Key messages
– We are very uncertain whether different dressings and securement devices reduce the risk of peripheral arterial catheter complications or failure.
– We found five studies that investigated this, but we are not very confident in their results due to small sample sizes and few outcome events.
– Future research should compare products currently used to secure and dress arterial catheters in hospitals, with high-quality methods and large numbers of people receiving catheters.
– It is important for patients and caregivers to discuss the risks and benefits of different arterial catheter dressing and securement devices with their healthcare provider. The healthcare provider can help the patient choose the best device for their individual needs.
What are peripheral arterial catheters?
Peripheral arterial catheters are thin tubes that are inserted into a patient's arteries through their skin. They are generally used in intensive and critical care settings or in operating theatres to monitor blood pressure or when a patient's blood needs to be regularly sampled. These patients may be critically unwell and require the catheter to support care.
Despite their importance, arterial catheters often fail (stop working) and need to be reinserted. There are many different dressings and securement devices that aim to keep arterial catheters in place and fully functioning. It is not clear which dressings or securement devices are the most effective for maintaining arterial catheter function and preventing arterial catheter complications.
What did we want to find out?
We wanted to find out which dressings or securement devices were the most effective for preventing arterial catheters from stopping working due to infection and complications including dislodgement, occlusion (blockages), and unwanted effects in hospitalised people.
What did we do?
We searched for well-designed studies that compared different types of dressings and securement devices for arterial catheters. We then compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and sizes.
What did we find?
We found five studies that involved 1228 people with 1228 arterial catheters. The studies compared different dressing and securement devices and included the following four comparisons.
1. Standard polyurethane plus tissue adhesive versus standard polyurethane (clear (transparent) dressing with medical grade 'super glue' versus clear dressing)
2. Bordered polyurethane versus standard polyurethane (bordered dressing versus clear dressing)
3. Standard polyurethane plus sutureless securement devices versus standard polyurethane (clear dressing with skin anchor device versus clear dressing)
4. Integrated securement dressings versus standard polyurethane (bordered dressing with additional securement dressing versus clear dressing)
Main results
We are uncertain whether use of the following dressing and securement products reduces the risk of arterial catheter failure or catheter-related bloodstream infection: standard polyurethane, bordered polyurethane, tissue adhesive, sutureless securement devices, and integrated securement dressings.
We are also uncertain if using the above dressings and securement products reduces the risk of arterial catheter dislodgement, blockages, or adverse (unwanted) events; or if these products lead to improved patient satisfaction.
What are the limitations of the evidence?
We are not very confident in the current available evidence because of the low number of participants included and few events in these studies. Due to the nature of the intervention, participants and investigators were aware of which treatment participants received. This could have had an effect on the way that participants who received different interventions were treated. Further trials could examine the effect of dressing and securement products in more defined populations, including children and newborn babies. In addition, a standardised set of outcomes would support researchers to measure the same outcomes, across similar measurement points to help data collection. The evidence in this field is evolving and future research may help address unanswered clinical questions.
How up to date is this evidence?
The evidence is up to date to 16 May 2023.
There is currently limited rigorous RCT evidence available about the relative clinical effectiveness of AC dressing and securement products. Limitations of current evidence include small sample size, infrequent events, and heterogeneous outcome measurements. We found no clear difference in the incidence of AC failure, CRBSI, or adverse events across AC dressing or securement products including SPU, BPU, SSD, TA, and integrated securement products. The limitations of current evidence means further rigorous RCTs are needed to reduce uncertainty around the use of dressing and securement devices for ACs.
Peripheral arterial catheters (ACs) are used in anaesthesia and intensive care settings for blood sampling and monitoring. Despite their importance, ACs often fail, requiring reinsertion. Dressings and securement devices maintain AC function and prevent complications such as infection.
To evaluate the effectiveness of peripheral AC dressing and securement devices to prevent failure and complications in hospitalised people.
We searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL Plus up to 16 May 2023. We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform up to 16 May 2023.
We included randomised controlled trials (RCTs) comparing different dressing and securement devices for the stabilisation of ACs in hospitalised people.
Two review authors independently selected trials for inclusion, extracted data, and assessed risk of bias using Cochrane's RoB 1 tool. We resolved disagreements by discussion, or by consulting a third review author when necessary. We assessed the certainty of evidence using GRADE.
