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49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting
March 21-23, 2024 | The Hilton Bayfront San Diego | San Diego, California
5454
QUANTIFYING STRENGTH OF COMMONLY EMPLOYED PERIPHERAL NERVE AND EPIDURAL CATHETER SECUREMENT METHODS
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Scientific Abstracts > Regional Anesthesia
Quantifying Strength of Commonly Employed Peripheral Nerve and Epidural Catheter Securement Methods
Jessica Liu, DO1; Kevin Tsai, MD2; Terry James Biel, MD2; Rana Movahedi, MD1
1Department of Anesthesiology & Perioperative Medicine
University of California, Los Angeles
2Department of Anesthesiology & Perioperative Medicine
Cedars-Sinai Medical Center
Introduction
§Epidural and peripheral nerve blocks provide effective postoperative analgesia for a variety of surgical procedures.
§Peripheral nerve catheters are associated with improved pain control with lower opioid requirements and higher patient satisfaction scores compared with single shot nerve blocks1.
§Reliable securement prevents premature or accidental dislodgement of nerve catheters.
§Several commercial adhesives are commonly utilized as adjuncts to decrease the incidence of catheter migration at the skin:
§2-octyl cyanoacrylate (Dermabond)
§Gum mastic, styrax, alcohol, and methyl salicylate (Mastisol)
§Reinforced skin-closure strips (Steri-strips)
§Our goal is to evaluate the effectiveness of several types of dressings and methods for securement in an in-vitro model by quantifying the force in Newtons required for catheter dislodgement using a force gauge.
Materials and Methods
§Regional and obstetric anesthesiologists from several academic institutions were polled on peripheral nerve and epidural catheter securement methods utilized in their practice, with the following most popular variations:
§transparent film dressing (Tegaderm) + 2-octyl cyanoacrylate (CA) + gum mastic, styrax, alcohol, and methyl salicylate (GM) + reinforced skin closure strips (SS) in cross-hatch pattern
§transparent film dressing + GM adhesive + SS flush to skin
§These were compared against a control securement method: transparent film dressing only
§Catheters were inserted through a silicone and foam model and secured at depth of 10cm using each method.
§With the distal end of the catheter fixed to a force gauge, steady traction was applied at a 45-degree angle until force-to-failure was achieved.
§Force-to-failure: force applied in Newtons until catheter migration of at least 1cm at the skin, or complete dislodgement of catheter from the model.
§Ten measurements were collected for each securement method.
§Data was analyzed by 1-way ANOVA and Tukey’s Honestly Significant Difference (HSD) test, each using an alpha value of 0.05.
§Statistical analysis was performed in Python 3 using SciPy version 1.11.4.
Results
§Force to catheter failure was significantly lower in the Tegaderm only control group compared with the Tegaderm + CA + GM + SS group (p < 0.001), as well as compared with the Tegaderm dressing + GM + SS group (p < 0.001).
§ Significantly less force was also required to dislodge catheters in the Tegaderm + GM + SS group compared with the group with CA adhesive added (p = 0.002).
Discussion
§Premature dislodgement may place patients at increased risk for adverse outcomes:
§potential epidural hematoma development in the setting of recent anticoagulation administration2
§infection at an exposed catheter insertion site3
§lower patient satisfaction
§2-octyl cyanoacrylate glue has been found to improve maintenance of catheter-to-nerve apposition when compared with gum mastic-based liquid adhesive4, as well as decrease the incidence of peri-catheter leakage compared with fixation with skin-closure strips5.
§From our literature search, there is little quantitative evidence to suggest the combination of several commonly used adhesives is superior in preventing migration at the skin, or if a more elaborate application of adhesive strips offers better catheter securement than straightforward applications.
Conclusion
§Our results suggest that using a combination of skin adhesives significantly increases the strength needed for catheter dislodgement.
References
1.Bingham AE, Fu R, Horn JL, Abrahams MS. Continuous peripheral nerve block compared with single-injection peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials. Reg Anesth Pain Med. 2012 Nov-Dec;37(6):583-94. doi: 10.1097/AAP.0b013e31826c351b. PMID: 23080349.
2.Horlocker TT, Wedel DJ, Rowlingson JC, Enneking FK, Kopp SL, Benzon HT, Brown DL, Heit JA, Mulroy MF, Rosenquist RW, Tryba M, Yuan CS. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med. 2010 Jan-Feb;35(1):64-101. doi: 10.1097/aap.0b013e3181c15c70. PMID: 20052816.
3.Kumar N, Chambers WA. Tunnelling epidural catheters: a worthwhile exercise? Anaesthesia. 2000 Jul;55(7):625-6. doi: 10.1046/j.1365-2044.2000.01645.x. PMID: 10919415.
4.Auyong DB, Cantor DA, Green C, Hanson NA. The Effect of Fixation Technique on Continuous Interscalene Nerve Block Catheter Success: A Randomized, Double-Blind Trial. Anesth Analg. 2017 Mar;124(3):959-965. doi: 10.1213/ANE.0000000000001811. PMID: 28151818.
5.Chalacheewa T, Arnuntasupakul V, Sangkum L, Buachai R, Chanvitayapongs J. Decreasing leakage during continuous femoral nerve catheter fixation using 2-octyl cyanoacrylate glue (Dermabond®): a randomized controlled trial. BMC Anesthesiol. 2021 Jun 11;21(1):169. doi: 10.1186/s12871-021-01386-7. PMID: 34116637; PMCID: PMC8194114.