Nicole Marsh, Catherine O'Brien, Emily N Larsen, Evan Alexandrou, Robert S Ware, India Pearse, Fiona Coyer, Maharshi S Patel, Ruth H Royle, Claire M Rickard, Kellie Sosnowski, Patrick N A Harris, Kevin B Laupland, Michelle J Bauer, John F Fraser, Craig McManus, Joshua Byrnes, Amanda Corley
{"title":"Securing Jugular Central Venous Catheters With Dressings Fixed to a Liquid Adhesive to Prevent Dressing Failure in Intensive Care Patients (the STICKY Trial): A Randomized Controlled Trial.","authors":"Nicole Marsh, Catherine O'Brien, Emily N Larsen, Evan Alexandrou, Robert S Ware, India Pearse, Fiona Coyer, Maharshi S Patel, Ruth H Royle, Claire M Rickard, Kellie Sosnowski, Patrick N A Harris, Kevin B Laupland, Michelle J Bauer, John F Fraser, Craig McManus, Joshua Byrnes, Amanda Corley","doi":"10.1097/CCM.0000000000006533","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Central venous catheters (CVCs) are vital for treating ICU patients. However, up to a quarter of CVCs fail from mechanical or infective complications. Poor securement of CVCs to the skin contributes to catheter failure, particularly CVCs placed in the jugular vein, which are highly vulnerable to pullout forces. This study evaluated the effectiveness of medical liquid adhesive (MLA) for improving jugular CVC dressing adhesion.</p><p><strong>Design: </strong>Multisite parallel group, superiority, randomized controlled trial.</p><p><strong>Setting: </strong>Four metropolitan Australian ICUs.</p><p><strong>Patients: </strong>Eligible patients were 18 years old or older, within 12 hours of jugular CVC insertion, expected to need the CVC for greater than or equal to 72 hours, and remain in ICU for greater than or equal to 24 hours.</p><p><strong>Interventions: </strong>Patients were randomly allocated (stratified by hospital and gender) to standard CVC dressings with the application of MLA to skin under the dressing border (intervention) or standard care CVC dressings (control).</p><p><strong>Measurements and main results: </strong>The primary endpoint was dressing failure within 7 days due to lifting edges. Secondary outcomes included the total number of dressing changes, skin injury, and CVC failure. In total, 160 participants (82 control; 78 intervention) were enrolled. There were 22 (28%) and 41 (50%) cases of premature dressing failure in the intervention and control groups respectively (odds ratio, 0.39; 95% CI, 0.20-0.76; p = 0.005). The intervention group had fewer dressing changes (incidence rate ratio [IRR], 0.74; 95% CI, 0.55-0.99). Time to dressing failure (log-rank test; p = 0.12) and all-cause CVC failure (IRR, 1.44; 95% CI, 0.36-5.79) did not differ between groups. Three skin injuries occurred: one in the intervention (blister) and two in the control (maceration and skin tear) groups.</p><p><strong>Conclusions: </strong>MLA is associated with significantly decreased jugular CVC dressing failure and longer dressing dwell, with an acceptable safety profile. MLA should be considered to preserve jugular CVC dressings in ICU.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"53 2","pages":"e282-e293"},"PeriodicalIF":7.7000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801464/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/CCM.0000000000006533","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/21 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Securing Jugular Central Venous Catheters With Dressings Fixed to a Liquid Adhesive to Prevent Dressing Failure in Intensive Care Patients (the STICKY Trial): A Randomized Controlled Trial.
Objectives: Central venous catheters (CVCs) are vital for treating ICU patients. However, up to a quarter of CVCs fail from mechanical or infective complications. Poor securement of CVCs to the skin contributes to catheter failure, particularly CVCs placed in the jugular vein, which are highly vulnerable to pullout forces. This study evaluated the effectiveness of medical liquid adhesive (MLA) for improving jugular CVC dressing adhesion.
Patients: Eligible patients were 18 years old or older, within 12 hours of jugular CVC insertion, expected to need the CVC for greater than or equal to 72 hours, and remain in ICU for greater than or equal to 24 hours.
Interventions: Patients were randomly allocated (stratified by hospital and gender) to standard CVC dressings with the application of MLA to skin under the dressing border (intervention) or standard care CVC dressings (control).
Measurements and main results: The primary endpoint was dressing failure within 7 days due to lifting edges. Secondary outcomes included the total number of dressing changes, skin injury, and CVC failure. In total, 160 participants (82 control; 78 intervention) were enrolled. There were 22 (28%) and 41 (50%) cases of premature dressing failure in the intervention and control groups respectively (odds ratio, 0.39; 95% CI, 0.20-0.76; p = 0.005). The intervention group had fewer dressing changes (incidence rate ratio [IRR], 0.74; 95% CI, 0.55-0.99). Time to dressing failure (log-rank test; p = 0.12) and all-cause CVC failure (IRR, 1.44; 95% CI, 0.36-5.79) did not differ between groups. Three skin injuries occurred: one in the intervention (blister) and two in the control (maceration and skin tear) groups.
Conclusions: MLA is associated with significantly decreased jugular CVC dressing failure and longer dressing dwell, with an acceptable safety profile. MLA should be considered to preserve jugular CVC dressings in ICU.
期刊介绍：
Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient.
Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.
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