Hello all, I'm new here however I wanted to ask some questions of practicing nurses about OSHA, CDC and NAPSSI, and INS recommendations for the use
of IV securement devices in an effort to reduce the incidence of accidental
needlesticks.
Have you used any of the IV securement devices out there?
Do you find these devices to extend the dwell time of IV's?
Does your administration mandate their usage?
Any comments or feedback would be greatly appreciated.
Rick
Hello Rick,
Do you work in the healthcare field? If so, at what capacity?
I represent a company that is developing an IV securement device. We would like to understand what health care workers view on securement devices is and how recent legislation is viewed.
Rick
Hi folks,
For some reason, I have a hard time with the term, "IV securement device." I know what the term refers to but I've never said "securement" before. Are we talking about the ageless "chevron" taping process or one of the many Tegaderm and foam tape contraptions, or both? My personal favorite is just a small Tegaderm applied over the site and covering only the catheter. This allows direct view of the insertion site and minimizes what needs to be taken down when and if the IV needs to be redressed. I hate struggling with a lot of bloody tape. No particular catheter securing procedure is required by my institution but we are diligent about q-shift flushing of ports not in use, especially in the ICU. I think this more than anything prolongs dwell time. I like to use extention sets on IV catheters too because I think it minimizes excessive movement of the catheter itself during intermittent access which I believe, reduces IV catheter life too. In short, I have no personal preference for "securement devices," only good insertion technique and careful maintenence. Thanks for asking, Rick.
R
IV Securement refers to an emerging concept that is backed by numerous studies that manufactured IV securement devices can prolong the IV dwell time. Tape, as you mentined is the most commonly used type of device right now, in particular the Tegaderm IV site dressing manufactured by 3M.
Tegaderm is a wonderful product and works for short term IV's very well, however it does not offer long term securement and certainly cannot offer securement up to the 96 hour dwell time, suggested by OSHA/CDC.
Recent studies suggest that the use of manufactured IV securement devices can not only prolong IV dwell times securely but they also carry the benefit of reducing accidental needlesticks by reducing the number of IV restarts.
Your exactly right in regard to movement of the catheter. If the movement of the catheter can be limited, or eliminated you can greatly extend the IV dwell time and that is exactly what IV securement devices offer.
There are lots of published studies showing the benefits of IV securement devices and in fact OSHA/CDC are now recommending their usage. These studies further show that tape can be contaminated and it's use as a securement device is now greatly discouraged.
Rick
rhaugen wrote:IV Securement refers to an emerging concept that is backed by numerous studies that manufactured IV securement devices can prolong the IV dwell time. Tape, as you mentined is the most commonly used type of device right now, in particular the Tegaderm IV site dressing manufactured by 3M.
Tegaderm is a wonderful product and works for short term IV's very well, however it does not offer long term securement and certainly cannot offer securement up to the 96 hour dwell time, suggested by OSHA/CDC.
Recent studies suggest that the use of manufactured IV securement devices can not only prolong IV dwell times securely but they also carry the benefit of reducing accidental needlesticks by reducing the number of IV restarts.
Your exactly right in regard to movement of the catheter. If the movement of the catheter can be limited, or eliminated you can greatly extend the IV dwell time and that is exactly what IV securement devices offer.
There are lots of published studies showing the benefits of IV securement devices and in fact OSHA/CDC are now recommending their usage. These studies further show that tape can be contaminated and it's use as a securement device is now greatly discouraged.
Rick
Hi again, Rich,
Thanks for the information. I guess I don't know enough about OSHA regs regarding IV securement. I think we agree that tape is no longer the ideal but what is the nature of the product that your company is working with that makes it superior to say, Tegaderm, for minimizing catheter movement while optimizing infection control?
R
My hospital started using some foam dogbone looking thing that works ok it does stick really well to your gloves. The tegaderm, opsite, clear film whatever name goes right on the site. I still chevron the hub. Dwell time in general isn't a problem for my unit 24 hrs is usually the longest time we need a site. Our hospital still have a 72 hr time on IV sites and they are only not changed with a MD order
We understand that because nurses have tried to "chevron" the catheter itself to the skin in an effort to minimize the movement of the catheter itself, that therein lies the problem.
