Effectiveness of different central venous catheter fixation suture techniques: An in vitro crossover study.

Abstract

Proper fixation of central venous catheters (CVCs) is an integral part of safety to avoid dislodgement and malfunction. However, the effectiveness of different CVC securement sutures is unknown. Analysis of maximum dislodgement forces for CVCs from three different manufacturers using four different suture techniques in an in vitro tensile loading experiment: 1. "clamp only", 2. "clamp and compression suture", 3. "finger trap" and 4. "complete", i.e., "clamp + compression suture + finger trap". Twenty-five tests were performed for each of the three CVC models and four securement suture techniques (n = 300 test runs). The primary cause of catheter dislodgement was sliding through the clamp in techniques 1 and 2. In contrast, rupture of the suture was the predominant cause for dislodgement in techniques 2 and 3. Median (IQR 25-75%) dislodgement forces were 26.0 (16.6) N in technique 1, 26.5 (18.8) N in technique 2, 76.7 (18.7) N in technique 3, and 84.8 (11.8) N in technique 4. Post-hoc analysis demonstrated significant differences (P < .001) between all pairwise combinations of techniques except technique 1 vs. 2 (P = .98). "Finger trap" fixation at the segmentation site considerably increases forces required for dislodgement compared to clamp-based approaches.