Ten years of clinical experience with cyanoacrylate glue for venous access in a 1300-bed university hospital

Abstract

In the past decade, cyanoacrylate glue has been progressively introduced into the clinical practice of venous access devices used for different purposes. Glue has been used to increase device stabilisation (to reduce the risk of catheter dislodgement), to seal the exit site (to both reduce local bleeding and decrease the risk of bacterial contamination) and to close skin incisions required for the insertion of tunnelled catheters or totally implanted venous ports. For many of these purposes, the efficacy and cost-effectiveness of cyanoacrylate glue has been demonstrated, while some indications are still controversial. This article reports on 10 years of clinical experience with cyanoacrylate glue in a large university hospital, and provides a narrative review of the scientific evidence on the benefits of glue in venous access that has been accumulating over the past decade.

Full text

© 2022 MA Healthcare Ltd
S4 British J ournal of Nursi ng, 2022, Vol 31, No 8 (IV and Vas cular Ac cess Sup plement)
VENOUS ACCESS SECUREMENT
Ten years of clinical experience with
cyanoacrylate glue for venous access
in a 1300-bed university hospital
Mauro Pittiruti, Maria Giuseppina Annetta, Bruno Marche, Vito D’Andrea and
Giancarlo Scoppettuolo
In the past two decades, dierent types of cyanoacrylate
glue (CG)—octyl-CG, butyl-CG and octyl-butyl-CG—
have been used in surgical practice to close skin incisions,
to repair lacerations of internal organs, to stop oesophageal
bleeding and to secure prostheses for inguinal hernias
(Singer and Thode, 2004).
Since 2000, octyl-CG has been widely used in the authors’
university hospital for closing skin incisions after minor surgical
procedures as an alternative to sutures and staples, with several
advantages in terms of control of local bleeding, to provide a
barrier to bacteria and for cosmetic results (Gurnaney et al,
2011; Auyong et al, 2017; Chalacheewa et al,2021).
In 2007, Wilkinson et al reported for the rst time the use
of CG to stabilise centrally inserted central venous catheters
(CICCs) as an alternative to sutures. The same authors reported
the eectiveness of CG in reducing dislodgment of epidural
catheters (Wilkinson et al 2007; Wilkinson and Fitz-Henry,
2008).
The benefits of CG include not only the sutureless
stabilisation of the catheter but also a potential antibacterial
activity, as proven in vitro—in particular for octyl-CG—
especially against Gram-positive bacteria (Bhende et al, 2002;
Narang et al, 2003; Wilkinson et al, 2008).
In the authors’ 1300-bed university hospital, most central
lines are inserted by a multiprofessional, multidisciplinary
vascular access team. The authors started to use CG 10 years
ago, mainly as a haemostatic strategy in patients at a high risk
of local bleeding.
In 2012, they reported for the rst time the eectiveness of
CG in reducing bleeding from exit sites within the rst 24
hours of peripherally inserted central catheter (PICC) placement.
They studied 45 adult patients requiring the insertion of
polyurethane PICCs without reverse tapering; no signicant
local bleeding at 1 hour and after 24 hours was recorded. Both
octyl-butyl-CG and butyl-CG were used, and no local reactions
were reported (Pittiruti et al, 2012).
The ecacy of CG in reducing the risk of bleeding was
further studied in a group of adult patients requiring polyurethane
CICCs and PICCs without reverse tapering, in a non-intensive
care ward in the authors’ hospital. The exit site of 65 central
Mauro Pittiruti, Vascular Access Specialist and Vascular
Access Team Member, Department of Surgery, Fondazione
Policlinico Universitario A Gemelli, Catholic University, Rome Italy,
mauropittiruti@me.com
Maria Giuseppina Annetta, Vascular Access Specialist and
Vascular Access Team Member, Department of Anesthesia and
Intensive Care, Fondazione Policlinico Universitario A Gemelli,
Catholic University, Rome Italy
Bruno Marche, Vascular Access Specialist and Vascular Access
Team Member, Department of Hematology, Fondazione Policlinico
Universitario A Gemelli, Catholic University, Rome Italy
Vito D’Andrea, Neonatologist, Neonatal Intensive Care Unit,
Fondazione Policlinico Universitario A Gemelli, Catholic University,
Rome Italy
Giancarlo Scoppettuolo, Infectious Disease Specialist, and
Consultant for the Vascular Access Team, Department of Infectious
Disease, Fondazione Policlinico Universitario A Gemelli, Catholic
University, Rome Italy
Accepted for publication: January 2022
ABSTRACT
In the past decade, cyanoacrylate glue has been progressively introduced
into the clinical practice of venous access devices used for different
purposes. Glue has been used to increase device stabilisation (to reduce
the risk of catheter dislodgement), to seal the exit site (to both reduce
local bleeding and decrease the risk of bacterial contamination) and to
close skin incisions required for the insertion of tunnelled catheters or
totally implanted venous ports. For many of these purposes, the efcacy
and cost-effectiveness of cyanoacrylate glue has been demonstrated,
while some indications are still controversial. This article reports on
10years of clinical experience with cyanoacrylate glue in a large university
hospital, and provides a narrative review of the scientic evidence on the
benets of glue in venous access that has been accumulating over the
pastdecade.