As discussed tape fails typically after a short time.
Our product in contrast anchors the catheter to the skin of the patient
completely eliminating movement of the catheter. This is accomplished
with our patented compound that is literally peel and stick technology.
Initial testing has shown that we can sustain securement of the catheter,
and lead tubing for 96 hours and beyond.
In terms of infection control, the compound is created with an anti-microbial
substance within it that adheres to the skin and catheter, and
has been very effective in eliminating infections associated with resistant bacteria on the skin and catheter itself.
In terms of an outright comparison to Tegaderm our product is much more comfortable to the patient and allows removal and reapplication if necessary
without degrading it's adhesive qualities. Additionally Tegaderm typically will not adhere more than 24 hours.
Rick
cassioo wrote:My hospital started using some foam dogbone looking thing that works ok it does stick really well to your gloves. The tegaderm, opsite, clear film whatever name goes right on the site. I still chevron the hub. Dwell time in general isn't a problem for my unit 24 hrs is usually the longest time we need a site. Our hospital still have a 72 hr time on IV sites and they are only not changed with a MD order
You may be referring to the Statlock IV Securement device, but not sure. Tegaderm is still in essence a piece of tape that will fail within 24 hours, which as you mentioned is your general dwell time.
For the applications that run longer there is definitely an cost and operational advantage to a product that will allow you to get to the 72/96 hour dwell time.
Rick
rhaugen wrote:You may be referring to the Statlock IV Securement device, but not sure. Tegaderm is still in essence a piece of tape that will fail within 24 hours, which as you mentioned is your general dwell time.
For the applications that run longer there is definitely an cost and operational advantage to a product that will allow you to get to the 72/96 hour dwell time.
Rick
Hi again, Rick,
I like the sound of a product that can be removed and restuck without loss of integrity. The added antimicrobial property is also compelling. What have been your research findings on the best preinsertion site prep? Additionally, I'm wondering if the per unit cost of this kit may make it more appropriate for use on IJ,SC or PICC lines which have a longer anticipated dwell time. Contrary to what seems to be your findings, my experience has been that a properly placed Tegaderm product typically lasts a lot longer than 24 hours.
R
Ricu wrote:Hi again, Rick,
I like the sound of a product that can be removed and restuck without loss of integrity. The added antimicrobial property is also compelling. What have been your research findings on the best preinsertion site prep? Additionally, I'm wondering if the per unit cost of this kit may make it more appropriate for use on IJ,SC or PICC lines which have a longer anticipated dwell time. Contrary to what seems to be your findings, my experience has been that a properly placed Tegaderm product typically lasts a lot longer than 24 hours.
R
Dr. Dennis G. Maki, MD professor of medicine and head of infectious disease at the University Wisconsin-Madison Medical school has said that Chlorhexadine should be used whenever available as the preferred skin prep solution.
Most studies (not ours) in which Tegaderm was tested with IV Securement devices have shown the Tegaderm product to fail within 48 hours vs IV securement devices.
Most institutions right now change the IV's every 72 hours because they do not have any means by which they can extend the IV to the maximum 96 hour dwell time.
I would agree with you that central lines, SC, or IJ, are all typically longer term IV proceedures whereby cost may become a factor, however right now
hospitals are not able to bill for Tegaderm, or tape when seeking reimbursement from insurance companies, so obviously they are seeking the lowest cost solution available.
Conversely if a product were made available that would reduce infections, increase dwell times to the CDC/OSHA guildelines of 96 hours, and the hospital could bill any insurace for reimbursement, the cost would of the product would no longer be an issue, particulary if the product were easier to use, and more comfortable for the patient, and reduced incidence of infection.
Rick
rhaugen wrote:Dr. Dennis G. Maki, MD professor of medicine and head of infectious disease at the University Wisconsin-Madison Medical school has said that Chlorhexadine should be used whenever available as the preferred skin prep solution.
Most studies (not ours) in which Tegaderm was tested with IV Securement devices have shown the Tegaderm product to fail within 48 hours vs IV securement devices.