We included five RCTs with 1228 participants and 1228 ACs. All included studies had high risk of bias in one or more domains. We present the following four comparisons, with the remaining comparisons reported in the main review.
Standard polyurethane (SPU) plus tissue adhesive (TA) compared with SPU: we are very uncertain whether use of SPU plus TA impacts rates of AC failure (risk ratio (RR) 0.44, 95% confidence interval (CI) 0.20 to 0.98; I² = 0%; 2 studies, 165 participants; very low-certainty evidence). Neither study (165 participants) reported catheter-related bloodstream infections (CRBSI), thus we are very uncertain whether SPU plus TA impacts on the incidence of CRBSI (very low-certainty evidence). It is very uncertain whether use of SPU plus TA impacts AC dislodgement risk (RR 0.54, 95% CI 0.03 to 9.62; I² = 44%; 2 studies, 165 participants; very low-certainty evidence). We are very uncertain whether use of SPU plus TA impacts AC occlusion rates (RR 1.20, 95% CI 0.37 to 3.91; I² = 3%; 2 studies, 165 participants; very low-certainty evidence). We are very uncertain whether use of SPU plus TA impacts rates of adverse events with few reported events across groups (RR 0.89, 95% CI 0.09 to 8.33; I² = 0%; 2 studies, 165 participants; very low-certainty evidence).
Bordered polyurethane (BPU) compared to SPU: we are very uncertain whether use of BPU impacts rates of AC failure (RR 0.67, 95% CI 0.21 to 2.13; 1 study, 60 participants; very low-certainty evidence). BPU may make little or no difference to CRBSI compared to SPU (RR 3.05, 95% CI 0.12 to 74.45; I² = not applicable as 1 study (60 participants) reported 0 events; 2 studies, 572 participants; low-certainty evidence). BPU may make little or no difference to the risk of AC dislodgement compared with SPU (RR 0.75, 95% CI 0.17 to 3.22; I² = 0%; 2 studies, 572 participants; low-certainty evidence). BPU may make little or no difference to occlusion risk compared with SPU (RR 0.80, 95% CI 0.60 to 1.07; I² = 0%; 2 studies, 572 participants; low-certainty evidence). It is very uncertain whether BPU impacts on the risk of adverse events compared with SPU (RR 0.33, 95% CI 0.01 to 7.87; 1 study, 60 participants; very low-certainty evidence).
SPU plus sutureless securement devices (SSD) compared to SPU: we are very uncertain whether SPU plus SSD impacts risk of AC failure compared with SPU (RR 0.78, 95% CI 0.40 to 1.52; I² = 0%; 2 studies, 157 participants; very low-certainty evidence). We are very uncertain if SPU plus SSD impacts CRBSI incidence rate with no events in both groups (2 studies, 157 participants; very low-certainty evidence). It is very uncertain whether SPU plus SSD impacts risk of dislodgement (RR 0.14, 95% CI 0.01 to 2.57; I² = not applicable as 1 study (96 participants) reported 0 events; 2 studies, 157 participants; very low-certainty evidence). It is very uncertain whether SPU plus SSD impacts risk of AC occlusion (RR 1.94, 95% CI 0.50 to 7.48; I² = 38%; 2 studies, 157 participants; very low-certainty evidence). We are very uncertain whether SPU plus SSD impacts on the risk of adverse events (RR 1.94, 95% CI 0.19 to 20.24; I² = not applicable as 1 study (96 participants) reported 0 events; 2 studies, 157 participants; very low-certainty evidence).
Integrated securement dressings compared to SPU: integrated securement dressings may result in little or no difference in risk of AC failure compared with SPU (RR 1.96, 95% CI 0.80 to 4.84; 1 study, 105 participants; low-certainty evidence); may result in little or no difference in CRBSI incidence with no events reported (1 study, 105 participants; low-certainty evidence); may result in little or no difference in the risk of dislodgement (RR 0.33, 95% CI 0.04 to 3.04; 1 study, 105 participants; low-certainty evidence), may result in little or no difference in occlusion rates with no events reported (1 study, 105 participants; low-certainty evidence), and may result in little or no difference in the risk of adverse events (RR 0.35, 95% CI 0.01 to 8.45; 1 study, 105 participants; low-certainty evidence).