Key words: Cyanoacrylate glue ■ Tissue adhesive ■ Peripheral venous
access ■ Peripherally inserted central catheter ■ Central venous access
■ Securement ■ Skin closure

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catheters (45 PICCs, 11 dialysis catheters and nine CICCs) was
assessed at 1 hour and 24 hours after insertion. No local bleeding
occurred. No local adverse reaction or damage to the
polyurethane was reported (Scoppettuolo et al, 2013).
In the same year, the authors also carried out a randomised
clinical study to evaluate the ecacy of two methods of sealing
exit sites—metallic powder (Statseal, Biolife) versus octyl-butyl-
CG—in patients in the intensive care unit. Thirty polyurethane
PICCs without reverse tapering with double (5 Fr) and triple
(6 Fr) lumen were randomised to be sealed with either metallic
powder or with CG.
Bleeding was assessed at 1 hour and 24hours after placement
and weekly thereafter. All catheters were removed after 3 weeks,
and cultures of both the subcutaneous tract of the catheter and
the catheter tip were performed. There was no early bleeding
at 1 hour, but there were two later bleedings (one in each
group) at 24 hours. All cultures of the subcutaneous tract were
negative. One PICC in the metallic powder group had a tip
culture test positive for Candida albicans, although the blood
culture was negative.
The authors concluded that both methods were eective
in reducing bleeding at the exit site, and that the compliance
of nurses and patients was higher for the glue. Preliminary data
about the cultures suggested that sealing the exit site (with
either method) was effective in reducing extraluminal
contamination (Annetta et al, 2013).
Two experimental in vitro studies further conrmed the
antimicrobial activity of CG. In 2012, the in vitro ecacy of
octyl-CG and butyl-CG for the securement of intravenous
catheters was studied (Simonova et al, 2012). While butyl-CG
was associated with stronger securement than octyl-CG, both
compounds showed signicant antibacterial activity against
Staphylococcus aureus and S.epidermidis. Another in-vitro study
(Rushbrook et al, 2014) demonstrated the bactericidal property
of octyl-CG against Gram-positive bacteria (but not against
Escherichia coli, Pseudomonas aeruginosa or C.albicans).
In 2014-2015, three more clinical studies analysed the ecacy
of CG in secur ing vascular access devices. Two randomised
studies addressed the use of CG for peripheral arterial catheters.
While the rst study was inconclusive (Edwards et al, 2014),
the second demonstrated that CG was associated with the
lowest risk of catheter failure and was more cost-eective than
other strategies, including bordered transparent dressings and/
or sutureless securement devices (Reynolds et al, 2015). Similar
results were reported in a randomised clinical study on short
peripheral cannulas (SPCs) (Marsh et al, 2015).
Meanwhile, further clinical studies carried out at the authors’
hospital demonstrated the high ecacy of both butyl-CG and
butyl-octyl-CG in reducing bleeding at the exit site. In a
prospective study on 45 PICCs without reverse tapering, the
risk of bleeding was reduced from 40% to zero in the rst hour
and from 15% to zero at 24 hours after insertion (Scoppettuolo
et al, 2015).
A wider retrospective study on 1429 central venous catheters
was also conducted in the university hospital (Pittiruti et al,
2016). This study included: 348 non-tunnelled PICCs inserted
in patients at a high risk of bleeding (those with chronic renal
failure, hepatic dysfunction or coagulation disorders or receiving
antithrombotic treatment); 165 non-tunnelled CICCs and
femorally inserted central catheters (FICCs) in patients at high
risk of local bleeding (including dialysis catheters); 114 tunnelled
central catheters (PICCs, CICCs and FICCs, cued or non-
cued); and 802 ports (both chest ports and PICC ports). At
the end of the study, the authors concluded that CG was 100%
eective in preventing post-insertion bleeding from the exit site
in every type of central venous access device, even in patients
at high risk of bleeding, in both children and adults. The use of
glue for sealing the exit site of PICCs was found to be not only
eective but also highly cost-eective, given that early bleeding
woul d often mean an unscheduled dressing change was neede d.
Considering the results of this retrospective study and the
evidence accumulated in previous years (2012-2015), the
university hospital’s policies were modied. In 2016, the ocial
hospital policies on the insertion and management of venous
access devices recommended the use of cyanoacrylate glue for
three main indications:
■
Sealing the exit site of all PICCs soon after insertion (Figure1)
■Sealing the exit site of other types of central venous access
devices (CICCs, and FICCs) in patients at a high risk of
local bleeding
■Closing the skin incisions required for the implantation of
tunnelled central catheters (Figure 2) and ports (Figure 3).
