Central Venous Catheter Securement Techniques: Suture Fixation Methods and Clinical Considerations

The illustration depicts a central venous catheter (CVC) secured to a patient’s skin using suture fixation, one of the most traditional and widely practiced methods for preventing catheter displacement and migration. This hand-drawn medical diagram shows the key components of proper CVC securement, with the catheter hub anchored to the skin via a suture through a dedicated suture wing or eyelet. Proper catheter securement is a critical aspect of central line management that directly impacts patient safety and catheter longevity. Inadequately secured catheters can lead to numerous complications including dislodgement, migration, venous thrombosis, and catheter-associated infections. While alternative securement methods such as adhesive devices and subcutaneous anchoring systems have been developed in recent years, suture fixation remains common practice in many clinical settings, particularly for short-term non-tunneled catheters used in acute care environments.

Understanding Central Venous Catheter Securement

Importance of Proper Fixation

Secure catheter fixation serves multiple critical functions in central venous access management. These functions directly impact patient outcomes and the utility of the central venous device.

• Properly secured catheters maintain consistent tip position at the cavoatrial junction, ensuring optimal flow dynamics and reducing risks of thrombosis and vessel wall irritation.
• Securement prevents accidental dislodgement during patient movement, transfers, or routine care activities, which can necessitate costly and risky catheter replacement procedures.

Despite its importance, catheter securement often receives less attention than insertion techniques or infection prevention bundles. This oversight can contribute to preventable complications and reduced catheter functional lifespan.

• Studies have shown that up to 15% of central venous catheters experience some form of securement failure during their dwell time.
• Each instance of securement failure increases infection risk, disrupts therapy, and may require catheter replacement with its associated costs and complications.

Suture Fixation Technique

The suture securement method illustrated in the image involves specific materials and techniques to achieve optimal results. This traditional approach requires careful execution to balance security with patient comfort.

• The typical suture material used is non-absorbable monofilament nylon or polypropylene (2-0 or 3-0), which maintains tensile strength throughout the catheter’s intended dwell time.
• A simple interrupted stitch is commonly used, passing through the catheter’s dedicated suture wing or eyelet and then through the patient’s skin, creating a secure anchoring point.

Proper suturing technique involves consideration of several factors that influence both security and patient outcomes. These technical aspects determine the effectiveness of the securement.

• The suture should be tight enough to prevent catheter movement but not so tight as to deform the catheter or cause tissue ischemia.
• Placement of the suture site should allow for proper dressing application while maintaining visibility for assessment of the insertion site.
• Some practitioners place multiple sutures for additional security, particularly for catheters in high-movement areas or confused patients.

Types of Central Venous Catheter Securement Methods

Suture-Based Securement

Suture fixation, as illustrated in the diagram, has been the traditional standard for central line securement for decades. This approach has both advantages and limitations in clinical practice.

• Advantages include immediate and reliable securement, familiarity among clinicians, and applicability in virtually all patient populations and catheter types.
• Limitations include risk of needlestick injury to healthcare providers, potential for suture site infection, and patient discomfort during placement and removal.

Various suturing techniques have evolved to address specific clinical needs and catheter designs. These modifications aim to optimize securement while minimizing complications.

• The “sandwiching” technique uses two sutures on either side of the hub to provide additional stability and prevent pistoning (in-and-out movement) of the catheter.
• Some specialized catheters feature pre-attached suture wings with reinforced holes designed specifically to withstand the tension of suture securement without damage to the catheter material.

Alternative Securement Technologies

In recent years, several sutureless alternatives have emerged in response to the limitations of traditional suturing. These technologies aim to provide comparable security while addressing the drawbacks of sutures.

• Adhesive securement devices feature specialized adhesive pads with integrated catheter clamps or channels that hold the catheter hub in position without penetrating the skin.
• Subcutaneous securement devices use anchors placed beneath the skin that connect to the catheter, providing internal fixation that may reduce infection risk.

Each alternative approach offers distinct advantages and disadvantages that influence selection in different clinical scenarios. No single method has demonstrated clear superiority across all contexts.

• Studies comparing different securement methods show variable results depending on catheter type, patient population, and placement site.
• Institutional protocols increasingly incorporate a combination of methods based on patient-specific factors and catheter characteristics.

Clinical Considerations in Catheter Securement

Infection Prevention

The relationship between catheter securement and infection risk represents an important clinical consideration. Securement directly influences several infection risk factors.

• Suture sites create additional breaks in the skin barrier that can serve as portals of entry for microorganisms, potentially increasing infection risk.
• However, inadequate securement leading to catheter movement or “pistoning” may cause greater infection risk through microorganism introduction along the catheter tract.

