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TECHNOLOGY, COMPUTING, AND SIMULATION

The Efficacy of the Arrow Staple Device for Securing Central Venous Catheters to Human Skin

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland

Address correspondence to Gregg K. Motonaga, MD, Department of Anesthesiology and Critical Care Medicine, Blalock 1410, 600 N. Wolfe St., Baltimore, MD 21287-4963. Address e-mail to gkm{at}alum.mit.edu Reprints will not be available from the authors.

We tested the hypothesis that the force necessary to dislodge a central venous catheter from human skin is related to its method of attachment. Specifically, we compared the peak axial force and torque required to remove a catheter hub attached to human skin with 2 3-0 silk sutures, 4 0.022-in. staples, or 4 0.025-in. staples. We used the tissue from the proximal end of discarded extremities after below-knee amputations to serve as a surrogate for the skin of living humans that would normally be the site for catheter stabilization. Central venous catheter hubs were secured to the area of grossly normal appearing tissue with 2 3-0 silk sutures or 4 staples. For each attachment method, 16 dislodgement trials were conducted. The mean peak force required for axial dislodgement with 3-0 silk sutures (40.9 ± 10.7 N; n = 16) was more than that for 4 0.022-in. staples (34.0 ± 7.2 N; n = 16;P = 0.04) but was not different from that for 4 0.025-in. staples (40.4 ± 5.8 N; n = 16). The major finding of this study is that securing a central venous hub with 4 0.025-in. staples is as effective as 2 3-0 silk sutures in preventing axial dislodgement.

IMPLICATIONS: Suturing central venous catheters to the skin exposes health care workers to unnecessary risks of needlestick injury. We compared the efficacy of an alternative attachment method using staples with the widely accepted suture method. Determining the anchoring strength of staples is important because there may be substantial risk and difficulty reinserting inadvertently dislodged catheters.