Most institutions right now change the IV's every 72 hours because they do not have any means by which they can extend the IV to the maximum 96 hour dwell time.
I would agree with you that central lines, SC, or IJ, are all typically longer term IV proceedures whereby cost may become a factor, however right now
hospitals are not able to bill for Tegaderm, or tape when seeking reimbursement from insurance companies, so obviously they are seeking the lowest cost solution available.
Conversely if a product were made available that would reduce infections, increase dwell times to the CDC/OSHA guildelines of 96 hours, and the hospital could bill any insurace for reimbursement, the cost would of the product would no longer be an issue, particulary if the product were easier to use, and more comfortable for the patient, and reduced incidence of infection.
Rick
Our institution has been using chlorhexidine for several years so it's good to learn that it's currently rated so well. I see how making the IV securement device a billable item could potentially eliminate the cost factor as an issue when using the product for all IV catheters. I will ask our unit rep to the new products committee to suggest trialing IV securement devices. Good luck and thank you for sharing your time and information.
R
I've been a nurse for 17 years. I now work on a very busy Ortho/Surg floor in a trauma center. Our hospital uses the stat lock / tegaderm products and I'm pretty pleased with that. When you stack it up against the whole Chevron securing method my personal opinion is that the Stat lock walks away the leader. I'm always amazed to see / hear nurses say they prefer to tape an I.V. site the old fashion way. It isn't beneficial to the patient no matter how used to doing it those nurses may be.
Having a product like that which would also limit risk of infection would be fabulous! Unfortunately (?), healthcare is a business and if any company wants to sell it's product wide scale it better beat the compatitions price, or have hard clinical evidence that it will save the system money by reducing risk.
On a side note about I.V.'s. Just wanted to remind nurses that any patient you get who had a field placed (I.V. placed at the scene or on the way to the hospital) needs a new I.V. placed immediately once stabalized. Field sticks are associated with much greater numbers of infections.
singingtothewheat wrote:I've been a nurse for 17 years. I now work on a very busy Ortho/Surg floor in a trauma center. Our hospital uses the stat lock / tegaderm products and I'm pretty pleased with that. When you stack it up against the whole Chevron securing method my personal opinion is that the Stat lock walks away the leader. I'm always amazed to see / hear nurses say they prefer to tape an I.V. site the old fashion way. It isn't beneficial to the patient no matter how used to doing it those nurses may be.
Having a product like that which would also limit risk of infection would be fabulous! Unfortunately (?), healthcare is a business and if any company wants to sell it's product wide scale it better beat the compatitions price, or have hard clinical evidence that it will save the system money by reducing risk.
On a side note about I.V.'s. Just wanted to remind nurses that any patient you get who had a field placed (I.V. placed at the scene or on the way to the hospital) needs a new I.V. placed immediately once stabalized. Field sticks are associated with much greater numbers of infections.
Hey Everyone:
I've not been here in awhile as my firm has been showing the new IV securement device around the country with great feedback from Statlock users and died in the wool tape users.
Since I started this thread almost 2 years ago a lot has transpired in the industry and the number of CRBSI's and Staph infections has gone through the roof. From a legal standpoint the numbers of lawsuits against hospitals where a patient has been injured or died as a result of some form of infection, particularly Staph infection, is mounting and is really going to impact the industry.
Staph is a huge problem, and it is everywhere in the hospital. Catheters are now shown clearly to be infected by the healthcare worker with Staph, due to the environment. This means that it is clearly necessary to apply a dressing/securement device over the catheter that offers some type of anti-microbial to kill the contamination placed by the healthcare worker.
To your point singingtothewheat, we have been working with first responders and they are in fact changing their thinking about IV's, how to dress them, securing them against infection, etc.
In fact they are now seriously considering changing they way they teach all new EMT's and moving away from the tape and gauze technique to our peel and stick technology similar to Tegaderm, only easier to remove and restick, and offering an anti-microbial.
I would like to offer samples to anyone who would like to try them, simply respond here within this forum and I'll be glad to send sample for your review. Obviously we would like to hear your feedback so please don't request samples if your not willing to give us some feedback.
Thanks
Rick