Expanding the indications: 2016-2019
After the 2016 hospital policies were introduced, the use of
CG in venous access was implemented signicantly in the
hospital (2000 vials/year for an estimated 7000 central venous
catheters inserted per year by the vascular access team).
Concerned that CG might potentially damage catheters,
the authors carried out an in-vitro study analysing the chemical
and physical interactions between octyl-butyl-CG and 12 brands
of PICCs (11 made of polyurethane and one of silicone). The
samples were analysed after 4, 8 and 12 weeks of contact with
the glue. The conclusion was that the long-term use of octyl-
butyl-CG was not associated with any damage to polyurethane
catheters, although it may alter the physical properties of silicone
(Di Puccio et al, 2018). Considering that use of silicone catheters
AB
Figure 1. Tunnelled peripherally inserted central catheters: glue is used both to
seal the exit site (a) and to close the puncture site (b)
a b

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VENOUS ACCESS SECUREMENT
because of a synergistic eect on the reduction of several
complications (infection, dislodgment and bleeding) (Judge et
al, 2018; Ortiz-Miluy et al, 2019).
The cost-eectiveness of CG (for both peripheral and central
venous catheters) was related mainly to its haemostatic eect,
with the elimination of a need for dressing changes 24 hours
after insertion, leading to signicant cost savings (Nicholson
and Hill, 2019).
The authors also agreed that CG should be used in all central
venous access devices requiring tunnelling (for closing the skin
incision at the puncture site) or requiring subcutaneous
placement of a reservoir (for closing the skin incision at the
pocket) (Martin et al, 2017).
The present: 2020-2021
Over the past 2 years, many more clinical studies have focused
on CG for both central and peripheral catheters and in dierent
patient populations.
Regarding CICCs, a randomised clinical trial involving 121
adult patients (Mitchell et al, 2020) conrmed that CG was
not optimal for the purpose of securement only. However, as
had been abandoned at the hospital since 2010, the ndings
of this study werereassuring.
In the following years, further clinical studies focused on
CG as securement device.
A randomised trial involving 380 SPCs inserted in 360 adult
patients demonstrated that, when using CG, catheter failure
was 10% lower and dislodgement was 7% lower than when
standard dressings were used (Bugden et al, 2016). On the other
hand, a randomised trial involving 221 cardiac surgical patients
showed that CG with a standard transparent dressing was not
eective for the securement of CICCs; however, when CG
was added to standard care (sutures and polyurethane dressing),
dislodgments were reduced from 4% to 0% in comparison with
standard care only (Rickard et al, 2016). A single-centre study
involving 124 PICCs in patients with cancer showed that
securement by CG and standard transparent dressing was
associated with the lowest risk of catheter failure (Chan et al,
2017). In a larger randomised trial involving 1807 patients that
analysed dierent strategies of SPC securement in adults, the
results were inconclusive, but some adverse events (skin damage)
were reported in the CG group (Rickard et al, 2018).
At this time, other studies focused on paediatric patients.
In a randomised trial involving 101 PICCs in children (Kleidon
et al, 2017), CG was eective both in reducing catheter
dislodgements and in decreasing local bleeding. A randomised
trial comparing securement devices in 48 tunnelled central
venous catheters in children (Ullman et al, 2017) was associated
with inconclusive results. In another randomised trial involving
108 children with non-tunnelled central venous devices,
securement by CG only was less eective than securement by
sutures or sutureless devices (Ullman et al, 2019).
However, in a clinical study car ried out in the university
hospital’s paediatric intensive care unit, an insertion bundle for
avoiding extraluminal bacterial contamination of CICCs
(cyanoacrylate glue with a sutureless device, tunnelling and a
transparent dressing) was associated with a 90% reduction in
catheter-related bloodstream infections from 15 to 1.5 episodes
per 1000 catheter days (Biasucci et al, 2018).
This potential antimicrobial activity of CG was conrmed
in several experimental studies (Bull et al, 2018; Prince et al,
2018; Waller et al, 2019). In one of these studies (Bull et al,
2018), the eectiveness of CG to inhibit bacter ial growth at
the extracorporeal membrane oxygenation (ECMO) cannulation
site and in secur ing ECMO cannulas was evaluated in vitro.
Bull et al (2018) concluded that combining CG at the cannula
insertion site with a sutureless securement device could be an
eective strategy to prevent or minimise both infection and
linedislodgement.
