Vascular Access Device Securement Policy

1. Policy Statement

All vascular access devices (VADs) placed or maintained within this organization must be secured using evidence-based, suture-free securement methods that prevent dislodgement, minimize catheter movement at the insertion site, preserve skin integrity, and do not impede vascular circulation, site assessment, or therapy delivery. Sutures as a VAD securement strategy are prohibited. Clinicians must select securement methods appropriate to device type, patient characteristics, and anticipated therapy duration, and must assess securement integrity at every dressing change and catheter care encounter.

2. Purpose

• To prevent unplanned VAD dislodgement and catheter migration that result in treatment delays, additional venipuncture attempts, and patient harm.
• To eliminate suture-based securement and its associated risks, including needlestick injury, biofilm growth on suture material, and increased catheter-associated bloodstream infection (CABSI) risk.¹²
• To standardize the selection, application, maintenance, and assessment of acceptable VAD securement methods across all patient populations and care settings.
• To reduce catheter-associated skin injury (CASI) resulting from improper securement device selection or technique.
• To provide device-specific securement guidance that reflects the current evidence base for peripheral intravenous catheters (PIVCs), midline catheters, peripherally inserted central catheters (PICCs), central venous access devices (CVADs), and arterial catheters.
• To establish clear requirements for management of a dislodged or partially dislodged VAD.

3. Scope

This policy applies to:

• All licensed and unlicensed clinical staff involved in the insertion, care, and maintenance of vascular access devices.
• All inpatient, outpatient, procedural, and home infusion settings operated by or affiliated with this organization.
• All vascular access device types including, but not limited to: short peripheral intravenous catheters (PIVCs), extended dwell PIVCs, midline catheters, peripherally inserted central catheters (PICCs), non-tunneled central venous catheters (CVCs), tunneled cuffed and non-cuffed CVCs, implanted ports, and peripheral arterial catheters.
• All patient populations including neonates, pediatric patients, and adults.
• Securement method selection, application, maintenance, replacement, and documentation.

4. Policy Requirements

4.1 Definitions

4.1.1 Adhesive Securement Device (ASD)

4.1.1.1 An adhesive-backed product that adheres to the patient’s skin and mechanically holds the VAD in place at the insertion site. A separate transparent semipermeable membrane (TSM) dressing must be applied over both the ASD and the insertion site. Both the ASD and the overlying dressing require removal and replacement at the scheduled dressing change interval.

4.1.2 Integrated Securement Device (ISD)

4.1.2.1 A single product that combines a transparent semipermeable dressing window with a bordered fabric collar incorporating a built-in securement mechanism. The ISD functions as both the securement device and the primary dressing in a unified product.

4.1.3 Subcutaneous Anchor Securement System (SASS)

4.1.3.1 A device that achieves catheter stabilization through flexible feet or posts positioned just beneath the skin surface at the insertion site, anchoring the catheter subcutaneously without adhesive bonding to the catheter hub. A separate dressing is placed over the SASS. The SASS does not require routine removal with dressing changes and may remain in place for the duration of VAD use in the absence of complications. The SASS is appropriate for PICCs, tunneled cuffed CVCs, and non-tunneled CVCs anticipated to remain in place for 15 or more days.

4.1.4 Tissue Adhesive (TA)

4.1.4.1 A medical-grade cyanoacrylate adhesive that seals the catheter insertion site and temporarily bonds the catheter to the surrounding skin. Three formulations are recognized:

• First-generation N-Butyl-2-cyanoacrylate: rapid drying, rigid bond.
• Second-generation 2-octyl-cyanoacrylate: longer drying time, flexible bond.
• N-Butyl-2-octyl cyanoacrylate: enhanced tensile strength with flexibility.

4.1.4.2 Tissue adhesive is used in conjunction with a primary dressing, not as a standalone securement solution, unless the product is specifically designed and labeled for standalone use.

