Table 2.

Tissue adhesive and sutureless securement device testing and clinical practice points for use in ECMO

Securement product	In vitro study findings	Advantages in ECMO	Clinical practice points
Cyanoacrylate tissue adhesive (Histoacryl)	• Higher tensile strength compared with transparent dressing at the cannula insertion point • Microbial inhibition along the cannula tunnel, under the cannula dressing and at the cannula insertion point compared with transparent dressing • Chemical compatibility of cannula and tissue adhesive remover agent (Remove wipes) after 15 min exposure, but cannula weakening observed after 1 h exposure time	• Promising simple, adjunct securement method to help stabilise peripheral cannulas at their percutaneous insertion point without the need for suturing • No risk for needlestick injury by avoiding cannula suturing • Potential to reduce incidence of cannula colonisation, localised infection and bloodstream infection	• Quick and easy to apply • Can remain in situ for days and be ‘topped up’ if needed • Easily removed with adhesive remover • Remover agent must be thoroughly cleansed from cannula after TA removal and long exposure times avoided • Prevents complications and failure in intravascular devices [39] • Low incidence of adverse skin effects such as skin tears has been reported [18, 22, 23] • Haemostatic properties prevent early post-insertion bleeding [40, 41] and early dressing change in patients with other intravascular devices [39] • Hair growth ‘against’ and ‘into’ TA with resultant pain on TA and central catheter removal has been reported [20]; hair must be clipped before applying TA at cannulation sites; rapid beard or pubic hair growth may preclude TA use • Further evidence required to guide clinical usage including the potential to reduce post-insertion cannula site bleeding in ECMO
Sutureless securement device (Grip-lok, MultiFix)	• Higher tensile strength compared with adhesive bandage (Tensoplast)	• More flexible approach and ease of use over adhesive bandages for securing lines • Avoids skin suturing and subsequent risk of oozing/bleeding and incidental perforation of tubing • Allows tubing to be easily readjusted or tightened as needed; therefore, less line handling needed and less risk of inadvertent line kinking or movement • When combined with TA, offers an optimal dual line securement strategy by minimising cannula micromotion (at insertion point) and gross movement of the tubing	• Simple and quick to apply • Velcro strap secures the hub of the device allowing for easy opening and closing • Can generally remain in place for several days and only needs changing when soiled • Not considered appropriate for securement of central ECMO cannulas in the absence of sutures but may help avoid gross line movement