The role of glue in venous access was discussed in a meeting
organised by the authors’ team in 2019, based on the literature
and on an audit of their exper ience. They concluded that
securement of central venous access devices by CG only was
not eective and that, for CICCs, FICCs and PICCs, CG should
be used not for securement but for the purpose of reducing
local bleeding and bacterial contamination. For long-term
central venous access, the combined use of CG, tunnelling and
subcutaneous anchorage was judged to be especially benecial
Figure 3. Glue used for closing the skin incision made for
brachial port implantation
AB
Figure 2. Glue used for centrally inserted central catheters (a) and for tunnelled
femorally inserted central catheters (b), on both the exit site and the puncture site
a b

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another trial with 150 adult patients showed, when added to
standard securement, CG may reduce the incidence of early
dressing change (Prachanpanich et al, 2021).
Findings seem to be dierent for SPC. A large, randomised
trial involving 350 adult patients (Bahl et al, 2021) suggested
that a transparent dressing combined with CG may improve
survival of an SPC if the line is expected to be used for more
than 48hours. In a randomised study with 330 children, both
integrated securement dressings and CG were more eective
than bordered transparent dressings in reducing catheter failure
(Kleidon et al,2020). Nonetheless, the greatest change in
practice in the past 2years has been the introduction of CG
into neonatal intensive care units.
Butyl-CG and octyl-butyl-CG have proven to be safe and
eective for the securement of epicutaneo-caval catheters (ECC)
(Barone and Pittiruti, 2020; D’Andrea et al, 2021; van Rens,
2021). The local application of small quantities of CG seems
to be harmless even in premature newborns, while it is highly
eective in reducing dislodgement and preventing bleeding
and oozing at the puncture site.
Data also suggest that CG may be associated with a reduction
in the risk of central-line bloodstream infection in neonates,
probably by reducing bacterial contamination via the
extraluminal route. One of the authors’ protocols on the use
of CG for umbilical venous catheters (UVCs) in pre-term
neonates is being investigated. Preliminary results suggest that
the addition of CG to a standard UVC securement may reduce
catheter dislodgment and tip migration (Pittiruti et al, 2020).
Finally, the antibacterial activity of CG has been further
conrmed by two recent studies. In one clinical study on 102
PICCs, local application of CG at the exit site soon after
insertion was compared with the local application of a
chlorhexidine-releasing sponge dressing. Both strategies were
eective in controlling bacterial colonisation; however, CG was
more eective in reducing local bleeding and more cost-eective
than the sponge dressing in the rst week after PICC insertion
(Gilardi et al, 2021).
In an experimental study, the antimicrobial properties of
two formulations of octyl-butyl-CG were compared in terms
of bacterial inhibition at peripheral ECMO cannula insertion
sites: both were capable of inhibiting bacterial growth and
migration of S. epidermidis (Pearse et al, 2021).
As a result, in the past 2 years, several evidence-based
documents have included specic recommendations about the
use of CG in venous access.
In 2020, the Italian Association of Pediatric Hematology
and Oncology guidelines recommended the use of CG at the
exit site of all central venous catheters in children. The rationale
for this recommendation is that glue is safe, allows rapid and
complete haemostasis at the exit site, reduces the incidence of
dressing change and decreases micromovements of the catheter,
so it may be useful in preventing thrombosis and infection. The
use of glue alone may not reduce the risk of catheter dislodgment
but, when used in with other securement devices, it may improve
the dwell time of central devices (Cellini et al, 2020).
The 2021 Standards of the Infusion Nursing Society include
CG as an option for securing SPCs, combined with a standard
transparent dressing or an integrated securement dressing, in
both adult and paediatric patients (Gorski et al, 2021).
Finally, the Consensus on European Recommendations on
the Proper Indication and Use of Peripheral venous access
devices stipulate securing ‘integrated’ SPCs and long peripheral
catheters (LPCs) using either a bordered transparent dressing
with an integrated securement system or a standard bordered
transparent dressing after application of cyanoacrylate glue at
the exit site. According to this consensus, local application of
CG should also be considered in any patient at high risk of
bleeding (Pittiruti et al, 2021).
Conclusion
In summary, there is now enough evidence on CG in
severalareas.
CG is an eective securement only for SPC (Kleidon et al,
2020; Bahl et al, 2021) and ECC (D’Andrea et al, 2021; Van
Rens et al, 2021); it should be used not alone but in combination
with a transparent semipermeable membrane.
CG is a safe, eective and cost-eective strategy for avoiding
the risk of early bleeding and oozing after the insertion of any
peripheral or central venous catheter (Pittiruti et al, 2012; 2016;
Scoppettuolo et al, 2013; Guido et al, 2020).
In all central venous access devices, CG may reduce the risk
of infection by decreasing bacter ial contamination via the
extraluminal route (Annetta et al, 2013; Biasucci et al, 2018,
Bull et al, 2018; Gilardi et al, 2021), but its antibacter ial use
should be limited to the rst week (Corley et al, 2017; Gilardi,
et al 2021), since there is not enough evidence to show that
weekly replacement of glue is harmless.
