Securement for vascular access devices: looking to the future

form a necessary component of health care; up to 90% of patients admitted to hospital require insertion of a device to enable the administration of therapies, monitoring and diagnostics (Alexandrou et al, 2015; iData Research, 2015). The range of devices inserted is as diverse as the clinical conditions they are used for: peripheral intravenous catheters (PIVCs), midlines, peripherally inserted central catheters (PICCs), nontunnelled and tunnelled central venous access devices (CVADs), totally implanted devices and many more specialty devices. These vary in shape and function, but across all types a basic characteristic prevails: a VAD is a foreign body, and something needs to stop it becoming dislodged, either accidentally or intentionally. Traditionally, clinicians focused on VAD dressings, rather than thinking about securement (Ullman et al, 2015a). Gauze or plastic (polyurethane) dressing products are used to cover the insertion wound to prevent contact with the environment to prevent infection. However, contemporary literature has brought attention to the common problem of accidental peripheral and central VAD dislodgement. For every 100 devices, 5-6% will be lost owing to dislodgement (Wallis et al, 2014; Ullman et al, 2015b). Clinical trials and meta-analysis comparing gauze and polyurethane products in PIVCs and CVADs (Ullman et al, 2015c, Marsh et al, 2015a) have not shown any difference in the prevention of device failure between the products. In addition, a laboratory study demonstrated that polyurethane products added no extra security against dislodgement Securement for vascular access devices: looking to the future