4.2 General Securement Requirements

4.2.1 Mandatory Securement

4.2.1.1 All VADs must be secured using at least one dedicated securement method in addition to or integrated with the primary dressing. Acceptable securement methods are: ASD, ISD, SASS, and tissue adhesive. These methods may be used individually or in combination based on clinical indication.

4.2.1.2 Securement must not interfere with routine visual and tactile assessment of the VAD insertion site or the surrounding skin.

4.2.1.3 Securement must not impede vascular circulation, compress underlying tissue, or compromise delivery of prescribed therapy.

4.2.2 Prohibition of Sutures

4.2.2.1 Sutures must not be used as a VAD securement method for any device type. Sutures are not an effective alternative to dedicated securement devices and carry the following documented risks:

• Needlestick injury to healthcare workers during placement and removal.
• Biofilm growth on suture material contributing to CABSI.
• Increased rates of catheter-associated bloodstream infection.

4.2.2.2 This prohibition applies to all device types, including non-tunneled CVCs, PICCs, and arterial catheters. Clinical situations that previously utilized sutures must transition to suture-free securement methods consistent with this policy.

4.2.3 Prohibition of Non-Sterile Tape

4.2.3.1 Rolls of non-sterile tape must not be used as any component of VAD securement. Non-sterile tape rolls are a documented source of pathogenic bacterial contamination and represent an unacceptable infection risk at the VAD insertion site.

4.2.4 Securement Method Selection Criteria

4.2.4.1 Clinicians must individualize securement method selection based on the following factors:

• Type and size of VAD.
• Patient age and developmental stage.
• Skin turgor, fragility, and overall integumentary integrity.
• Anticipated duration of therapy and VAD dwell time.
• History of adhesive-related skin injury or documented adhesive allergy.
• Presence of drainage, diaphoresis, or other conditions at the insertion site that may compromise adhesion.
• Anatomical location of the insertion site and proximity to joints.

4.3 Device-Specific Securement Requirements

4.3.1 Peripheral Intravenous Catheters (PIVCs)

4.3.1.1 All PIVCs must be secured with a primary dressing and a dedicated securement method or ISD.

4.3.1.2 Enhanced securement strategies—defined as tissue adhesive applied in addition to the primary dressing, or use of an ISD—must be evaluated and implemented for high-risk patients meeting any of the following criteria:

• Difficult intravenous access (DIVA), defined as three or more failed venipuncture attempts or prior documented DIVA history.
• Anticipated dwell time exceeding 48 hours.
• Active delirium, agitation, or cognitive impairment posing dislodgement risk.
• Pediatric patients with developmental or behavioral dislodgement risk.

4.3.1.3 The evidence base for tissue adhesive in PIVCs supports its targeted use in DIVA patients and those with anticipated prolonged dwell; large superiority trials in unselected adult inpatients have not demonstrated reduction in failure rates, supporting a risk-stratified rather than universal application approach.

4.3.2 Midline Catheters

4.3.2.1 Midline catheters must be secured using a dedicated securement method (ASD, SASS, or tissue adhesive) applied in addition to the primary dressing, or an ISD.

4.3.2.2 Given the extended dwell time associated with midline catheters, the clinical and fiscal benefits of SASS must be evaluated during securement selection.

4.3.3 Peripherally Inserted Central Catheters (PICCs)

4.3.3.1 PICCs must be secured using ASD, ISD, SASS, or tissue adhesive. Sutures are contraindicated per Section 4.2.2.

4.3.3.2 Clinicians must evaluate the use of SASS for PICCs anticipated to remain in place for 15 or more days, consistent with endorsement by the National Institute for Health and Care Excellence (NICE).

4.3.3.3 Available pilot and observational data suggest improved securement outcomes with SASS, ISD, and tissue adhesive compared to ASD alone for PICCs; clinicians should apply this evidence in securement selection while recognizing the need for larger confirmatory trials.