CG is an eective and cost-eective replacement for sutures
when a skin incision needs to be closed (ie in tunnelled venous
access devices and in ports)(Pittiruti et al, 2016; Martin et al,2017).
Based on such evidence, in 2021 the Italian Group of Long-
Term Venous Access Devices (GAVeCeLT) released specic
recommendations for the use of CG (Ta b l e 1 )(Pittiruti and
Scoppettuolo, 2021).
Table 1. Italian Group of Long-Term Venous Access Devices
recommendations on the use of glue in venous access
1. Use cyanoacrylate glue
■ As an additional securement of peripheral venous access devices at a high risk
ofdislodgement
Particularly in peripheral catheter s with expected duration >48 hours
■ For sealing the exit site of any central venous access device soon after insertion
to avoid post-procedural local bleeding , prevent unscheduled dressing changes and
protect the exit site from bacterial contamination during the rst week
Use chlorhexidine-releasing sponge dressing (in non-tunnelled central catheters)
after the rst week
■ For closing any skin incision related to venous access procedures (skin incisions for
tunnelling or for subcutaneous port placement)
Never use stitches
2. Remember to p refer butyl- cyanoacryla te or octyl-butyl- cyanoacrylate
3. Use a minimal amount o f cyanoacr ylate glue and only at the time of insertion
Source: Pittiruti and S coppet tuolo (2021)

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VENOUS ACCESS SECUREMENT
In spring 2021, a revised version of the university hospital
policies was issued. This document recommends the use of
butyl-CG or octyl-butyl-CG for venous access, while octyl-CG
is considered appropriate for skin closure after minor surgical
procedures only. Its recommendations include:
■
Consider using CG for sealing the exit site of SPCs in
neonates, in children and in any patient at high risk of local
bleeding, before covering with a semipermeable transparent
membrane (Figure 4)
■
Use CG for sealing the exit site of all ECCs in neonates,
before covering with a semipermeable transparent membrane
(Figure 5)
■
Always use CG for sealing the exit site of any LPC, any
midline catheter (Figure 6), and any central venous catheter
(PICC, FICC or CICC), in both children (Figure 7) and
adults (Figure 8), in addition to standard sutureless securement
and coverage with a transparent semipermeable membrane
■
Always use CG for closing any skin incision related to venous
Figure 7. Glue used for sealing the exit site of a centrally
inserted central catheter in a small infant
Figure 8. Glue used for sealing exit site of dialysis catheter
Figure 4. Glue used to seal the exit site of a short peripheral
cannula
Figure 6. Glue used to seal the exit site of a midline
catheter
Figure 5. Glue used to secure of an epicutaneo-cava catheter
in a pre-term neonate

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org/10.1177/1129729820969309
Chalacheewa T, Arnuntasupakul V, Sangkum L, Buachai R, Chanvitayapongs J.
Decreasing leakage during continuous femoral nerve catheter xation using
2-octyl cyanoacrylate glue (Dermabond®): a randomized controlled trial.
BMC Anesthesiol. 2021;21(1):169. https://doi.org/10.1186/s12871-021-
01386-7
Chan RJ, Northeld S, Larsen E et al. Central venous Access device
SeCurement And Dressing Eectiveness for peripherally inserted central
catheters in adult acute hospital patients (CASCADE): a pilot randomised
controlled trial. Trials. 2017;18(1):458. https://doi.org/10.1186/s13063-017-
2207-x
Corley A, Marsh N, Ullman AJ, Rickard CM. Tissue adhesive for vascular access
devices: who, what, where and when? Br J Nurs. 2017;26(19): S4–S17.
https://doi.org/10.12968/bjon.2017.26.19.S4
D’Andrea V, Pezza L, Barone G, Prontera G, Pittiruti M, Vento G. Use of
cyanoacrylate glue for the sutureless securement of epicutaneo-caval
catheters in neonates. J Vasc Access. 2021:11297298211008103. https://doi.
org/10.1177/11297298211008103
Di Puccio F, Giacomarro D, Mattei L, Pittiruti M, Scoppettuolo G. Experimental
study on the chemico-physical interaction between a two-component
cyanoacrylate glue and the material of PICCs. J Vasc Access. 2018;19(1):58–
62. https://doi.org/10.5301/jva.5000816
Edwards M, Rickard CM, Rapchuk I et al. A pilot trial of bordered
polyurethane dressings, tissue adhesive and sutureless devices compared with
standard polyurethane dressings for securing short-term arter ial catheters.
Crit Care Resusc. 2014;16(3):175–183
Gilardi E, Piano A, Chellini P et al. Reduction of bacterial colonization at the
exit site of peripherally inserted central catheters: a comparison between
chlorhexidine-releasing sponge dressings and cyano-acrylate. J Vasc Access.
