Vascular Access Research Services
Securement devices and adhesive dressings serve a critical role in protecting IV catheters. While securements are becoming stronger and more robust, no securement can protect the catheter when large macro forces are applied to the IV tubing. To understand the force at which IV catheters begin to be threatened by pull forces on the IV line, four of the industry leading securement devices were tested in a pig skin model.
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Test Method
Young pig skin with the hair shaved off was draped and secured over a three-inch diameter PVC pipe that was cut in half to simulate a human arm. An IV catheter was installed and secured according to the instructions for use for each of the four top selling adhesives that represent over 75% of US market share. A constant force pulling at 1 meter/minute was applied from three different angles until the catheter failed. The pull was repeated seven times for each securement device from each of the three angles for a total of 21 pull tests performed for each adhesive. To the right is a video showing a sample of how the study was conducted.
Study Results
The hand in the chart to the right shows the angle from which the pull occurred in the 90 degree shear pull test The force at which the catheters had a loss of function, which was defined as pulling out of the skin 1 cm or torqueing to an angle greater than 45 degrees, is indicated by a circle on the graph. The point of initial dressing disruption is indicated by a square, and the point at which the catheter completely dislodged is indicated by the line dropping to zero. The data from all 7 pulls was averaged to create a line for each securement device in the chart, and a chart produced for each angle of pull. As was expected, the performance of the securement devices varied. The design and construct of each device had a large impact on its performance. For instance, one piece securements like StatLock performed more poorly when pulled at certain angles when compared to integrated two-piece securements like Tegaderm 1683 and Sorbaview PIV.
Consistently, forces slightly above 4 lbs led to either dressing disruption, loss of catheter function and with one securement, full dislodgement. Full dislodgement with the other securements tended to occur at forces greater than 8 lbs. Forces above 8 lbs were shown to dislodge the catheter, but other mechanical complications occur before dislodgement. Based on the study results, it appears that forces between 4 and 8 lbs can compromise the catheter, possibly precipitating or directly causing phlebitis, occlusion and/or infiltration.
Some normal or safe forces placed on an IV catheter are acceptable and occur with activities of daily living. There are clearly dangerous forces that lead to dislodgement of the IV catheter, and other forces can occur in the spectrum between normal and dangerous forces, which are referred to as harmful forces. These zones of forces vary by securement design. The full data set from the study is presented in the chart below and shows the averages from all the pulls with descriptions of the force categories.
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