Experience of using cyanoacrylate glue to secure midline and centrally inserted central catheters: a retrospective analysis of 57 cases

Introduction

The fixation of vascular access devices (VADs) is an important challenge in clinical practice, which affects the duration of its maintenance and the risk of preventable complications, and thus optimizes the cost of care and increases patient satisfaction [1, 2]. In addition to proper physical stabilization, it is equally important to effectively secure the catheter exit-site from the skin, which has a significant role in preventing infections and minimizing the risk of bleeding and the need for premature dressing changes [1, 2]. One solution in this regard, gaining increasing popularity, is the use of tissue adhesives (TA) called “cyanoacrylate glue” as an adjunct to basic vascular access stabilization techniques [1, 2].
Tissue adhesives are a group of fast-polymerizing cyanoacrylate-based adhesives that have been widely used in a variety of fields, including industry, everyday use and medicine [3, 4]. The history of cyanoacrylates dates back to 1947, when they were developed for potential military use. The breakthrough for clinical practice came in 1998, when cyanoacrylate glues were officially approved for use in medicine [3, 4]. Since then, they have begun to be seen as a modern alternative to classic methods of wound closure, such as surgical sutures, which translated into shorter healing times and reduced risk of infection, among other things. In 2012, the innovative use of TA to secure vascular access was introduced. This solution has contributed to increasing the level of patient safety and improving the comfort of therapy, becoming an important part of securing the cannulation site [3, 4].
Tissue adhesives are increasingly being used as an adjunct to standard vascular catheter fixation, in combination with a transparent semi-permeable membrane (TSM) [2]. Application of the adhesive within the catheter’s exit-site from the skin leads to an effective seal, facilitating hemostasis and reducing potential leakage. The resulting polymer layer acts as an antimicrobial barrier, thereby reducing the risk of catheter-associated bloodstream infection (CABSI) [2]. Tissue adhesives are also being used as an alternative to traditional methods of mechanical stabilization, such as surgical sutures [2, 5]. They are combined with adhesive sutureless fixation systems, enhancing their effectiveness and durability. In the context of minimizing the risk of infection and improving patient comfort, this form of stabilization can be an important part of a strategy to prevent vascular access complications [5–7].
The aim of the study was to analyze the efficacy of tissue adhesive in patients with midline catheters (MCs) and centrally inserted central catheters (CICCs) inserted by the vascular access team (VAT), and to determine whether coagulation parameters affected premature TA removal.

Material and methods

The study was retrospective in nature. The subjects of the analysis were 57 cannulation and observation charts maintained by VAT and medical staff at a university hospital in Poland from October 2024 to January 2025. The study was approved by the Bioethics Committee (AKBE/103/2023).

Patient eligibility

Assessment of patient eligibility for tissue adhesive application was performed by the VAT. The patients most commonly selected for the procedure were those with reduced platelet (PLT) levels or those taking anticoagulants. Based on the initial clinical assessment, a VAT member made the decision to apply TA.

Tissue adhesive application

Secure Port IV tissue adhesive (Adhezion Biomedical, USA), containing butyl cyanoacrylate, was used to secure the MC or CICC exit-site in according to the current hospital procedure. The product was applied immediately after the cannulation procedure, after confirming the correct position of the catheter and before the TSM was applied (Figs. 1 and 2). Tissue adhesives were applied using the aseptic non-touch technique (ANTT) directly to the catheter exit site after cleaning and thoroughly drying the skin. After assessing the exit site, a thin layer of glue was applied around the catheter using an applicator held vertically, covering the skin on each side. Excess product was avoided. After application, the adhesive was allowed to completely dry for 30–60 seconds, without contacting the application site. A TSM was then applied. Excess adhesive was used to strengthen the adhesion of the TSM. The procedure was applied uniformly to all patients who underwent MC or CICC implantation.

Data collection

After administering TA, the VAT member made an observation card record of the VAD. Throughout the period of intravenous therapy, the VAT conducted routine observation and evaluation of the condition of the TSM and the skin around it, with particular attention to monitoring for potential bleeding at the catheter exit-site from the skin. In the event of a TSM change or a decision to remove the vascular access, an appropriate entry was made in the documentation.
After data collection was completed, the following variables were analyzed: the patient’s age, height and weight, the reason for hospitalization, the vein being cannulated, the location of the catheter’s exit from the skin according to the Zone Insertion Method™ (ZIM™), the depth of the vein’s location, the diameter of the cannulated vein, the values of laboratory parameters (PLT, APTT, INR), whether anticoagulants were used, the occurrence of bleeding at the site of the catheter’s exit from the skin, and the type of fixation and TSM used.
Tests for measuring normality of distribution, the t-test and the Kruskal-Wallis test were used for statistical analysis. The level of statistical significance was set at p < 0.05. Calculations were performed using the statistical package IBM SPSS Statistics 29.

