or for the drip to become partially or fully dislodged.
These alarming statistics and outcomes for a common nursing procedure used around-the-clock in wards, theatres and in critical care in hospitals across Australia and around the world could soon be a thing of the past.
Australian researchers believe tissue adhesive or ‘super’ glue could hold the solution.
Griffith University Professor Claire Rickard, a Chief Investigator with the NHMRC Centre of Research Excellence in Nursing and a member of the Critical Care Research Group, said the results of laboratory trials showed medical grade superglues Histoacryl® and Dermabond® provide a reliable method of peripheral IVC fixation in vitro.
“This glue has been around for a while. It’s not one you can buy down at Bunnings although it’s actually not much different…chemically it’s the same formula,” she said.
“These glues are commonly available within the hospital at the moment. They are just not used for this purpose.
“They are mostly used for children in the emergency department. If you have a child with a small wound, instead of suturing it up, which is very painful and then the stitches have to be removed, we just glue it up.
“That would be the most common use but it is used for internal surgery and external wounds and even eye surgery.
“The results of our studies are a surprise but often the common things are right under our noses.”
Professor Rickard said the solution was discovered after her earlier study of 6000 IV catheters found a large number failed while still needed.
“People were having additional needles and missed out on the medication treatment,” she said.
“We thought – that’s absolutely unacceptable and we started looking at the reasons why this was happening and how we could improve it.
“We just really sat around talking. We looked at how catheters were being held in place and we looked at all of the new products…many of which are high cost but virtually untested.
“Our scientists were using the glue to secure lines in sheep in the animal lab – their greasy skin meant that usual dressings wouldn’t stick.
“One of the research nurses breeds dogs and she reported that the vets were also gluing in the IVs, for similar reasons. Then we tracked down a couple of papers in the U.K. where an anaesthetist had been gluing in IVs and epidural lines – (he) wasn’t researching it but he had published his report – he reckoned it was 100 per cent successful.
“We thought, of course we have to research this a bit more scientifically and that’s what happened.”
The work was carried out by the Griffith Health Institute in conjunction with the Critical Care Research Group, and led by Gabriela Simonova, a biomedical engineer.
The study, which was completely independent of manufacturers, was funded by the NHMRC Centre for Research Excellence in Nursing Interventions for Hospital Patients along with the Prince Charles Hospital Foundation.
The series of three studies compared the glues to current fixation methods for compatibility with IVC material and the ability to prevent both pull out and microbial growth.
The two glues, along with two standard dressings (Tegaderm™ 1624 and 1633) and an external stabilisation device (Statlock®) were tested to secure 16G peripheral IVCs in new born fresh porcine skin. Control IVCs with no securement were also studied.
The results found that neither super glue weakened the catheters, and they were up to 400 per cent stronger than current dressings at preventing IV drips from pulling out.
The super glues were also quick and easy to apply, there was no irritation or skin damage, no visible bacterial growth and the glues can be safely removed with paraffin, causing no tissue damage.
A clinical trial, thanks to further support from the Prince Charles Hospital Foundation and the Griffith Health Institute, will begin as soon as March – studying the use of the glues in peripheral IVC fixation on about 400 patients at the Prince Charles Hospital, led by Professor John Fraser, and at the Royal Brisbane and Women’s Hospital, led by Professor Joan Webster.
The trial will compare the glues and standard care dressings against other recently released commercial dressings and securement devices, including Statlock®, with results expected to be released late this year.
Professor Rickard said there were also plans for the introductory study to be followed up with a larger scale study of about 2000 patients next year, if funding could be secured.
“It’s a world first and very innovative and ground breaking,” she said.
“We imagine that if successful, it would really change the game and all the tissue adhesives would be marketed and changed for this indication.”
Professor Rickard said clear plastic polyurethane dressings have been used for around three decades to secure intravascular drips and now research to glue in IV drips could change the way nurses, including theatre and critical care nurses, work.
“We find with patient transfer, say between the emergency department and ward, or between the operating theatre and ICU, there’s a lot of catheter migration because the lines get pulled or damaged, the tubing can catch on the bed clothes or the bed rail in the lift,” she said.
“If the central lines migrate that can be life-threatening. If suddenly the patient is not receiving their medication that can be an emergency situation.
“We know where the problems are occurring. We hope we can minimise or avoid that all together.
“And if nurses are not having to waste their time troubleshooting catheters that are faulty and removing them and replacing them, that will make a big difference,” she said.
Professor Rickard said if the clinical trials prove successful gluing in catheters will be a new technique for nurses.
“It’s just going to be a change in people’s mindset in hospital, to have these glued in,” she said.
“We have certainly got the data to show that the dressings aren’t effective at the moment – it’s a Band-Aid solution.”
For nurses, the only difference will be to monitor the glue and re-apply the glue as it slowly degrades after seven to 10 days, or to easily remove it with paraffin when the IV is removed.
Professor Rickard said the trials were exciting.
“Everyone wants to find a cure for cancer, which of course is wonderful, but these sort of day to day issues in the hospital often go under the radar,” she said.
“We are hoping we can make a difference.”