A comparison of the force required for removal of intravenous cannulae using two taping methods

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A comparison of two commonly used methods for securing intravenous cannulas Objective: There is a wide variety of techniques to secure intravenous cannulas but little objective evidence to support their relative efficacy. This study compares the security of the two most common methods used within a major Australian Emergency Department. Methods: The plastic sheaths of four needle-less intravenous cannulas were secured to the skin surface (not intravenously) of 40 volunteers using two different taping styles, an ‘under and over’ method with one of the tapes applied to the posterior surface of the hub then crossed anteriorly to adhere to the opposite skin surface or ‘horizontal’ taping with the tapes applied horizontally across the anterior surface of the hub. The peak force required to dislodge the taped cannulas using each of these different methods was then measured in both an anterograde and retrograde direction of force using a force transducer. In more detail, the force of dislodgement was measured in antergrade and retrograde directions with a force transducer and these forces compared. The "under and over" technique was the intervention arm being compared to the more standard "two horizontal tape" method. The plastic sheaths of four needle-less intravenous cannulae were secured to the skin surface (not intravenously) using an ‘under and over’ method with one of the tapes applied to the posterior surface of the hub then crossed anteriorly to adhere to the opposite skin surface or ‘horizontal’ taping with the tapes applied horizontally across the anterior surface of the hub. The peak force required to dislodge the taped cannulae using each of these different methods was then measured in both an anterograde and retrograde direction of force using a force transducer. Each participant had two cannulae for each of the two techniques ie four cannulae in total. The cannulae were applied sequentially to the cubital fossae (2 per arm)of the body. The first cannula was placed in one cubital fossa using the control technique and removed in an anterograde fashion, followed by the second cannula on the same cubital fossa utilising the intervention technique, again dislodged using anterograde force. The process was repeated on the opposite cubital fossa using retrograde force. Cannulae were left in place 5 mins before removal and there was approximately five minutes again until the next cannula removal. Anterograde / retrograde removal is defined as the hub is pulled in direction of cannula removal (anterograde) and against the direction of removal (retrograde) until dislodged. A senior clinician grade operator (often PI) applies the force transducer to the cannula hub whilst blinded to the technique utilised. A second senior clinician grade applies the cannulae without revealing this to the operator attempting removal. There were no adherence monitoring process applied. Results: The force required to dislodge a cannula taped in an ‘under and over’ taping style was significantly higher than that required for the horizontal taping in both anterograde and retrograde directions of force. (p <0.001) Conclusion: The results of this study suggest that the ‘under and over’ taping technique offers significantly more security than ‘horizontal’ taping and should be considered as a more effective method for securing intravenous cannulas.

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