4.3.4 Non-Tunneled Central Venous Catheters (CVCs) — Neck and Groin Sites

4.3.4.1 Non-tunneled CVCs inserted at jugular, subclavian, or femoral sites must be secured using a suture-free method. Accepted alternatives include ISD, tissue adhesive combined with ASD, or SASS where applicable.

4.3.4.2 The most effective securement method for non-tunneled CVCs has not been definitively established. Pilot trials suggest that ISD and tissue adhesive combined with sutures (in contexts where suture prohibition has not yet been implemented) may reduce failure rates compared to suture alone; however, this organization’s policy prohibits suture use, and ISD or tissue adhesive must be employed as the primary securement method.

4.3.5 Subcutaneous Anchor Securement for PICCs and Tunneled CVADs

4.3.5.1 The clinical and fiscal benefits of SASS must be evaluated for all PICCs and CVADs, including tunneled cuffed and non-cuffed catheters, when VAD duration is anticipated to be 15 or more days.

4.3.5.2 A separate dressing is required over the SASS. The SASS itself does not require removal at routine dressing change intervals unless complications are present.

4.3.6 Peripheral Arterial Catheters

4.3.6.1 Peripheral arterial catheter securement must include evaluation of innovative securement strategies such as tissue adhesive or keyhole dressings to reduce catheter failure rates. Standard securement with ASD or ISD is the minimum requirement.

4.4 Use of Rolled Bandages and Tubular Sleeves

4.4.1 Rolled Bandages

4.4.1.1 Rolled bandages must not be used as primary VAD securement. Rolled bandages do not provide adequate catheter stabilization and may conceal complications at the insertion site.

4.4.1.2 When additional site coverage is clinically indicated (e.g., protection from environmental soiling or to reduce tension on administration set connections), a single tubular sleeve that can be readily removed for site inspection is acceptable as a supplementary measure.

4.4.2 Special Population — Adhesive-Contraindicated Skin Conditions

4.4.2.1 Patients with skin disorders that contraindicate adhesive application—including epidermolysis bullosa, toxic epidermal necrolysis, and extensive burns—present unique securement challenges. For these patients:

• Tubular gauze mesh may be used as the primary cover or supplementary securement element.
• SASS must be evaluated as the preferred securement method, as it does not rely on adhesive bonding to the skin surface.
• All securement decisions for these patients must be documented with clinical rationale.

4.5 Securement Maintenance, Assessment, and Replacement

4.5.1 Assessment Frequency

4.5.1.1 Securement device integrity must be assessed at every dressing change and at each catheter care encounter.

4.5.1.2 Assessment must include evaluation for: lifting of adhesive edges, contamination beneath the securement device, evidence of skin injury, catheter migration (measurement of external catheter length), and signs of infection at the insertion site.

4.5.2 ASD Maintenance

4.5.2.1 ASD must be removed at each scheduled dressing change. Skin antisepsis must be performed following ASD removal. A new ASD must be applied prior to placement of the replacement dressing.

4.5.3 Tissue Adhesive Maintenance

4.5.3.1 Tissue adhesive must be reapplied at each dressing change in accordance with the specific product formulation’s instructions for use (IFU) and the manufacturer’s recommended reapplication interval.

4.5.4 SASS Maintenance

4.5.4.1 SASS does not require removal at routine dressing changes. The SASS must be assessed for integrity at each catheter care encounter. Indications for SASS removal include: skin injury beneath or adjacent to the anchor posts, device malfunction, signs of infection at the insertion site, or VAD removal.

4.5.5 Skin Injury Prevention

4.5.5.1 Clinicians must assess for catheter-associated skin injury (CASI) at each securement device change. CASI risk is elevated in the following circumstances:

• Extremes of patient age (neonates and elderly patients).
• Presence of edema at or adjacent to the insertion site.
• VAD placement at anatomical areas subject to repetitive joint movement.
• Prolonged securement device dwell time.
• Prior documented adhesive-related skin injury.

