Historically, neonatal clinicians have relied upon medical adhesive tapes and surgical sutures for catheter securement. Some types of tape pose a significant risk of medical adhesive-related tissue injury (MARSI) in this vulnerable patient population (16–18, 21–22) due to the interaction of intrinsic and extrinsic factors, including anatomical and physiological skin barrier immaturity, skin maturation processes, frequent invasive procedures, and therapeutic medical device use (16, 22).

Recently, engineered catheter securement devices and a CSCA have entered practice (1, 2, 15, 23–29). Initially, these approaches were limited to central vascular catheter (CVC) securement but are now recommended as an adjunct for peripheral intravenous catheter (PIVC) securement (1, 19, 28). Currently, only one product, marketed as SecurePortIV® (Adhezion Biomedical, Wyomissing PA, USA), has Food and Drug Administration (FDA) and Certificate European (CE) approval for use in VA across all patient age groups and catheter types (1, 2, 20). There is an emerging body of empirical evidence from neonatal studies that this CSCA formulation is safe to use and can achieve the benefits reported in studies with other patient age groups (27–29).

The CSCA formulation used in VA has an established safety record, but MARSI remains a risk, particularly if the product is over-applied (16, 17, 21, 24). A characteristic of CSCA is that the adhesive bond forms more efficiently when thin layers are applied, as thicker layers can lead to less effective catheter securement. Consequently, it is essential to avoid overapplication; normally only 1–2 drops are required to achieve effective securement (Figure 1) (20).

Applied correctly, CSCAs are painless, aid insertion site closure, and promote hemostasis. They provide effective securement, reduce catheter migration, the risk of accidental removal, and decrease the need for frequent dressing changes (15, 23). Furthermore, CSCAs inhibit bacterial and fungal growth, with evidence supporting reductions in the risk of acquiring catheter-associated infection (1, 2, 5, 15, 24, 27–30). Standards and guidelines for catheter securement recommend that CSCA, used alone or combined with tapes, other securement devices, and the primary transparent dressing can reduce VA-related complications (1, 2, 19, 26, 31).

In practice, there are three common situations when early (before the natural separation of the adhesive from exfoliated skin cells) CSCA removal may be required. First, and most common, is to facilitate the repositioning of the CVC tip shortly after insertion of the catheter. Second, is elective catheter removal following the completion of therapy. Finally, the removal of a catheter after infusion-related complications, such as leakage, occlusion, peripheral IV infiltration/extravasation (PIVIE), or catheter dislodgment, is another unplanned removal situation.

Neonates are at risk from numerous iatrogenic complications from VA procedures. Utilizing mnemonics, such as the “5Rs for VA” or “PIV5rights” (27, 39), before insertion can reduce harm. In addition, formal skin condition scoring using a validated tool, e.g., the Braden QD or Neonatal Skin Condition Score (NSCS) (40–42), can be useful for identifying risks and aiding objective assessment and documentation.

Preventing MARSI begins before the application of medical adhesive. Preventative strategies include appropriate adhesive selection for the intended purpose and the application of non-alcoholic silicone skin barrier preparations. Evidence suggests that the preapplication of skin barrier products (e.g., Cavilon^TM No Sting Skin Barrier Film, 3M Saint Paul, MN, USA.) protects the skin from MARSI and epidermal stripping. It should be noted that while authoritative guidance supports their use (e.g., 42, 43) most skin barrier product use is “off-label” in neonates.

Generally, in neonates, gentle rolling manipulation of the CSCA plaque in a horizontal direction avoiding vertical lifting is all that is required to aid the removal of the adhesive and catheter. Unless it is essential for ongoing care and management of the VA catheter, it is not necessary to remove all the CSCA residue. It is sufficient to remove enough to facilitate the safe removal of the catheter and any remaining CSCA will naturally separate in time; this reduces the risk of MARSI (16–18, 21).

CSCA can be removed before it naturally separates by applying adhesive removers (20). However, formulations containing acetone, alcohol, or latex can be harmful for neonates or can damage some types of catheters [alcohol softens polyurethane (PUR)]. In general, adhesive removers containing alcohol or acetone are best avoided in neonates. This is to protect against further skin damage and avoid possible toxicities from the absorption of ingredients through the skin (16). Numerous branded skin-compatible formulations, such as Acetone Free Adhesive Remover Pads (Medline Industries Northfield lL, USA), or silicone-based adhesive removers, such as Adapt™ Medical Adhesive Remover (Hollister Incorporated, Libertyville IL, USA) and Esenta™ Adhesive Remover and Sensicare™ Sting-Free Adhesive Releaser (both, Convatec Incorporated Bridgewater NJ, USA), are available and when used with care can facilitate easier CSCA removal in difficult cases. If adhesive removers are used then interventions to limit exposure, such as avoiding contaminating adjacent skin and pooling underneath the infant and promptly removing any residue, should be implemented.

Adhere to the principles of proper documentation practices and institution requirements. This will ensure compliance with the expectations of professional practice and that the care provided to the patient and family is accurately recorded (33). The documentation includes the reason for catheter removal, date and time of removal, skin and catheter site condition assessment and any recommendations for ongoing care and observation, effectiveness of comfort interventions, and education to the parents. Document adverse outcomes using incident reporting as per institution guidelines.