Securement options for central venous catheters

Securement options	Description	Benefits or concerns
Sutures	Synthetic or silk sutures have traditionally been used to attach the CVC to the patient's subcutaneous tissue	Device dislodgement if suture is pulled out and possible increased risk of CRBSI^[1]
Adhesive securement devices	Adhesive footplate and clasp or Velcro-based attachments to the external IV device provide sutureless securement	Enhanced security without increased risk of needle puncture
Integrated securement devices	New-generation dressings that incorporate a securement function, such as engineered adhesives and padded borders	Unimpaired view of the insertion site
Tissue adhesive	Medical-grade cyanoacrylate glue used at the insertion site to promote hemostasis	Potentially improve device security^[2,3]; have not been demonstrated to reduce CRBSI or device dislodgement for CVCs^[4]; may cause skin irritation
Subcutaneous anchor securement systems	Flexible posts (usually nitinol based) placed beneath the skin to secure CVCs at the insertion point; the product stays in place for the entire CVC dwell	Useful to reduce the time needed to complete dressing changes, especially when the peri-skin is irritated or injured^[5]; requires training for insertion and removal

CVC: central venous catheter; CRBSI: catheter-related bloodstream infection; IV: intravenous.

References:

Yamamoto A, Solomon J, Soulen M, et al. Sutureless securement device reduces complications of peripherally inserted central venous catheters. J Vasc Interv Radiol 2002; 13:77.
Kleidon TM, Ullman AJ, Gibson V, et al. A pilot randomized controlled trial of novel dressing and securement techniques in 101 pediatric patients. J Vasc Interv Radiol 2017; 28:1548.
Rickard CM, Marsh N, Webster J, et al. Dressings and securements for the prevention of peripheral intravenous catheter failure in adults (SAVE): A pragmatic, randomised controlled, superiority trial. Lancet 2018; 392:419.
Rickard CM, Edwards M, Spooner AJ, et al. A 4-arm randomized controlled pilot trial of innovative solutions for jugular central venous access device securement in 221 cardiac surgical patients. J Crit Care 2016; 36:35.
Goossens GA, Grumiaux N, Janssens C, et al. SecurAstaP trial: Securement with SecurAcath versus StatLock for peripherally inserted central catheters, a randomised open trial. BMJ Open 2018; 8:e016058.

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