P021 - Glue to the Rescue: Evaluation of Cyanoacrylate to Improve Dressing Adherence, Hemostasis and Central Line-Associated Bloodstream Infections of Central Venous Catheters

Mara Fox - CVICU RN, CVICU Quality Council Chair, Froedtert Hospital
Emily Dreier - CVICU RN, Froedtert Hospital
Jennifer Popies - CVICU CNS, Froedtert Hospital
Nancy Froggatt - Hematology/Oncology CNL, Froedtert Hospital
Melody Pyzyk - CVICU RN, Froedtert Hospital

Purpose - What was the goal of the study?: The purpose of this quality improvement (QI) project was to evaluate the effectiveness of cyanoacrylate in reducing early dressing changes as well as central line-associated bloodstream infections (CLABSI) for internal jugular (IJ) introducers and non-tunneled dialysis catheters, with secondary outcomes being staff satisfaction and cost implications.

Background - What was the problem? Why was it important?: Central line-associated bloodstream infection (CLABSI) causes 150 excess deaths for every 1,000 in hospital cases, with an average additional cost of $48,108. Between May 2020 and April 2021, the Cardiovascular Intensive Care Unit (CVICU) was above the desired benchmark for patients who developed a hospital-acquired CLABSI. Patients in the CVICU often require continuous anticoagulation as well as an introducer and/or non-tunneled dialysis central venous access devices (CVAD) most often in the IJ location. Keeping these CVAD dressings clean, dry and intact is challenging, as these patients have a tendency to bleed and because the weight of the catheter in the IJ location pulls the dressing down from the site. The 2021 Infusion Nurses Society Standards of Practice has declared tissue adhesive (cyanoacrylate) one of four acceptable standards for vascular access device securement. Benefits in addition to securement have been found through various studies, including reduction of local bleeding and decreased bacterial colonization. Thus the CVAD Committee and CVICU collaborated to trial the use of tissue adhesive on these catheters.

Results - What were the findings?: During the two-month trial, a 75% reduction in CLABSIs occurred compared to the same timeframe after project completion when cyanoacrylate was no longer being used. Median days between dressing changes increased from 1.1 to 1.8 days with use of cyanoacrylate. The reduction in early dressing changes translates to reduction in costs of nursing time as well as reduction in utilization of central line dressing kits. The secondary outcome of staff satisfaction with the product showed 91% of staff reported product is easy to use, with 84% reporting practice improvement.

Conclusions - What do the final outcomes mean?: The improved CLABSI outcomes contribute to high-quality patient care and decreased cost. The cost to treat additional CLABSIs without use of the product within a two-month timeframe was estimated to be $100,000. The trial data was presented to the health network’s CVAD and CLABSI Committees, at both an internal and local Nursing Research Conference, and at the Hospital Quality and Safety Council meeting. Committees were largely in favor of the organization pursuing product purchase, which was endorsed by the CLABSI Domain Team for the health network.