4.5.5.2 A barrier solution (skin protectant) must be applied to the skin prior to application of any adhesive-backed securement device or dressing, in accordance with manufacturer IFU and patient skin condition.

4.5.6 Neonatal Tissue Adhesive Precautions

4.5.6.1 Tissue adhesive must be used with caution in neonates, particularly early premature infants and low-birthweight neonates. The evidence base for tissue adhesive safety and efficacy in this population is limited. Clinical judgment must guide tissue adhesive use in neonates, and any adverse skin reactions must be documented and reported.

4.6 Management of Dislodged Vascular Access Devices

4.6.1 Prohibition of Catheter Readvancement

4.6.1.1 A dislodged or partially dislodged VAD must never be readvanced into the vein. Readvancement of a contaminated catheter segment is contraindicated due to the risk of introducing surface contaminants into the vascular system.

4.6.2 Assessment Following Dislodgement

4.6.2.1 Following identification of VAD dislodgement, the clinician must:

• Assess catheter tip location and integrity.
• Evaluate suitability of the remaining catheter for prescribed therapy, including confirmation that catheter tip position is appropriate for the intended therapy.
• Notify the ordering provider and document assessment findings.
• Determine whether the VAD may be safely maintained (if tip location is confirmed appropriate), requires repositioning by a qualified clinician, or must be removed and replaced.

4.6.2.2 Central venous catheters that have migrated must undergo tip location confirmation (chest radiograph or other accepted modality) prior to resuming infusion therapy, particularly for vesicant or irritant agents, hypertonic solutions, and parenteral nutrition.

5. Compliance

5.1 Key Performance Indicators

• Rate of unplanned VAD dislodgement per 1,000 catheter-days, tracked by device type and patient population.
• Percentage of VADs with documented securement method in the medical record at time of insertion and at each dressing change.
• Incidence of suture use for VAD securement (target: zero).
• Rate of catheter-associated skin injury attributed to securement devices, reported through the organization’s adverse event tracking system.
• Compliance with suture-free securement policy as measured by periodic chart audit (target: 100%).
• Rate of SASS utilization for PICCs with anticipated dwell of 15 or more days, as a process measure supporting NICE-aligned best practice.
• Staff competency completion rate for VAD securement, assessed annually.

5.2 Enforcement

Adherence to this policy is a condition of clinical practice within this organization. Clinicians who deviate from this policy, including use of sutures as primary VAD securement, must document clinical rationale in the medical record. Repeated non-compliance will be addressed through the organization’s progressive performance management process. This policy will be reviewed by the Vascular Access Governance Committee no less than every two years or whenever significant new evidence is published.

6. Exceptions

Exceptions to this policy require documented clinical justification entered in the medical record at the time of deviation. Recognized exception circumstances include:

• Surgeon-directed suture use in the immediate post-operative period for specific surgical VAD placements, pending transition to suture-free securement within 24 hours of placement.
• Patients with documented adhesive allergy or skin conditions precluding all adhesive-backed products, for whom SASS or tubular gauze mesh represents the only clinically appropriate option.
• Clinical emergencies in which ideal securement materials are temporarily unavailable; in such cases, the least-risk alternative must be employed and the situation resolved within the same care episode.

Exceptions do not exempt clinicians from the requirement to assess and document securement device integrity at each catheter care encounter.

7. Related Documents

• Vascular Access Device Insertion Policy
• Vascular Access Device Site Care and Dressing Change Policy
• Vascular Access Device Selection and Insertion Policy
• Standard Precautions Policy
• Catheter-Associated Bloodstream Infection Prevention Bundle
• Skin Antisepsis and Site Preparation Policy
• Adverse Event Management and Reporting Policy
• Product Management and Device Safety Policy
• Pediatric Vascular Access Considerations Guideline
• Infection Control and Prevention Policy

8. Revision History

References