Histoacryl ® for securing central venous catheters: not so sticky!

In 2007, Wilkinson et al. 1 described the use of the tissue adhesive Histoacryl® (B Braun, Sheffield, UK) as an alternative to sutures for securing central venous catheters (CVCs). They reported securing 30 CVCs with ‘complete success. Using a skin glue such as Histoacryl to fix CVCs has intuitive appeal: it is quick and easy to apply, reduces the risk of needlestick injury, has antimicrobial properties 2, and is potentially more comfortable for patients, with reduced risk of skin scarring. Keen to replicate Wilkinson et al.'s success, and following local clinical audit committee approval, we evaluated the use of Histoacryl to secure 20 CVCs inserted pre-operatively in theatres by anaesthetists. Feedback from anaesthetists was extremely positive: everyone found the glue easy to use and the application process was universally felt to be preferable to suturing. The patients were followed until line removal, either on the ICU or on the ward. There were three incidents of accidental CVC removal, one resulting in brief extravasation of total parenteral nutrition, and one in bleeding. One line was dislodged, requiring re-siting of a new CVC. At least six CVCs were found to be unstuck at the time of planned line removal, which was as early as the second postoperative day in some patients. Although staff found some CVCs remained well secured for several days, and subsequent removal with the recommended acetone straightforward, the complications encountered during the pilot evaluation were felt to be too significant to adopt the use of Histoacryl in our practice. We would be interested to know if other departments have been able to replicate the success of Wilkinson et al.'s results.