Dislodgement forces and cost effectiveness of prehospital securement of peripheral intravenous catheters on moist skin: a randomized controlled clinical trial in healthy volunteers.

OBJECTIVES: Peripheral intravenous catheters (PIVC) are widely used clinical devices for administering fluids or essential drugs to patients. The failure rate of PIVC remains high and Emergency Medicine has been shown to be a risk factor for dislodgement. When the skin is moist from sweat or fluids, standard intra-hospital dressings and securements fail. In emergency situations, a failed catheter can then critically delay intravenous therapies. The most effective dressing to prevent accidental removal of a prehospital PIVC remains unclear. It was the aim of this study to compare the force required to dislodge a PIVC with four different methods of securing PIVCs used in emergency medicine. In addition, the costs were calculated.

METHODS: Artificial sweat was applied to the skin of 180 volunteers. PIVCs were attached onto the forearm using four different securements (elastic gauze, cohesive gauze, clingfilm and a velcro securing device). Continuously increasing traction force was applied until dislodgement of the respective securement. For statistical tests, either Friedman's test or repeated measures ANOVA was used.

RESULTS: Clingfilm showed the greatest resistance to increasing pulling force with cohesive bandages as close second. The velcro securing device was strongest at resisting low level of forces but fell off sharply at higher force. Elastic bandages were the weakest in both categories. Clingfilm was the most cost-effective method (4ct), followed by elastic gauze (12 ct), cohesive gauze (60 ct) and the velcro device (316 ct).

CONCLUSIONS: In situations where intravenous catheters are difficult to secure or at high risk of dislodgement either clingfilm or cohesive dressing should be used. Simple elastic bandages should not be used in any setting for securement of PIVC.