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Table 2 Tissue adhesive and sutureless securement device testing and clinical practice points for use in ECMO

From: Extracorporeal membrane oxygenation line-associated complications: in vitro testing of cyanoacrylate tissue adhesive and securement devices to prevent infection and dislodgement

Securement product

In vitro study findings

Advantages in ECMO

Clinical practice points

Cyanoacrylate tissue adhesive (Histoacryl)

• Higher tensile strength compared with transparent dressing at the cannula insertion point

• Microbial inhibition along the cannula tunnel, under the cannula dressing and at the cannula insertion point compared with transparent dressing

• Chemical compatibility of cannula and tissue adhesive remover agent (Remove wipes) after 15 min exposure, but cannula weakening observed after 1 h exposure time

• Promising simple, adjunct securement method to help stabilise peripheral cannulas at their percutaneous insertion point without the need for suturing

• No risk for needlestick injury by avoiding cannula suturing

• Potential to reduce incidence of cannula colonisation, localised infection and bloodstream infection

• Quick and easy to apply

• Can remain in situ for days and be ‘topped up’ if needed

• Easily removed with adhesive remover

• Remover agent must be thoroughly cleansed from cannula after TA removal and long exposure times avoided

• Prevents complications and failure in intravascular devices [39]

• Low incidence of adverse skin effects such as skin tears has been reported [18, 22, 23]

• Haemostatic properties prevent early post-insertion bleeding [40, 41] and early dressing change in patients with other intravascular devices [39]

• Hair growth ‘against’ and ‘into’ TA with resultant pain on TA and central catheter removal has been reported [20]; hair must be clipped before applying TA at cannulation sites; rapid beard or pubic hair growth may preclude TA use

• Further evidence required to guide clinical usage including the potential to reduce post-insertion cannula site bleeding in ECMO

Sutureless securement device (Grip-lok, MultiFix)

• Higher tensile strength compared with adhesive bandage (Tensoplast)

• More flexible approach and ease of use over adhesive bandages for securing lines

• Avoids skin suturing and subsequent risk of oozing/bleeding and incidental perforation of tubing

• Allows tubing to be easily readjusted or tightened as needed; therefore, less line handling needed and less risk of inadvertent line kinking or movement

• When combined with TA, offers an optimal dual line securement strategy by minimising cannula micromotion (at insertion point) and gross movement of the tubing

• Simple and quick to apply

• Velcro strap secures the hub of the device allowing for easy opening and closing

• Can generally remain in place for several days and only needs changing when soiled

• Not considered appropriate for securement of central ECMO cannulas in the absence of sutures but may help avoid gross line movement