Containing Costs and Risks With Catheter Line Migration

The previous blog of this 2-part series focused on the importance of proper dressing removal, especially in oncology patients. We examined how the use of an adhesive remover with ports, PICC lines, and their associated dressings can help reduce the risk of damage to fragile skin in this patient population. (View Blog 1 of 2.) In part 2 of the series, we will look at the costs and risks of catheter line migration.

More than 5 million central venous catheters (CVCs) are inserted annually in the US.1 Yet despite highly skilled operators and the use of ultrasound guidance, CVC malpositioning can occur.2 Moreover, dislodgement can occur as a result of improper technique when removing a dressing, inadequate securement of the catheter, and physical activity.3

Improper placement and/or dislodgement of CVCs are associated with numerous risks to patients, including catheter dysfunction, hypotension, hemorrhagic shock, pleural effusion, pulmonary edema, dyspnea, chest pain, back pain, cardiac tamponade, thrombosis, endothelial damage, and fluid leakage.4 Reinsertions of CVC devices are costly and require skilled staff, large amounts of sterile and disposable equipment, monitoring devices, and radiologic confirmation of placement (eg, ultrasound/x-ray).5

The 2016 Infusion Therapy Standards of Practice detail proper use of CVC devices.6 Proper tip placement is critical:

  • Ensure proper placement of the central vascular access device (CVAD) tip, within the lower one-third of the superior vena cava or cavoatrial junction

If dislodgement is suspected at dressing changes or any other time, specific guidance is provided:

  • Measure the external CVAD length and compare it to length at insertion. (The length of the catheter outside the patient at insertion should remain constant; it should not change.)

As you know, peripherally inserted central catheters (PICCs) are commonly used for delivering intravenous therapy.7 PICC failure is surprisingly high. Up to 40% of PICCs fail due to mechanical, infectious, and thrombotic complications.7 PICC failure contributes to negative patient experiences, including painful repeated needle-sticks, and increases in length of hospital stays, equipment costs, and workloads.

The movement of the device from its central placement, or “catheter migration,” has become a key clinical concern because it can potentially result in infiltration and extravasation.7 In a 2017 randomized controlled trial pilot, the most common failure type (6% of all PICCs) was dislodgement, indicating that securement is a significant problem and an important area for improvement.7

The results of this study demonstrate the need to ensure the appropriate securement and removal of CVC device dressings. For CVAD dressings, use:

    • Mastisol® Liquid Adhesive: Reduce the likelihood of dressing or device migration or accidental removal as well as the risk of infection by creating a lasting occlusive dressing barrier by incorporating Mastisol®
    • Detachol® Adhesive Remover: Minimize risk of skin injury and catheter tip migration during dressing changes by implementing Detachol® for safe dressing removal

For more information about Mastisol® Liquid Adhesve, Detachol® Adhesive Remover, or ReliaTect® Post-Op Dressing with CHG, please contact your sales consultant or Eloquest Healthcare®, Inc., by calling 1-877-433-7626 or visiting www.eloquesthealthcare.com.

Minimizing infection risk is an essential part of optimizing “The Triple Aim” of the Affordable Care Act. Eloquest Healthcare is committed to providing solutions that can help you reduce the risk of CLABSI and post-op wound contamination.

Come back for more practical tips and important information in our subsequent blogs.

References

  1. Kornbau C, Lee KC, Hughes GD, et al. Central line complications. Int J Crit Illn Inj Sci. 2015;5(3):170–178.
  2. Roldan CJ, Paniagua L. Central venous catheter intravascular malpositioning: cause, prevention, diagnosis, and correction. West J Emerg Med. 2015;16(5):658-664.
  3. Central venous access devices: complications of central lines. Assessment Technologies Institute. www.atitesting.com. Accessed October 9, 2017.
  4. Wang L, Liu ZS, Wang CA. Malposition of central venous catheter: presentation and management. Chin Med J. 2016;129(2):227-234.
  5. Ullman AJ, Marsh N, Mihala G, et al. Complications of central venous access devices: a systematic review. Pediatrics. 2015;136(5):e1331-1344.
  6. Gorski L, Hadaway L, Hagle M, et al. Infusion Therapy Standards of Practice. J Infus Nurs. 2016;39(suppl 1S):S1-S159.
  7. Chan RJ, Northfield S, Larsen E, et al. Central venous access device securement and dressing effectiveness for peripherally inserted central catheters in adult acute hospital patients (CASCADE): a pilot randomised controlled trial. Trials. 2017;18:458. doi: 10.1186/
    s13063-017-2207-x.