34, 58, 57, 59, 60
Securement fails often and inadequate securement is the commonest named cause; secure at multiple points, standardise, and do not change securement method on the basis of the non-significant suturing association.
Exploratory comparisons between practice groups
DOI 10.1371/journal.pone.0227248; PMID 31887197; PMC6936833
Not applicable (survey of line practices: antisepsis, dressings, securement, circuit access)
Self-report, recall and social-desirability bias, no patient denominator (outcome = centre recalling any event), possible double enrolment, US-dominated. Never-suture group very small (upper CI 28% implies roughly a dozen centres, book's arithmetic). Volume and suturing associations confounded by exposure.
Suturing at insertion site 93% (Americas and Europe 96%, Australia/NZ 68%). Primary securement along line: skin suture 45%, bed/fixed object 19%, sutureless device 16% (42% in Australia/NZ), adhesive tape 10%. Femoral fixation points: two 48%, more than two 26%, one 21%. 34% reported a line malposition, dislodgement or decannulation with adverse outcome in previous 5 years. Causes (71 events, 61 respondents): inadequate securement 28%, insertion/manipulation 14%, patient removed 13%, turning/bathing 11%, transport 4.2%, material failure 2.8%, ambulation 1.4%, not stated 25%. Always-suture centres 35% (95% CI 30-41) vs never-suture 0% (0-28), chi-square 4.40, p=0.04, not significant at Bonferroni-adjusted 0.01. Adult centres over 30 cases/year 56% vs 1-6 cases 22% (p under 0.001). Dressings: transparent 75%; CHG-alcohol commonest antiseptic (53% insertion, 54% maintenance); 78% want an evidence-based guideline.
391 responses from 45 countries (43% response rate; invitations to directors/coordinators of 396 ELSO-member centres in 51 countries); US 181, UK 32; neonatal, paediatric and adult peripheral ECMO; some double enrolment acknowledged.