Comparison of perineural catheter fixation methods: a volunteer study

Continuous peripheral nerve block catheters provide prolonged analgesia but secondary catheter failure is frequent due to dislocation or withdrawal of the [1]. A healthy volunteer study showed rate perineural was 25% for femoral and 5% interscalene after 6 h physical movements [2]. Dislocation rates are likely higher in patients, affected by design, anatomic site, patient movement method fixation [3, 4]. Various techniques have been described, including use topical skin adhesive, closure strips, adhesive sprays, dressings, anchoring devices tunnelling. Overall, there a lack consistency no accepted standards regarding fixation. Another common clinical problem disconnection from connector friction between 20-G male tubing female Touhy-Borst adaptor clamp [5]. This may result early removal concern infection. compared strength various methods using commercially available materials. After institutional review board approval, were placed subcutaneous fat thigh six adult volunteers secured one (Table 1). Following fixation, portable digital scale (Nonzers; Xiamen Wopin E-Commerce Co., Xiamen, China; sensitivity 0.05 N) used measure force required dislodge catheter. The connection connecter also evaluated four securement methods. We distribution variables Kruskal-Wallis test equality proportions. performed post-hoc analysis pairwise Wilcoxon rank-sum tests with Bonferroni correction multiple comparisons techniques. value p < considered significant. median dislocate at insertion site significantly different among groups (p = 0.001; Fig. Use glue Steri-Strip did not increase combined transparent dressing, (glue), medical spray greatest (IQR [range]) 8.6 N (8.3–9.2 [7.2–10.9 N]). Addition increased 21.2 (20.9–22.0 [20.7–23.2 N]) control (14.6 (13.1–15.8 [12.8–18.4 N]); 0.003). Topical glue, 2-octylcyanoacrylate, sterile liquid that polymerises application within minutes forms waterproof bond keratin epidermis. this first described 2003 [6]. Application 2-octylcyanoacrylate has shown decrease incidence leakage catheters; however, our show contributed dressing [7]. Admittedly, we migration over time, blood, sweat local anaesthetic play large role promoting and/or dislocation. Placement prevent infusate leakage, seal around polymer improve integrity overlying bandages thus indirectly promote found wrapping improved connection. underestimated effect reinforcement, as every broke before clamp, essentially eliminating point weakest link. It appear addition Our several limitations. small sample size. Catheters only, data might be generalisable other body sites, such upper torso where placement difficult impossible. Further, subcutaneously minimise risk harm subjects; reduced patients through muscles deeper structures. Finally, exercise infusion fluid which limits translation into true practice. In conclusion, results strongest ideal when clinically feasible chlorhexidine Tegaderm, (glue) either benzoin spray. recommend reinforcing Steri-Strip. AK DM received research funding Pacira Biosciences. JG personal fees Biosciences grants Mallinkrodt Pharmaceuticals. Institutional approval obtained Duke University Medical Center February 2017, registered prospectively on ClinicalTrials.gov (ID NCT03375190). No competing interests declared.