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BOTH ENDS OF THE LINE: A CLINICAL AND PATIENT PERSPECTIVE ON CATHETER SECUREMENT M.L. Hawes, RN, DNP, CRNI, VA-BCTM
“I HAVE NOW EXPERIENCED LIFE FROM BOTH ENDS OF THE LINE. CLINICALLY I HAVE STABILIZED A MULTITUDE OF PICCS IN PATIENTS OF ALL AGES AND BODY TYPES WITH SASS SINCE 2012. NOW, AS A PATIENT WHO HAS LIVED WITH A LINE ANCHORED IN PLACE, I FOUND THE EXPERIENCE UNREMARKABLE. WHICH IS EXACTLY WHAT PATIENTS WOULD PREFER. “
In 2012 I met a couple of gentlemen at an AVA conference expo (aka IV Geek Theme Park) who showed me a device that had a chance to survive the demands of long-term acute care patients with central venous access devices (CVAD). Until the opportunity to stroll the aisles of the expo, my team was securing CVADs with an adhesive engineered securement device (AESD), a transparent semi-permeable membrane (TSM), and then covered with an elastic net. Although far superior to sutures, this type of adhesive-based securement could not hold up to patients on long-term ventilation, total parenteral nutrition, and frequent physical repositioning. With the disruption of the adhesive securement, a CVAD would retract out of the superior vena cava and require replacement. Unfortunately, replacing a CVAD in this patient population is often more difficult secondary to the numerous invasive lines they have received in their extensive recovery phase. Therefore, finding even the possibility of genuinely securing the CVAD for these patients was worth investigating. The subcutaneous anchor made sense to me immediately. Growing up helping my father build things, I have understood various methods to secure one thing to another; tape, glue, nails, staples, anchors, et al. The SASS seemed like an ingenious answer to what, in a simplistic view, is an anchoring issue. Why expect a tiny tube to stay in place with adhesives designed not to stick too hard to the skin surface? Instead, anchor the line under the skin and keep that anchor holding the catheter for the duration of therapy.
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The subcutaneous anchor securement system (SASS) took my team a short time to master placement and removal.1 We followed the first 20 patients from implant to explant. My team was impressed with this small orange device’s ability to do what all securement manufacturers claim, keep the CVAD in place until no longer needed. In addition, none of the patients with the SASS experienced catheter dislodgement, and none had a bloodstream infection related to the CVAD. The outcome seems evident that a securement device would perform the role it was engineered to do, but this remains a problem for many patients in many settings.2 Change is difficult for everyone, but when it comes to securing any vascular access catheter, many hospitals still rely on sutures which were an improvised method that followed the birth of CVADs in the 1950s.3 Using sutures to secure external devices
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FEBRUARY 2022 | VOLUME XII | ISSUE 1