2021;22(4):597–601. https://doi.org/10.1177/1129729820954743
Gorski LA, Hadaway L, Hagle ME et al. Infusion therapy standards of
practice, 8th edn. J Infus Nurs. 2021;44(1S Suppl 1):S1–S224. https://doi.
org/10.1097/NAN.0000000000000396
Guido A, Zhang S, Yang C, Pook L. An innovative cyanoacrylate device
developed to improve the current standard of care for intravascular
catheter securement. J Vasc Access. 2020;21(3):293–299. https://doi.
org/10.1177/1129729819872881
Gurnaney H, Kraemer FW, Ganesh A. Dermabond decreases pericatheter local
anesthetic leakage after continuous perineural infusions. Anesth Analg.
2011;113:206. https://doi.org/10.1213/ANE.0b013e31821d38fb
Judge M, Welty N, Feltner R, Smoot A, Mugford A. GVNG: glue vs no-glue
clinical evaluation. Electronic poster (iPoster) presented at the Annual
Meeting of the Association for Vascular Access, Columbus (OH), 15-18
September 2018. https://tinyurl.com/2p93uzfz (accessed 3 April 2022)
Kleidon TM, Ullman AJ, Gibson V et al. A pilot randomized controlled trial of
novel dressing and securement techniques in 101 pediatric patients. JVasc
Interv Radiol. 2017;28(11):1548–1556.e1. https://doi.org/10.1016/j.
jvir.2017.07.012
Kleidon TM, Rickard CM, Gibson V et al. Smile—secure my intravenous line
eectively: a pilot randomised controlled trial of peripheral intravenous
catheter securement in paediatrics. J Tissue Viability. 2020;29(2):82–90.
https://doi.org/10.1016/j.jtv.2020.03.006
Marsh N, Webster J, Flynn J et al. Securement methods for peripheral venous
catheters to prevent failure: a randomised controlled pilot trial. J Vasc Access.
2015;16(3):237–244. https://doi.org/10.5301/jva.5000348
Martin JG, Hollenbeck ST, Janas G et al. Randomized controlled trial of octyl
cyanoacrylate skin adhesive versus subcuticular suture for skin closure after
implantable venous port placement. J Vasc Interv Radiol. 2017;28(1):111–
116. https://doi.org/10.1016/j.jvir.2016.08.009
Mitchell ML, Ullman AJ, Takashima M et al. Central venous access device
securement and dressing eectiveness: the CASCADE pilot randomised
controlled trial in the adult intensive care. Aust Crit Care. 2020;33(5):441–
451. https://doi.org/10.1016/j.aucc.2019.10.002
Narang U, Mainwaring L, Spath G, Barefoot J. In-vitro analysis for
microbial barrier properties of 2-octyl cyanoacrylate-derived wound
treatment lms. J Cutan Med Surg. 2003;7(1):13–19. https://doi.
org/10.1177/120347540300700103
Nicholson J, Hill J. Cyanoacrylate tissue adhesive: a new tool for the vascular
access toolbox. Br J Nurs. 2019;28(19):S22–S28. https://doi.org/10.12968/
bjon.2019.28.19.S22
Ortiz-Miluy G, Ruiz-Hernánez P, Sellán-Soto C, Pittiruti M, Ajejas-Bazán
MJ. Tunnel, glue and SAS: the perfect match. Abstracts from the I
International Congress on Vascular Access (CIAV), September 26–27,
2019, Coimbra, Portugal. J Vasc Access 2019;20(2_suppl):6. https://doi.
org/10.1177/1129729819872288
Pear se I , C orle y A, Bar tnikowsk i N, Fr aser JF. In vit ro te sting o f cya noac ryla te
tissue adhesives and sutures for extracorporeal membrane oxygenation
cannula securement. Intensive Care Med Exp. 2021;9(1):5. https://doi.
org/10.1186/s40635-020-00365-5
Pittiruti M, Emoli A, Scoppettuolo G. Cyanoacrylate glue prevents early
access procedures (e.g skin incisions required by tunnelled
catheters and skin incisions for reservoir placement during
port insertions).
In the authors’ hospital, the vascular access team is currently
using approximately 10 000 vials per year of butyl-CG or octyl-
butyl-CG; no adverse eects related to CG have been reported
in the last decade.
Prospective extensions of the use of glue (still to be supported
by evidence) include UVC, peripheral arterial catheters and
any SPC, as well as in patients at a low risk of bleeding/
dislodgment. In addition, the safety and cost-eectiveness of
weekly replacement of glue over the exit site of central venous
access devices needs to be evaluated by future studies. BJN
Declaration of interest: none
Annetta MG, Pittiruti M, Scoppettuolo G et al. Randomized clinical study on
the ecacy of metallic powder vs cyanoacrylate glue in sealing the exit
site of the peripherally inserted central catheters: preliminary results. Oral
presentation at the Annual Meeting of the Association for Vascular Access,
Nashville, 20-23 September 2013
Auyong DB, Cantor DA, Green C, Hanson NA. The eect of xation technique
on continuous interscalene nerve block catheter success: a randomized,
double-blind trial. Anesth Analg. 2017;124(3):959–965. https://doi.
org/10.1213/ANE.0000000000001811
Bahl A, Gibson SM, Jankowski D, Chen NW. Short peripheral
intravenous catheter securement with cyanoacrylate glue compared
to conventional dressing: a randomized controlled trial. J Vasc Access.