Current evidence regarding infection rates with different securement methods remains somewhat inconclusive, though trends favor sutureless approaches in some contexts.

• Several studies have demonstrated lower catheter-associated bloodstream infection rates with adhesive securement devices compared to sutures.
• The CDC’s Guidelines for the Prevention of Intravascular Catheter-Related Infections recommend considering the use of sutureless securement to reduce infection risk when compatible with the clinical situation.

Dressing Compatibility

The interaction between the catheter securement method and dressing is an important practical consideration. The securement approach must function synergistically with the selected dressing.

• The suture site shown in the illustration requires accommodation within the catheter dressing, with care taken to ensure the suture knot doesn’t compromise dressing integrity.
• Modern transparent semipermeable membrane dressings must adhere properly around sutures without lifting, which can compromise the sterile barrier.

Dressing changes require careful attention to maintaining catheter position while the temporary security provided by the dressing is disrupted. This represents a high-risk period for accidental dislodgement.

• During dressing changes, a second practitioner may be needed to stabilize the catheter while the primary clinician removes and replaces the dressing.
• Some facilities employ temporary additional securement during dressing changes to mitigate the risk of accidental catheter displacement.

Special Population Considerations

Certain patient populations present unique challenges for catheter securement that may influence the choice of method. These considerations often necessitate modified approaches.

• Pediatric patients may be poor candidates for suturing due to thin skin, increased risk of scarring, and developmental factors that increase the likelihood of dressing or suture disruption.
• Elderly patients with fragile skin or patients on long-term anticoagulation may experience excessive bleeding or skin tears with suture placement.

Patients with excessive diaphoresis, oily skin, or specific dermatological conditions may experience reduced effectiveness of adhesive-based alternatives, sometimes necessitating a return to suture fixation.

• Modified approaches include using additional skin preparation products to enhance adhesive effectiveness.
• Combination methods employing both sutures and adhesive devices may be used in challenging cases where a single method proves insufficient.

Complications Related to Catheter Securement

Securement-Related Adverse Events

Improper catheter securement can lead to several complications beyond the obvious risk of complete dislodgement. These complications may have significant clinical consequences.

• Partial migration can result in malposition of the catheter tip, potentially leading to vessel erosion, cardiac arrhythmias, or thrombosis.
• Excessive tension on sutures can cause local tissue ischemia, necrosis, or pressure injuries where the catheter presses against underlying structures.

Suture-specific complications include local inflammatory reactions, stitch abscesses, and granuloma formation. These localized issues can sometimes necessitate catheter removal.

• Stitch abscesses present as localized purulent collections at suture sites and may progress to systemic infection if untreated.
• Granulation tissue formation around long-term sutures can complicate removal and create a persistent inflammatory focus that increases infection risk.

Prevention and Management

Proactive assessment and maintenance of catheter securement helps prevent many complications before they manifest clinically. Regular evaluation is essential regardless of the securement method used.

• Daily assessment of catheter position, securement integrity, and surrounding skin condition is recommended as part of routine central line care.
• Documentation of external catheter length provides an objective measure to detect subtle migration before clinical symptoms develop.

When securement complications do occur, prompt intervention is essential to prevent progression to more serious events such as complete dislodgement or bloodstream infection.

• Management may range from simple reinforcement of existing securement to complete catheter exchange, depending on the nature and severity of the complication.
• Institutional protocols should include clear guidance on indications for securement revision versus catheter replacement when concerns arise.

Conclusion

The illustrated central venous catheter secured with suture represents a fundamental aspect of vascular access management that significantly impacts patient safety and treatment effectiveness. While the simple line drawing might suggest a minor technical detail in the broader context of central venous catheterization, proper securement is increasingly recognized as a critical component of catheter care that deserves focused attention from clinicians. The evolution of securement methods from traditional suturing to advanced adhesive and subcutaneous technologies reflects ongoing efforts to optimize this aspect of vascular access. Despite these innovations, suture fixation remains widely used and clinically relevant, particularly in acute care settings where its immediate reliability continues to offer advantages. For all central venous catheters, regardless of the securement method employed, regular assessment and maintenance of fixation integrity constitutes an essential element of comprehensive line care protocols aimed at maximizing catheter longevity while minimizing complications that can compromise patient safety and disrupt necessary therapies.

1. Central Venous Catheter Suture Securement: Techniques and Clinical Considerations
2. Securing Central Lines: Traditional Suture Methods and Modern Alternatives
3. Preventing Catheter Dislodgement: A Comprehensive Guide to CVC Securement
4. Central Line Fixation Techniques: From Suture-Based to Advanced Securement Devices
5. Optimizing Central Venous Catheter Stability: Suture Securement and Clinical Implications