TISSUE ADHESIVE BLEEDING AND OOZING PRACTICE SUMMARY Lori Kaczmarek, MSN, RN, VA-BC™ | Vascular Access Clinical Specialist, Adhezion Biomedical, LLC
INTRODUCTION Oozing and bleeding at a vascular access insertion site contributes to the device and/or dressing failure. The device failure may be a result of dislodgement or unintentional removal when the dressing or securements fail. The presence of blood or moisture under the dressing requires unscheduled dressing changes adding to an increased risk of catheter-associated bloodstream infections (CABSI).1-3
A STANDARD OF CARE A highly purified medical cyanoacrylate or tissue adhesive (TA) was approved by the United States (US) Food and Drug Administration (FDA) for vascular access (SecurePortIV®, Adhezion Biomedical, LLC, Wyomissing, PA USA) in 2017 and since then has seen increased use to improve vascular access outcomes. While mentioned in the 2016 Infusion Nurse Society (INS) Infusion Therapy Standards of Practice,4 TA was still a “consideration” for its benefit with vascular access (VA) and more research was recommended. The development of a unique cyanoacrylate formula, the expanded use, data collection and published reports propelled TA to become one of four recommended securement technologies in the 2021 INS Standards along with additional recommendations for hemostasis and providing a microbial barrier.1,5
BLEEDING AND OOZING The point of skin penetration for vascular access creates a surgical wound providing a direct route for pathogen entry into the body and 9 | IQ | INTRAVASCULAR QUARTERLY NEWSLETTER
an exit site for blood and capillary fluid.6 To control post insertion bleeding, clinicians may resort to using direct manual pressure, use of thrombotic agents, pressure dressings or a combination of interventions. This may lead to frequent or early dressing changes and obscure direct visualization of the insertion point necessary for routine assessment and critical for the prevention of complications.1 7 Use of hemostatic agents or gauze pressure dressings add additional cost, patient, and clinician risk, and require additional time to the care and management of the vascular access device (VAD).2,8,9 Traditional interventions for post insertion bleeding and oozing require additional products or dressings and limit the use or effectiveness of chlorhexidine gluconate (CHG) disks or gel dressings that may be used for microbial protection. Once bleeding and oozing are controlled the patient will require a dressing change (usually within 24 hours) to remove the hemostatic product or soiled gauze and replace with the facility protocol dressing. The manipulation of the VAD and dressing replacement during this process may cause re-bleeding which necessitates yet another cycle of care not to mention additional risk.
HEMOSTATIC EFFECT Cyanoacrylate tissue adhesive formulas have been used for decades in emergency care and surgical arenas and are known for their ability to provide wound hemostasis.5,10 The innovative cyanoacrylate formula approved for VA provides a potent mechanical hemostatic effect and is CONTINUED ON NEXT PAGE
