Reducing Dressing Failure in Jugular CVCs: ICU Nurse Guide

Introduction: When Good Dressings Go Bad

If you've cared for a critically ill patient with a jugular central venous catheter (CVC), you've likely faced the frustration of a dressing that doesn't stick; it lifts, peels and compromises the insertion site.

We know that proper securement is important for CVC function: These dressings deliver lifesaving medications, fluids and nutrition. Yet, in the real world of the ICU (humid rooms, sweating patients, multiple infusion lines, neck movements), keeping jugular CVC dressings intact can be challenging. Despite testing many novel dressings and securement products, we couldn't seem to find a solution to the perplexing problem of persistent lifting of CVC dressings at the jugular site. Every time an edge lifted or a dressing failed, the risks multiplied — contamination, infection, thrombosis, even dislodgement. And every failed dressing meant another time-consuming change for nurses. So we started exploring innovative options, a little outside the box, to find a solution that increased the longevity of CVC dressings - and the STICKY trial was born.

Why Central Line Dressings Fail (and Why It Matters)

Each year, millions of CVCs are inserted worldwide. Up to one in four fails prematurely, frequently because the dressing doesn't adhere well enough to the skin. Jugular CVC dressings are particularly challenging to keep secured to the skin. The limited space for dressing placement on the neck doesn't give adhesives much area to cling to, especially with constant head turning, facial hair growth, perspiration, multiple lines tugging on the CVC, and the close presence of other medical devices (endotracheal tube, tracheostomy, pulmonary artery catheter).

When a CVC dressing fails, the consequences are serious:

• The risk of central line-associated bloodstream infections (CLABSIs) rises, adding about U.S. $48,108 per episode to hospital costs.
• Thrombosis and occlusion become more likely as catheters move within the vessel and "piston" in and out of the insertion site.
• Dislodgement can occur, which is potentially catastrophic for critically ill patients.

The Sticky Idea: A Simple Step That Makes a Big Difference

We wondered if we could make dressings adhere better without adding complexity or cost. That's when we considered a medical-grade liquid adhesive (MLA). It is a non-water-soluble gum mastic derived from the Pistacia lentiscus tree - essentially a medical-grade resin that helps dressings adhere longer. It's applied to the skin, after antisepsis, where the dressing border will sit, creating a tacky surface that enhances the dressing's seal and longevity.

The STICKY Randomized Controlled Trial

We conducted the STICKY trial across four metropolitan ICUs in Australia from September 2021 to February 2023, enrolling 160 adult patients with internal jugular CVCs expected to remain in place for at least 72 hours. Participants were randomly assigned to standard care, or standard care plus MLA applied to the dressing border. Our primary outcome for the trial was dressing failure within seven days due to edges lifting, with secondary outcomes including dressing changes, time to dressing failure, skin injury and CVC failure.

What We Found: Fewer Dressing Failures, Longer Wear

The trial results were clear:

• Dressing failure decreased from 50% in the control group to 28% with MLA.
• Median dressing dwell time more than doubled - from 24 hours to nearly 59 hours.
• Fewer dressing changes were needed overall (64 vs. 124).
• Skin integrity remained comparable across both groups.
• All-cause CVC failure did not differ between the two groups.

Does It Help Prevent Infection? Early Signs Say Yes

A microbiological substudy found that fewer samples from the MLA group showed bacterial growth compared with the control group (40% vs. 80%). Additionally, only one swab in the MLA group exceeded 100 colony-forming units (CFUs) compared with four swabs greater than 100 CFUs in the control group. While it was a small sample size for infection outcomes, these results suggest that better dressing adhesion may help reduce contamination risk.

The Economics of Adhesion: Small Savings, Big Picture

Our cost analysis found MLA saved approximately $11 Australian or $7 U.S. per patient when considering materials and nursing time. In the four Australian study hospitals, over 5,000 patients are admitted to ICUs annually with 60% of these patients requiring one or more CVCs. We estimate a savings of about AUD $33,000 ($21,546 U.S.) annually in dressing-related costs. Scaled across the hundreds of thousands of annual ICU admissions in the U.S., the cost savings add up quickly.

Skin Safety and MARSI: What About the Trade-offs?

While medical adhesive-related skin injury (MARSI) can be a concern, we observed only three mild cases during the trial - one in the MLA group and two in the control group - indicating the adhesive was well tolerated. Proper removal using an adhesive remover remains key to protecting skin integrity.

Real-World Impact: From Research to Bedside

Similar findings emerged at the University of Virginia Health's Cardiac Surgical ICU, where using a gum mastic adhesive helped cut CLABSI rates dramatically. Together with the STICKY trial, these results reinforce the goal that improving securement can be a simple, evidence-based way to enhance patient safety.

Practical Tips for ICU Nurses: Making Dressings Last

• Choose your products wisely; plan ahead for extra securement support when using the jugular vein.
• Prep the skin properly, and let antiseptics dry fully before applying the dressing.
• Apply MLA along the dressing border only, and allow it to dry fully.
• Press, don't stretch, the dressing when applying it.
• Inspect the dressing daily and change it if the edges lift or it loses its integrity.
• Use adhesive remover for dressing changes to protect skin integrity.

Looking Ahead: Future Studies

The STICKY trial should be replicated across different device types and populations to examine the clinical utility of MLA as an adjunct securement option. Future studies should explore how improved dressing adhesion impacts potential infection outcomes such as local infection and CLABSI.

Conclusion: Sometimes Simple Is Smart

The STICKY trial showed that adding a gum mastic such as MLA to jugular line dressings cut failures nearly in half, doubled wear time, and saved costs without compromising skin integrity. For ICU nurses, it means fewer dressing disruptions and more time for what matters most: caring for patients.

Call to Action: What's Your Experience?

Have you struggled to keep jugular line dressings intact in your ICU? Have you tried dressing and securement techniques that worked (or didn't)? Share your insights and experiences — because the more we stick together, the better we can protect our patients.

More Resources

For further insights from the STICKY trial, Dr. Nicole Marsh presents "The STICKY Solution: Preventing Dressing Disruption in Central Line Care," an exclusive Association for Vascular Access webinar on demand. This webinar is a partnership between the Association for Vascular Access and Eloquest Healthcare.