Feature Article

The pace of change is quickening in the temporary adherent medical securement device sector. Advances in adhesive technology have led to a wave of new securement technologies that promise to improve patient comfort, address infection control concerns and promote favourable conditions for wound healing. Medical device manufacturers can use these new products to enhance the capabilities and functionality of their own product offerings.

Temporary adherent securement devices come in varying types and perform a range of medical functions. These include safely and securely attaching catheter lines, tubing lines, dressings and electrodes to patients. Securement products help prevent accidental dislodgement of the catheter caused by pulling or snagging of tubing or lines, thereby minimising the need for catheter reinsertion. Some securement devices cover and protect wounds and insertion sites of vascular and nonvascular percutaneous medical devices.

Securing medical devices and reducing infection risks

Medical tape has long been the most widely used product for securing medical devices. Paper tape for medical applications was introduced more than 50 years ago, and tape varieties made of fabric, silk, plastic and other materials have since entered the market. Standard medical tape generally exhibits low tensile strength so it can be detached or divided as needed. It is usually coated with latex-free acrylic adhesive.

Although versatile and relatively inexpensive, standard tape in roll form has its drawbacks. Multiple studies have shown that roll tape can become contaminated with bacteria during normal clinical use, raising concerns about the potential spread of infection. Clinicians commonly place rolls of tape in their pockets and carry them between patient sites. Portions of tape are sometimes adhered to nonsterile bedsides or tray tables. In one study, researchers found that 74% of tape specimens collected from one hospital were colonised by pathogenic bacteria. In 41% of the samples, the bacterial colonies were too numerous to count. The study noted that a full revolution of tape had to be removed before reaching an uncontaminated portion.¹

Securement technology providers have recently introduced new tape varieties and formats that help address infection issues. One such product consists of sheets of perforated paper tape strips on a release liner. The adhesive-backed strips effectively secure medical dressings and light- to medium-weight tubes and devices. In contrast to roll tape, the sheet format allows clinicians to take into patient areas only the amount of tape needed for a given procedure, helping to reduce infection concerns.

A single sheet contains multiple tape strips in both ½- and 1-inch widths. The sheet of tape strips is perforated and can be easily divided in half or into quarters to fit the task. The strips are coated with a highly breathable skin-friendly acrylic adhesive that adheres to dry or slightly moist skin.

The product’s breathable carrier and adhesive work together to facilitate moisture and oxygen transmission, minimising the risk of skin softening or maceration. The tape strips can be used on fragile skin or where repeat taping is required. Each strip has an adhesive-free tab at both ends to facilitate application with gloved hands.

In several countries, treatment guidelines around cleaning and disinfecting items after use exist, such as in dialysis care. Because medical tape cannot be cleaned or disinfected, it must be thrown out after one use. Tape strips in sheet form can help clinicians comply with these guidelines and reduce tape waste by allowing them to bring into the patient care area only the amount of tape they need.

Tube and line fixation
Standard medical tape is also used to secure medical tubes, lines and cords. These tapes typically feature paper, silk or plastic carriers coated with an acrylic adhesive. Securement with standard tape, however, often requires repeated tape application and removal to reposition lines or cords. Moreover, repeated exposure to the tape’s acrylic adhesive can irritate and damage skin, especially among patients with compromised immune systems or heightened skin sensitivity.

Many tube securement devices have been introduced as alternatives to standard tape. Most target a narrow range of specific applications. These include devices for securing feeding lines or vascular access catheters. Another device is primarily designed to secure cords or lines during surgical procedures: a strip of adhesive on the outside of the device attaches the tube or line to the patient’s skin or the operating table. There are also devices for neonatal applications with skin-friendly adhesives.

Demand from clinicians spurred development of an innovative new tube fixation device with more broad-based functionality. The bandage-shaped device secures a range of medical equipment including IV catheter lines, epidural lines, Foley catheter lines, gastric nasal tubes, chest tubes, urinary drainage tubes and surgical drain lines. It can also accommodate multiple tubes or lines at one time.

The device minimises the need for hospitals to purchase and inventory multiple securement products for a host of specific applications. The tube fixation device uses an absorbent hydrocolloid adhesive that is gentle to the skin and helps reduce skin damage associated with standard acrylic adhesives.

The device’s specially designed hook-and-loop closure system allows clinicians to reposition lines and cords without removal and reapplication, and prevents tubes or lines from contacting or rubbing against the patient’s skin. The closure system can be opened and closed repeatedly without damage to the fixation device or the patient’s skin, allowing comfortable long-term wear. The device accommodates lines, tubes, cords and drains of varying sizes.

Transparent film dressings
New securement options also exist among transparent film dressings. The category originated with a landmark medical study in the 1960s that changed prevailing ideas about the proper environment for wound healing. It demonstrated that wounds that were kept moist healed much faster than wounds that were exposed to air and allowed to dry out. In the study, wounds were kept moist by covering them with a polymeric film.

The sector today includes both basic and advanced film dressings. Basic dressings usually consist of a transparent film coated with an acrylic adhesive. They secure catheters and other devices and cover superficial wounds, allowing clinicians to monitor wound healing in progress.

Transparent film dressings, for example, secure vascular and nonvascular percutaneous medical devices and protect surgical incisions, skin graft donor sites and first- and second-degree burns. The dressings feature a transparent polyurethane film, latex-free adhesive and paper frame. The thin waterproof film provides an effective barrier against external contaminants when intact. The highly breathable film facilitates moisture vapour exchange and does not allow a build-up of moisture under the dressing, which can cause skin maceration. The dressing’s skin-friendly pressure-sensitive adhesive provides sufficient tack to secure catheter sites and other devices. The transparent film and adhesive combine to create an ideal environment that is conducive to moist wound healing.

The transparent dressing facilitates accurate positioning over the catheter site or wound. The dressing’s paper frame has handling tabs that allow clinicians to apply the dressing with gloved hands. The frame also provides stability and strength to the dressing and prevents it from folding over onto itself during application.

Advanced transparent film dressings incorporate specialised adhesives, foams, carriers and materials to address specific clinical requirements. Examples include dressings with nonwoven borders for added reinforcement in securement applications, and pattern-coated adhesives that exhibit high levels of breathability and reduce the amount of adhesive applied to the skin, making the dressings easier to remove. Antimicrobial technologies are also a focus of innovation and research, and new products based on this research are likely to be introduced in the near future.  

High-value prepackaged kits
European and global demand for advanced prepackaged medical kits continues to grow in response to medical costs, ease of use, infection control concerns and related factors. The adhesive-based securement innovations profiled here are well suited for inclusion in high-value prepackaged and custom kits, including urology, suture removal and laceration kits. Medical device manufacturers and distributors are encouraged to consult with securement technology providers to identify products that complement their existing product offerings.

References
1.    D.A. Redelmeier, MD, and N.J. Livesly, MD, “Adhesive Tape and Intravascular-Catheter-Associated Infections,” JGIM, 14 June 1999.

Emily Berlin
is Global Market Segment Manager, Avery Dennison Medical Solutions, Tieblokkenlaan 1, 2300 Turnhout, Belgium
e-mail: emily.berlin@averydennison.com.
www.medical.averydennison.com