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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