Results

The mean age of the patients was 58.9 years (range 18–93, SD = 19.9). Cyanoacrylate glue was used in 57 patients of internal medicine and surgical wards, in whom MCs (n = 49; 86%) and CICCs (n = 8; 14%) were inserted (Table 1). In 75.5% of patients (n = 43), TA successfully secured the catheter exit-site from the skin for the required time. In 54.4% of cases (n = 31) the TA, according to the local procedure, was removed routinely during the TSM change on day 7 after insertion, while in 21.1% (n = 12) the reason for earlier removal of the TA was patient discharge, death or catheter removal. The need for early TSM change due to fluid or blood leakage affected 24.6% of cases (n = 14), including 4 cases (28.5%) related to fluid leakage and 10 cases (71.5%) related to blood leakage. Protectfilm TSM was used in 71.9% (n = 41) of cases, Tegaderm in 22.8% (n = 13), and Tegaderm with chlorhexidine was used in 3 cases (5.3%). Adhesive sutureless fixation systems were used to fix 87.7% (n = 50) of all midline catheters, and surgical sutures were used in 7 CICCs (12.3%).
Platelet count averaged 207.09 (min. 3, max. 603, SD = 120.69), APTT 28.71 (min. 15.5, max. 43.5, SD = 5.57), and INR 1.07 (min. 0.87, max. 2, SD = 0.17). Tissue adhesive dwell time averaged 4.91 days (min. 1, max. 10, SD = 2.43) and was statistically significantly lower than expected (< 7 days, p < 0.0001). The reason for adhesive removal was not dependent on the level of any of the coagulation parameters (p > 0.05). There were no complications reported in the records related to the mere application of glue to the skin near the catheter exit-site from the skin.

Discussion

The results of the study showed that the use of cyanoacrylate glue in the area of the VAD can be an effective complement to standard methods of fixation, such as TSM and adhesive sutureless fixation systems. The average adhesive dwell time was 4.91 days, which is lower than the possible 7 days recommended by the manufacturer. Nonetheless, the reduced TA dwell time did not negatively affect the functional period of the vascular access. In addition, the correlation analysis between glue maintenance time and coagulation system parameters (PLT, APTT, INR) showed no significant relationship. This result suggests that the use of cyanoacrylate glue is also safe in patients with coagulation disorders. Similarly, as demonstrated in the CIANO-ETI randomized clinical trial, the use of cyanoacrylate glue in combination with a seamless fixation system significantly reduces peri-catheter bleeding and catheter displacement during the first 24 hours after implantation [8]. Similar benefits were also reported in a retrospective study by Karate et al., where the use of cyanoacrylate glue helped reduce the rate of VAD removal due to infection [7]. In patients with coagulation disorders, effectively securing vascular access is often a significant clinical challenge. The lack of a significant correlation between adhesive retention time and coagulation parameters confirms the feasibility of safe TA use in patients with coagulation disorders. Similar findings were presented by Zhang and colleagues; TA used in patients taking anticoagulants effectively stopped bleeding without negatively affecting coagulation time [9]. In consideration of these results, our study confirms that TA is a safe and effective solution for securing vascular access in patients with coagulation disorders, which may contribute to improving the quality of care for this group of patients.
In conclusion, the data obtained support the usefulness of TA as a support for securing VADs, especially in groups of patients at risk of bleeding. However, further research is needed to clearly define its role in the standard of care for patients requiring infusion therapy.

Conclusions

The use of cyanoacrylate-based tissue adhesive in securing vascular access in hospitalized patients may be an effective and safe complement to standard fixation methods. Observations indicate its usefulness especially in cases of increased bleeding risk and in populations with coagulation disorders. Despite a shorter-than-expected adhesive dwell time, its use was not associated with significant local complications. Further prospective studies involving larger groups of patients are needed to make clear recommendations for the routine use of TA in clinical practice.

Limitations

This study has several limitations. First, its retrospective design may limit the accuracy and completeness of the collected data. Second, the documented reasons for TSM changes on vascular access devices may not always reflect the actual clinical circumstances, as discrepancies between medical records and real-world practice are possible.

Disclosures

1. Institutional review board statement: The study was approved by the Bioethics Committee (AKBE/103/2023).
2. Assistance with the article: None.
3. Financial support and sponsorship: None.
4. Conflicts of interest: None.

References