Bugden, S et al. Skin glue reduces the failure rate of emergency department-inserted peripheral venous catheters: a randomized controlled trial. Annals of Emergency Medicine. 2015 Dec 31. pii: S0196-0644(15)01535-8 (epub ahead of print)

33-69% of peripheral IVs eventually fail due to infection, phlebitis, occlusion, or dislodgment. A novel approach is use of medical grade cyanoacrylate skin glue at the insertion site. Its effectiveness has been reported for central lines, arterial lines and epidural lines. Cyanoacrylate also has antimicrobial properties which may reduce risk of infection. (Dermabond is 2-octyl cyanoacrylate.)

Hypothesis: Addition of skin glue to the peripheral IV insertion site will reduce the 48-hour IV failure rate.

Population: 380 patients 18 and older at a 52,000-annual visit community hospital 50 km north of Brisbane, Australia. Of note, patients with a high likelihood of intentional peripheral venous catheter removal were excluded.

Method: 2-arm, randomized, nonblinded superiority trial from November 2012 to March 2013. In the intervention group, the research nurse added the skin glue to a patient in whom the IV had already been inserted and secured. (Interesting…)

Primary outcome: IV failure rate at 48 hours, defined as 1 or more of the following: dislodgment, infection, phlebitis or occlusion. Any replacement was considered a device failure.

Results: Failure rate was 17% in the intervention group and 27% in the standard care group (CI -18% to -2%, p = 0.02). Failure rate by dislodgment was 7% in the intervention group and 14% in the standard care group.  (CI -13% to 0)
Failure by occlusion and phlebitis were the same in both groups.
There were no reported adverse effects of the skin glue.

Future questions:
Does the addition of skin glue reduce the IV failure rate at 48 hours in children?
Does the addition of skin glue in children or adults reduce the IV dislodgment rate during the ED visit for patients who are discharged?
Is the addition of skin glue to the peripheral IV catheter insertion cost-effective?
Does the dislodgment rate drop even further when the skin glue is applied at the time of insertion rather than dislodging an already attached peripheral IV?