Tissue adhesive as an alternative to sutures for securing central venous catheters

Tissue adhesives have been used in the past for a wide range of applications, including wound and laceration closure [1], repair of gastric varices [2], incisional hernias [3], retinal detachment [4], and for securing epidural catheters [5]. They have numerous advantages over traditional sutures [6], with the potential to reduce complications associated with traditional methods for both the patient and doctor. They are safe (having been tested extensively in a wide range of areas) and cost effective, with less need for local anaesthetic and dry dressings. They prevent the need for painful suturing and suture removal with the potential for significant reductions in percutaneous injuries from suture needles and better cosmetic results for the patient [7]. They are tough, durable, have high mechanical strength and can remain in place for a number of days. In addition, such agents have intrinsic bactericidal properties [8], another advantage in the context of long-term catheters used in ICU where catheter-related infections are a common problem. Here we describe the use of Histoacryl® tissue adhesive (B Braun, Sheffield, UK) to secure a standard three-port femoral central venous catheter in an obese male burns patient. To our knowledge such use of tissue adhesives has not been described before. It is, however, an obvious application for these agents (with all the advantages described above), especially in individuals in whom suturing may be difficult due to positional or anatomical reasons, or in whom the catheter is required to stay in for a long period of time, as with our patient. After insertion, the catheter is coated sparingly with a thin layer of adhesive to anchor it at the insertion point and wing tips (Fig. 5) and then held in place for about 30 s while the adhesive sets. This is much less time consuming than using sutures. The adhesive can safely be removed at any time using acetone if necessary, for example for repositioning. Otherwise, it starts to loosen naturally after 5–10 days, and washes off with soap and water [9]. CVP catheter being secured with tissue adhesive. We have secured over 30 lines using this glue with complete success and have undertaken a successful volunteer study securing epidural catheters (abstract submitted). We have also secured 50 thoracic epidurals in place in following thoracotomy with excellent results.