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Stabilization of venous access: what is the reason to do better?

To begin this article, I propose a reflection: what are we doing to improve the patient experience? If we consider the pediatric population, we need to understand that the parents' anxiety is that the little ones do not suffer beyond what is necessary. Do you agree?

Well, after internalized considerations, we can take a look at some evidence. Several studies confirm that peripheral venous access devices are associated with early losses and frequent complications, and that the analysis of these indicators is always a warning sign. In addition, if the professional is not successful in the first attempt, stress is established between the professional and the patient. In the case of pediatric patients, the drama can be even greater if access is lost with the start of treatment.

Adequate catheter stabilization is recognized as one of the main interventions to decrease the occurrence of the risk of phlebitis and catheter displacement and can bring advantages for the prevention of infections as well, since the pathogenesis of IPCS is directly related to microbiota migration through the insertion site, among other factors. Stabilization devices without sutures prevent unnecessary injuries to the skin adjacent to the insertion site and can contribute to the reduction of colonization by bacteria. In addition, this type of device also significantly reduces the risk of accidents by sharps, also protecting the professional who is providing care.  

Considering pediatric patients, there are some specific characteristics in dressings and stabilization devices that must be considered. There is rarely a resistant bandage, in the size and shape compatible with babies and young children, who usually end up removing the device, even when they do not do it intentionally. Imagine when this access was only possible in a difficult place, for example in the shoulder or joint area ... 

Any device that is chosen for this purpose should facilitate regular site assessment to monitor for early signs of infiltration, leakage, phlebitis and local irritation. It must be easy to apply and remove, even in adverse conditions such as in a restless child in constant motion.  

The current national recommendations: Measures to Prevent Infection Related to Health Care ”, published by ANVISA in 2017 (National Health Surveillance Agency) reinforce that stabilization should always be performed using aseptic technique and that non-sterile adhesive tapes and sutures MUST NOT be used to stabilize peripheral catheters. They also state that two types of stabilization for peripheral catheters should be considered: polyurethane dressing with an edge over a catheter that already has a built-in stabilization device or specific adhesive device for stabilization over a traditional peripheral catheter. 

The international recommendations - the guidelines of the CDC of the United States - show the use of a transparent, sterile semipermeable dressing to cover the insertion site as Category IA. Regarding the use of devices without sutures to stabilize the catheters, he mentions that it reduces the risk of infections of intravascular catheters in general (Category II).

According to INS, in its practice standards (INS Standards of Practice, 2016 - S37), it recommends that vascular devices should be stabilized in a way that prevents complications and inadvertent loss of access, emphasizing that the methods used must not interfere in the evaluation and monitoring the insertion site of the access nor in the administration of the prescribed therapy and circulation of the punctured limb.

Taking into account all the evidence, it is essential to know a solution that is already available in Brazil.

Part 1- Stabilization pad

Foam base, adhesive, to accommodate the catheter connector, stabilizing peripheral access. It was designed to provide comfort and safety to the patient and minimize skin irritation. It creates a barrier between the catheter Luer connector and the patient's skin. It is compatible with most devices on the market. Its use provides adequate stabilization of vascular access. It allows adherence to recommendations for good care practices and meets the definition of “stabilization device” provided by the FDA / CDC and INS. 

Reinforced edge / prevents the edges of the dressing from curling and creates a barrier against the migration of microorganisms. 2

Part 2 - Transparent film

  • Visualization window at the puncture site / Does not interfere with the inspection / evaluation of the insertion site
  • Hypoallergenic adhesive / Adheres to the skin, allowing safe stabilization without causing damage
  • Bacterial and viral barrier / Selective permeability allows oxygen and moisture exchange.2
  • Dotted / perforated area - Assists when removing the dressing

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