Roland

There will be a topic on cyanoacrylate in your new BAMP guidelines.

Happy to share the units but perhaps better from a privacy point of view not in an online post? What do you think?

Dear Ali, Thank you for raising this — it’s a very relevant topic. Cyanoacrylate tissue adhesive for catheter securement has been increasingly studied over the past years. The potential advantages include not only improved catheter stabilization, reduced micromotion at the insertion site, decreased early dislodgement, and a possible reduction in bleeding but also microbial ingress at the exit site. However careful product selection and application technique are essential. It is also important to distinguish between wound-closure adhesives and medical-grade catheter securement glues, as they are not interchangeable in terms of formulation, flexibility, and regulatory approval. Recent international vascular access guidelines, including the Infusion Nurses Society (INS) Standards of Practice, recognise medical-grade tissue adhesive as part of a securement and stabilisation bundle for vascular access devices. While UK uptake has perhaps been slower and varies between centres, the direction of use internationally is toward viewing cyanoacrylate as an adjunct to improve stabilisation rather than as a standalone solution. In neonatal practice specifically, the published evidence to date has not demonstrated increased harm or medical adhesive-related skin injury (MARSI) when appropriate products and techniques are used (for application and removal), although continued evaluation and careful implementation remain important. Cyanoacrylate glue of catheter securement is available within the NHS and used in many NICU's in the UK. In my experience, uptake often depends less on the adhesive itself and more on local culture, training, and clarity about indications. Themes I’ve seen influencing “buy-in” include concerns about skin integrity (especially in neonates), unfamiliarity with application technique, uncertainty around removal practices, and the perception that current securement methods are “good enough.” Where implementation has been successful, it has usually involved clear protocols, defined indications, staff education, and outcome monitoring rather than blanket adoption. Happy to discuss further if helpful. Regards, Roland A few references: Piersigilli, F., Iacona, G., Yazami, S. et al. Cyanoacrylate glue as part of a new bundle to decrease neonatal PICC-related complications. Eur J Pediatr 182, 5607–5613 (2023). https://doi.org/10.1007/s00431-023-05253-0 Barone G, Piersigilli F, Pittiruti M. Vascular access in the newborn: a position paper of Neonatal European Vascular Access Teams (NEVAT). Eur J Pediatr. 2026;185(2):71. Published 2026 Jan 12. doi:10.1007/s00431-025-06717-1 D’Andrea V et al (2022) Use of cyanoacrylate glue for the sutureless securement of PICC's (epicutaneo-caval catheters) in neonates. J Vasc Access 23(5):801–804 - DOI - PubMed D’Andrea V et al (2023) Securement of umbilical venous catheter using cyanoacrylate glue: a randomized controlled trial. J Pediatr 260:113517 - DOI - PubMed van Rens M et al (2022) Cyanoacrylate securement in neonatal PICC use: a 4-year observational study. Adv Neonatal Care 22(3):270–279 - DOI - PubMed van Rens MF et al (2023) Octyl-butyl-cyanoacrylate glue for securement of peripheral intravenous catheters: a retrospective, observational study in the neonatal population. J Vasc Access 25(4):1229–1237. 10.1177/11297298231154629 - PMC - PubMed

While Vygon is known for its high-quality products, exploring alternatives like the Modified Seldinger Introducer (MST) Kit by Neo Medical is important for ensuring we have the best options available. This allows us to compare features, benefits, and pricing to make the most informed decision for our needs. Evaluating various suppliers can lead to better outcomes in terms of innovation, efficiency, and overall performance in medical procedures. We did tried Neo Medical; however, our team preferred the Vygon set.

Thanks for your nice words @Stefan Johansson The venflon has two major drawbacks. The first is the lumen, which is only suitable for a 1Fr. PICC. Secondly the venflon itself can’t be removed. This results either in a venflon which stays in the vein or the venflon making it difficult to place proper dressing for fixation and stabilization. In short: yes please explore the micro-MST set which should be available e.g. by Vygon or NeoMed (US based). More than happy to support a potential shift to better and best evidence based practice.

fped-12-1395395 2.pdf The study underscores the viability of MST facilitated by an all-in- one micro kit for neonatal PICC insertion. Utilized by adept and trained inserters, this approach is associated with improved first-attempt success rates, decreased catheter-related complications, and fewer incidences of CLABSI. However…..enjoy reading.