2021:11297298211024037 (epub ahead of print). https://doi.
org/10.1177/11297298211024037
Barone G, Pittiruti M. Epicutaneo-caval catheters in neonates: new insights
and new suggestions from the recent literature. J Vasc Access. 2020;21(6):
805–809. https://doi.org/10.1177/1129729819891546
Bhende S, Rothenburger S, Spangler DJ, Dito M. In vitro assessment
of microbial barrier properties of Dermabond topical skin
adhesive. Surg Infect (Larchmt). 2002;3(3):251–257. https://doi.
org/10.1089/109629602761624216
Biasucci DG, Pittiruti M, Taddei A et al. Targeting zero catheter-related
bloodstream infections in pediatric intensive care unit: a retrospective
matched case-control study. J Vasc Access. 2018;19(2):119–124. https://doi.
org/10.5301/jva.5000797
Bugden S, Shean K, Scott M et al. Skin Glue reduces the failure rate of
emergency department-inserted peripheral intravenous catheters: a
randomized controlled trial. Ann Emerg Med. 2016;68(2):196–201. https://
doi.org/10.1016/j.annemergmed.2015.11.026
Bull T, Corley A, Smyth DJ, McMillan DJ, Dunster KR, Fraser JF. Extracorporeal
membrane oxygenation line-associated complications: in vitro testing of
cyanoacrylate tissue adhesive and securement devices to prevent infection
and dislodgement. Intensive Care Med Exp. 2018;6(1):6. https://doi.
org/10.1186/s40635-018-0171-8
Cellini M, Bergadano A, Crocoli A et al. Guidelines of the Italian Association
of Pediatric Hematology and Oncology for the management of the central
veno us acc ess dev ices i n ped iatri c p atients with onco-hematol ogica l dise ase.
J Vasc Access. 2020:1129729820969309 (epub ahead of print). https://doi.
KEY POINTS
■Glue is effective for securement only for short peripheral cannulas
and epicutaneo-cava catheters and when used with a transparent
semipermeable membrane
■At all central venous access devices, glue is effective in minimising local
bleeding and is cost-effective as it reduces unscheduled dressing changes
■Glue is probably effective in minimising bacterial contamination for all
central venous access devices but should be used only in the rst week as
replacing it every week may be harmful
■To close skin incisions, glue is effective and cost-effective for all venous
access procedures

© 2022 MA Healthcare Ltd
British Journal of Nur sing, 2022, Vol 31, No 8 (IV and Vascular A ccess S uppleme nt) S13
VENOUS ACCESS SECUREMENT
Simonova G, Rickard CM, Dunster KR, Smyth DJ, McMillan D,
Fraser JF. Cyanoacrylate tissue adhesives—eective securement
technique for intravascular catheters: in vitro testing of safety and
feasibility. Anaesth Intensive Care. 2012;40(3):460–466. https://doi.
org/10.1177/0310057X1204000311
Singer AJ, Thode HC Jr. A review of the literature on octyl-cyanoacrylate tissue
adhesive. Am J Surg. 2004;187(2):238–248. https://doi.org/10.1016/j.
amjsurg.2003.11.017
Ullman AJ, Kleidon T, Gibson V et al. Innovative dressing and securement of
tunneled central venous access devices in pediatrics: a pilot randomized
controlled trial. BMC Cancer. 2017;17(1):595. https://doi.org/10.1186/
s12885-017-3606-9
Ullman AJ, Long D, Williams T et al. Innovation in central venous access
device security: a pilot randomized controlled trial in pediatric critical care.
Pedi atr Crit C are M ed. 20 19;2 0(10) :e48 0–e488. h ttps ://do i.or g/10 .1097 /
PCC.0000000000002059
Van Rens M, Nimeri AMA, Spencer TR et al. Cyanoacrylate securement in
neonatal PICC use: a 4-year observational study. Adv Neonatal Care. 2021
(epub ahead of print). https://doi.org/10.1097/ANC.0000000000000963
Waller SC, Anderson DW, Kane BJ, Clough LA. In vitro assessment of microbial
barrier properties of cyanoacrylate tissue adhesives and pressure-sensitive
adhesives. Surg Infect (Larchmt). 2019;20(6):449–452. https://doi.
org/10.1089/sur.2018.280
Wilkinson JN, Sheikh N, Jayamaha J. Tissue adhes ive as an al ternative to sutures
for securing central venous catheters. Anaesthesia. 2007;62(9):969–970.
