Extracorporeal membrane oxygenation cannula dressing and securement practices: A point prevalence study

Abstract

BACKGROUND: Effective securement of extracorporeal membrane oxygenation (ECMO) cannulae, both at the insertion site and along the length of circuit tubing, may reduce the risk of cannula migration, dislodgement, and infection, all of which can lead to adverse patient outcomes. Despite this, there are no evidence-based clinical practice guidelines to inform cannula dressing and securement practices. However, before recommendations for best practice can be made, current practice must be understood. AIM/OBJECTIVE: The aim of this study was to describe current ECMO cannulae and circuit tubing dressing and securement practices across Australia and New Zealand. METHODS: A prospective, observational point prevalence study was conducted in 11 centres across Australia and New Zealand over a 12-month period. Data were collected for every patient receiving ECMO who met inclusion criteria during 12 prespecified data collection periods, each separated by 3 to 4 weeks. RESULTS: A total of 127 patients (adult, n = 100; paediatric, n = 27) and 256 cannulae (venous = 179, arterial = 77) were included in the analysis. Peripherally inserted cannulae were most commonly dressed with a transparent semipermeable dressing (arterial: n = 50/59 [85%]; venous: n = 127/165 [77%]), while centrally inserted cannulae were less uniformly dressed. Sutures were used to secure cannulae at the insertion site in neonatal and paediatric patients (n = 48/51, 94%) more often than in adults (n = 88/205, 43%). Circuit tubing was most frequently secured using sutureless securement devices (arterial: n = 50/77 (65%); venous: n = 93/179 [52%]). Most centres (82%) had a dressing and securement guideline; however, only 12% of insertion sites (n = 13) and 6% of circuit tubings (n = 6) were dressed and secured according to the guideline. CONCLUSIONS: Variation exists in ECMO cannula dressing and securement practices across Australia and New Zealand intensive care units, and adherence to local guidelines is low. Further evidence on optimal cannula dressing and securement techniques is urgently required to inform the development of clinical practice guidelines and improve patient care and outcomes.