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Abstract
Background and Aims Local anaesthesia (LA) nerve infusions are increasingly used in our institution for rib fracture analgesia; they provide not only excellent analgesia but reduce morbidity, mortality and improve economic outcomes [1]. Data from a local audit demonstrated 33% of rib fracture LA infusions were prematurely removed due to accidental disconnection. Currently there is no consensus on the optimum method of securing LA catheters in place [2]. Accordingly, we aimed to reduce rates of catheter disconnection through a benchtop experiment to determine the optimal LA catheter fixation method.
Methods We used a porcine abdominal wall model (figure 1) to determine the force required to displace catheters secured using seven methods (table 1). We used our in-service wingless catheter-through-needle system (Pajunk), except when examining suturing strength, where a Vygon arterial line with suturing wings was used. The force required to displace the catheter by 1cm from the skin was measured. Each method was repeated 5 times. Data was analysed using parametric tests.
Results Catheters secured using Tegaderm and Dermabond (13.04 N, p=0.0004), Epifix and Dermabond (11.18 N, p=0.007) and Tegaderm and suturing (42.18 N, p=0.001) required significantly more force to displace than those using Tegaderm alone (5.94 N)(figure 2).
A table demonstrating different methods used to secure local anaesthetic catheters in situ, using a porcine abdominal wall model
Photographs depicting local anaesthetic catheter fixation methods, in situ, on a porcine abdominal wall model
A bar chart illustrating the mean force (newtons) required to displace local anaesthetic catheters secured on a porcine abdominal wall model using different methods of fixation. Error bars represent +/- 1 standard deviation. Statistical significance was analysed with ANOVA and post hoc t-tests (*P<0.01)
Conclusions Tegaderm with suturing was the most effective method of catheter fixation, requiring a force several times that required to displace catheters secured using other means. However, Tegaderm and Dermabond provide effective fixation while also being both more cost-effective and patient/operator friendly. Consequently, we changed our department’s catheter fixation policy to advocate routine use of skin glue.