https://doi.org/10.1111/j.1365-2044.2007.05240.x
Wilkinson JN, Fitz-Henry J. Securing epidural catheters with Histoacryl
glue. Anaesthesia. 2008a;63(3):324. https://doi.org/10.1111/j.1365-
2044.2008.05468.x
Wilkinson JN, Chikhani M, Mortimer K, Gill SJ. The antimicrobial eect of
Histoacryl skin adhesive. Anaesthesia. 2008b;63(12):1382–1384. https://doi.
org/10.1111/j.1365-2044.2008.05775.x
bleeding of the exit site after PICC placement (abstract from second World
Congress on Vascular Access (WoCoVA), Amsterdam, 27-29 June 2012). J
Va s c A cc e s s 2 0 12 ; 1 3 : 2 7 A . h t tp s : / / d o i. o r g / 1 0 .5 3 0 1 / J VA . 20 1 2 . 9 3 6 2
Pittiruti M, Scoppettuolo G, Emoli A, Musarò A, Biasucci D. Cyanoacrylate glue
and central venous access device insertion. J Ass Vasc Access. 2016;21(4):249.
https://doi.org/10.1016/j.java.2016.10.026
Pittiruti M, D’Andrea V, Pinna G, Costa S, Vento G. Securing umbilical venous
catheter with glue: why not? (abstract from sixth World Congress on Vascular
Access (WoCoVa 2020—June 17–19th). J Vasc Access. 2020;21(6):NP16–17.
https://doi.org/10.1177%2F1129729820953245
Pittiruti M, Van Boxtel T, Scoppettuolo G et al. European recommendations
on the proper indication and use of peripheral venous access
devices (the ERPIUP consensus): a WoCoVA project. J Vasc Access.
2021:11297298211023274 (epub ahead of print). https://doi.
org/10.1177/11297298211023274.
Pittiruti M, Scoppettuolo G. Raccomandazioni GAVeCeLT 2021 per
l’indicazione, l’impianto e la gestione dei dispositivi per accesso venoso.
GAVeCeLT—Gli Accessi Venosi Centrali a Lungo Termin (ar ticle in Italian).
2021. https://tinyurl.com/y8j7dxth (accessed 31 March 2022)
Prachanpanich N, Morakul S, Kiatmongkolkul N. Eectiveness of securing
central venous catheters with topical tissue adhesive in patients undergoing
cardiac surgery: a randomized controlled pilot study. BMC Anesthesiol.
2021;21(1):70. https://doi.org/10.1186/s12871-021-01282-0
Prince D, Solanki Z, Varughese R, Mastej J, Prince D. Antibacterial eect and
proposed mechanism of action of a topical surgical adhesive. Am J Infect
Control. 2018;46(1):26–29. https://doi.org/10.1016/j.ajic.2017.07.008
Reynolds H, Taraporewalla K, Tower M et al. Novel technologies can provide
eective dressing and securement for peripheral arterial catheters: a pilot
randomised controlled trial in the operating theatre and the intensive care
unit. Aust Crit Care. 2015;28(3):140–148. https://doi.org/10.1016/j.
aucc.2014.12.001
Rickard CM, Edwards M, Spooner AJ et al. A 4-arm randomized controlled
pilot trial of innovative solutions for jugular central venous access device
securement in 221 cardiac surgical patients. J Crit Care. 2016;36:35–42.
https://doi.org/10.1016/j.jcrc.2016.06.006
Rickard CM, Marsh N, Webster J et al. Dressings and securements for the
prevention of peripheral intravenous catheter failure in adults (SAVE):
a pragmatic, randomised controlled, superiority trial. Lancet. 2018;
392(10145):419–430. https://doi.org/10.1016/S0140-6736(18)31380-1
Rushbrook JL, White G, Kidger L, Marsh P, Taggart TF. The antibacterial
eect of 2-octyl cyanoacrylate (Dermabond®) skin adhesive. J Infect Prev.
2014;15(6):236–239. https://doi.org/10.1177/1757177414551562
Scoppettuolo G, Annetta MG, C Marano, Tanzanella E, Pittiruti MF.
Cyanoacrylate glue prevents early bleeding of the exit site after CVC
or PICC placement. Crit Care. 2013;17(Suppl 2):P 174. https://doi.
org/10.1186/cc12112
Scoppettuolo G, Dolcetti L, Emoli A, La Greca A, Biasucci DG, Pittiruti M.
Further benets of cyanoacrylate glue for central venous catheterisation.
Anaesthesia. 2015;70(6):758. https://doi.org/10.1111/anae.13105
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CPD reective questions
■Is cyanoacrylate glue (CG) completely safe on the skin at any age?
■What evidence is there that CG actually reduces local bleeding at the
exitsite?
■Is there evidence that CG may reduce bacterial contamination of the
exitsite?
■Which venous access devices may benet from CG being used as a
securement strategy?