Despite the prevalence of intravenous (IV) therapy, not enough attention is given to the securement technique and IV dressings used, including the host of complications that can occur all based upon which IV dressing was applied.
Not all IV dressings are made equal, and the choice of dressing, including factors such as acrylic vs. silicone, have an impact on the standard of care, delivery of therapy, patient’s skin and whether or not they will be at high risk.
Intravenous (IV) therapy is one of the most common invasive medical procedures used every year - with over 300 million peripheral intravenous catheters (PIV) used annually in the United States alone.
Approximately 60%-90% of hospitalized patients require an IV during their hospital stay - chances are if you’re reading this article you’ve experienced IV therapy yourself.
IV therapy is required for the delivery of life saving medications, fluids and blood directly into a patient’s bloodstream through the vein.
While IV therapy is a common and routine procedure, what’s often overlooked are the complications that can occur from the securement technique and dressings used.
In this article, we look at what IV dressings are used for, the different types, the differences between acrylic vs. silicone and what to look out for when choosing an IV dressing for your patients.
What are IV dressings?
IV vascular access dressings (VADs) are an incredibly important component of the delivery of medicine and healthcare.
They are used to secure catheters and IV cannula to the skin surrounding the insertion site - which opens up direct access to a patient’s bloodstream.
IV dressings are intended to keep the IV in place and protect the patient from bacteria, germs and external contaminants. They are also supposed to be comfortable, not only for the duration of wear, but also upon removal.
Yet, not all IV dressings are made equally.
Due to differences in adhesive materials and active ingredients, IV dressings may not provide patients the protection from infection intended and cause medical adhesive related skin injuries (MARSI) surrounding the IV insertion site, an area vulnerable to pathogen entry.
The function of IV dressings
The optimal IV dressings should deliver the following:
- Protection from external contaminants and infection
- Transparent observation and assessment of the IV site
- Patient comfort during wear and dressing changes
- Protection and maintenance of skin integrity
- Provide antimicrobial protection to the catheter insertion site and surrounding skin
- Catheter securement
Ultimately, IV dressings work in conjunction with the entire delivery system of IV therapy. A dressing can make the difference between gentle, compassionate care or pain, additional trauma and setbacks to healing.
Even a small medical device, such as an IV dressing and the application and removal of the dressing can play a critical role in the delivery of patient centred care - and mean the difference between pain, infection and delayed healing or comfort, protection and successful patient outcomes.
How IV dressings are designed
IV dressings typically have the following design principles:
- Shape and size: the shape, size and thickness of the dressing will impact how secure the catheter is especially with patient movement.
- Adhesive securement: dressings use different adhesive properties to secure the catheter to the patient. These properties may be acrylic or silicone.
- Site visibility: Dressings can be transparent, translucent or provide no visibility to the site.
- Infection prevention: Dressings are made with different formulations like chlorhexidine or silver to protect patients from infection.
- Moisture management (moisure barrier and vapour permeability): Dressings are designed to be permeable to moisture vapor, oxygen, impermeable to external contaminants and should be waterproof allowing patients to shower.
- Application and removal: The design of the dressing should promote efficient and consistent application and removal of the dressing, being easy for healthcare providers to use and remove from the skin without adhesive injury.
Complications associated with IV device wounds
IV therapy complications can result in pain, infection, delayed treatment and in worse case scenarios sepsis.
Poor placement technique, lack of hygienic practices and the wrong IV dressing can lead to the following IV device wound complications:
- Dislodgement - failure to protect an IV site with the right dressing can lead to a catheter being dislodged or removed by the patient
- Vessel wall trauma - catheter movement can lead to vessel wall trauma and potentially thrombosis
- Extravasation - the leaking of a medication or fluid into the surrounding tissue
- Phlebitis - inflammation leading to a blood clot to form in the vein
- Medical adhesive-related skin injuries (MARSI) - trauma caused when the medical adhesive is too strong or incompatible with skin sensitivities
- Bloodstream infections - the entry of bacteria and microorganisms into the IV site leading to bloodstream infections such as central line-associated bloodstream infections (CLABSI)
The difference between acrylic vs. silicone dressings
IV dressings are designed to secure catheters, prevent infection, protect skin health and integrity and help heal insertion wounds.
The adhesive properties of an IV dressing play a critical role in both the function of the dressing and the impact of the dressing on the patient.
The two most common adhesive components used in IV dressings are acrylic and silicone.
Below we’ll take a look at the pros and cons of each, both to the function of the dressing and the experience of the patient.
Acrylic adhesives are known to be incredibly strong due to their tackiness.
Acrylic can perform well when it comes to holding, fixing and gripping - but the cost is that acrylics can be incredibly traumatic to the patient’s skin. They can also be time consuming to move, requiring healthcare providers to use solvents and scrapers.
Acrylic dressings are often less costly.
Soft silicone dressings are tacky enough to adhere to the surrounding skin, while being gentle enough to allow for minimized trauma during dressing changing.
Silicone dressings are flexible both in design and function but also are suitable for a wide range of indications where it’s especially important to prevent trauma to the patient, their skin and the wound.
Silicone adhesives can be more expensive to produce.
The pros and cons of acrylic vs silicone adhesives
- Strong, tacky and rigid
- Can cause epidermal stripping on removal
- Supports devices and tubes for a long period of time
- Rough and traumatic on skin
- Often require skin barrier be applied prior to protect the skin site
- Require adhesive removers and “low & slow” technique to avoid sin in injury
- Secure, malleable and flexible
- Gentle and atraumatic on skin
- Atraumatic on removal to prevent epidermal stripping and skin injury
- Clean and genle removal without use of adhesive removers
- Do not require skin barriers or protectants be applied prior to use
- Prevent scarring
- No adhesive remover required for safe removal
Selecting the right IV dressing for the patient
While IV therapy is commonplace, it’s critical to remember the potential harm that can occur to the patient when the right tools and technique aren’t used.
When deciding which IV dressing to use, it’s important to put the patient first.
If you have a patient that has delicate skin, will be wearing an IV securement dressing for long periods of time and would like to minimize pain and trauma - a silicone securement dressing may be the way to go.
It’s important to take into consideration the full application and removal process - both the steps involved and what mitigation factors may or may not need to be taken if the application or removal doesn’t go well.
For example, your team may find successful application and securement with acrylic dressings, but are you spending extra time removing residue with solvents, scraping and dealing with the trauma of cringeworthy dressing removals?
Beyond deciding between silicone and acrylic adhesives, consider the complete design of the dressing - is it possible to find all of the essential components of a high-performing IV dressing all-in-one?
Take Covalon’s IV Clear dressing for example. It is the only dual antimicrobial silicone adhesive vascular access dressing.
- Chlorhexidine and silver embedded into the entire surface of the dressing provide broad spectrum protection at safe and effective concentrations
- Silicone adhesive helps to maintain skin integrity and keep patients comfortable
- Complete transparency allows for visualization and easy daily assessment of the site and surrounding skin
One of the best ways to choose between different IV dressings is to sample them yourself. Feel and experience the difference between each type - especially the difference between silicone and acrylic.
Request your free samples of IV Clear today: https://covalon.com/
Open Forum Infectious Diseases - Peripheral Intravenous Catheters
Journal of Infusion Nursing - Improving Vascular Access Outcomes and Enhancing Practice