Securing epidural catheters with Histoacryl ® glue

The rate of accidental loss of epidural catheters (fall-out) in the UK varies from 1% to 35% [Wilkinson JN, Sycamore HL. A survey of UK epidural practice (abstract). First European New York School of Regional Anaesthesia Symposium, London, November 2007]. We developed a new technique of securing catheters in place to reduce the fall-out rate in our unit of 12.3%. We devised a technique using Histoacryl® skin adhesive (B. Braun, Sheffield, UK) to secure the catheter to the skin. After insertion of the catheter it is coiled and three points on the coil are bonded to the skin, with an additional bonding point at the entry site of the catheter (Figure 7). The catheter loop is then covered with a Neoderm® (Conmed, Swindon, UK) dressing. The NHS cost of a vial of Histoacryl is about £4. Epidural catheter attached to skin with Histoacryl® glue. Arrows denote the points around the loop where a ‘glob’ of glue should be placed and the site of entry of the catheter. In a volunteer study this technique was completely successful at preventing catheters from falling-out [1]. We then introduced the technique into our clinical practice and over a five-day period, during which anaesthetists could choose to use either the traditional suture method or the Histoacryl glue method to secure their thoracic epidurals, use of the glue reduced fall-out rate from 12.3% to 3.8%. There were no skin reactions or mechanical problems with the catheters. The glue fixation was also highly acceptable to the patients. These results suggest that this method of fixation is effective, comfortable to patients, and is both simple and quick to perform.