Effectiveness of dressings and other devices that are used to keep a peripheral venous catheter in place

Background

Most people admitted to an acute/emergency hospital ward require the insertion of a peripheral venous catheter/cannula (PVC), often known as a 'drip' or 'IV'. A PVC is a flexible, hollow, plastic tube that is inserted in a peripheral vein, most commonly in the hand, or lower arm. Up to half of all PVCs stop working before treatment has finished and a new one has to be inserted. This is uncomfortable for the patient and costly for the healthcare system. One of the reasons PVCs fail, is that the products used to hold them in place are not fully effective, and allow the PVC to move around. This movement causes redness, inflammation and even blood infections. The PVC can become blocked, or leak into the surrounding tissues, or even fall out as a consequence of the movement. The function of PVC dressings and/or securement devices is to keep the PVC in the vein, and to cover the insertion site so that it is kept dry and clean and protected from infection.

Review question

We reviewed the evidence about the effect that different PVC dressings and securement devices have on PVC failure rates.

Study characteristics

We searched the medical literature for studies that compared different types of products that are used to keep PVCs in place. We found six studies (involving 1539 participants) that compared four different ways of securing PVCs. These included:

1. a plain transparent film dressing compared with a gauze (woven fabric) dressing;
2. a bordered transparent dressing (clear transparent window with a reinforced fabric edge) compared with a securement device (that has anchor points or clips that hold the PVC in place over a strong adhesive base pad on the skin) that is used in conjunction with a transparent film dressing;
3. a bordered transparent dressing compared with non-sterile medical tape;
4. a plain transparent film dressing compared with sticking plaster.

The participants in the studies were both adults and children on medical and surgical wards. There were no studies based in emergency departments.

Key results

Two studies provided very low quality evidence that PVCs were less likely to fail when a transparent dressing was used rather than gauze.

Other positive outcomes favouring one dressing over another were based on the results of very low quality, single studies. Overall there is a lack of high quality evidence and continued uncertainty regarding the best methods of securing a peripheral venous catheter remains.

More high quality research is needed in this area.

Quality of the evidence

We assessed a number of quality indicators regarding the methods used in each study and graded the overall quality of studies as very low. Each study had a high or unclear risk of bias for some of the quality indicators. For example, it is likely that clinical staff responsible for assessing participants' outcomes knew the treatment group to which each person belonged, as the securement methods for PVCs looked different.

There were only a limited number of studies available for consideration in this review, and they did not investigate some securement products that are in common use.

Authors' conclusions: 

It is not clear if any one dressing or securement device is better than any other in securing peripheral venous catheters. There is a need for further, independent high quality trials to evaluate the many traditional as well as the newer, high use products. Given the large cost differences between some different dressings and securement devices, future trials should include a robust cost-effectiveness analysis.

Read the full abstract...
Background: 

A peripheral venous catheter (PVC) is typically used for short-term delivery of intravascular fluids and medications. It is an essential element of modern medicine and the most frequent invasive procedure performed in hospitals. However, PVCs often fail before intravenous treatment is completed: this can occur because the device is not adequately attached to the skin, allowing the PVC to fall out, leading to complications such as phlebitis (irritation or inflammation to the vein wall), infiltration (fluid leaking into surrounding tissues) or occlusion (blockage). An inadequately secured PVC also increases the risk of catheter-related bloodstream infection (CRBSI), as the pistoning action (moving back and forth in the vein) of the catheter can allow migration of organisms along the catheter and into the bloodstream. Despite the many dressings and securement devices available, the impact of different securement techniques for increasing PVC dwell time is still unclear; there is a need to provide guidance for clinicians by reviewing current studies systematically.

Objectives: 

To assess the effects of PVC dressings and securement devices on the incidence of PVC failure.

Search strategy: 

We searched the following electronic databases to identify reports of relevant randomised controlled trials (RCTs): the Cochrane Wounds Group Register (searched 08 April 2015): The Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), Ovid MEDLINE (1946 to March 7 2015); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, March 7 2015); Ovid EMBASE (1974 to March 7 2015); and EBSCO CINAHL (1982 to March 8 2015).

Selection criteria: 

RCTs or cluster RCTs comparing different dressings or securement devices for the stabilisation of PVCs. Cross-over trials were ineligible for inclusion, unless data for the first treatment period could be obtained.

Data collection and analysis: 

Two review authors independently selected studies, assessed trial quality and extracted data. We contacted study authors for missing information. We used standard methodological procedures expected by Cochrane.

Main results: 

We included six RCTs (1539 participants) in this review. Trial sizes ranged from 50 to 703 participants. These six trials made four comparisons, namely: transparent dressings versus gauze; bordered transparent dressings versus a securement device; bordered transparent dressings versus tape; and transparent dressing versus sticking plaster. There is very low quality evidence of fewer catheter dislodgements or accidental removals with transparent dressings compared with gauze (two studies, 278 participants, RR 0.40; 95% CI 0.17 to 0.92, P = 0.03%). The relative effects of transparent dressings and gauze on phlebitis (RR 0.89; 95% CI 0.47 to 1.68) and infiltration (RR 0.80; 95% CI 0.48 to 1.33) are unclear. The relative effects on PVC failure of a bordered transparent dressing and a securement device have been assessed in only one small study and these were unclear. There was very low quality evidence from the same single study of less frequent dislodgement or accidental catheter removal with bordered transparent dressings than securement devices (RR 0.14, 95% CI 0.03 to 0.63) but more phlebitis with bordered dressings (RR 8.11, 95% CI 1.03 to 64.02) (very low quality evidence). A small single study compared bordered transparent dressings with tape and found very low quality evidence of more PVC failure with the bordered dressing (RR 1.84, 95% CI 1.08 to 3.11) but the relative effects on dislodgement were not clear (very low quality evidence). The relative effects of transparent dressings and a sticking plaster have only been compared in one small study and are unclear. More high quality RCTs are required to determine the relative effects of alternative PVC dressings and securement devices.

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