Back to the future: Mastisol® improves jugular CVC dressing adhesion
Myron Yaster MD and Lynne G. Maxwell MD
How to dress and secure jugular central lines or really any IV (or neural cathter) has long bedeviled pediatric anesthesiologists. In a previous PAAD (May 09/2024 https://ronlitman.substack.com/p/a-game-changing-way-to-better-secure ) we presented overwhelming evidence that applying an integrated securement dressing (Sorbaview® or Tegaderm™) with tissue adhesive skin preparation at the site of insertion (SecurePort IV® or Dermabond™) significantly increased peripheral IV survival. In today’s PAAD, Marsh et al.1 investigated the effectiveness of using a medical liquid adhesive (MLA) (Mastisol®) around the edges of topical dressings to improve jugular CVC dressing adhesion and increase the duration the dressings stay intact. Myron Yaster MD
Original article
Marsh N, O'Brien C, Larsen EN, Alexandrou E, Ware RS, Pearse I, Coyer F, Patel MS, Royle RH, Rickard CM, Sosnowski K, Harris PNA, Laupland KB, Bauer MJ, Fraser JF, McManus C, Byrnes J, Corley A. Securing Jugular Central Venous Catheters With Dressings Fixed to a Liquid Adhesive to Prevent Dressing Failure in Intensive Care Patients (the STICKY Trial): A Randomized Controlled Trial. Crit Care Med. 2025 Feb 1;53(2):e282-e293. doi: 10.1097/CCM.0000000000006533. Epub 2025 Feb 21. PMID: 39982180; PMCID: PMC11801464.
Catheter dressing failure, particularly in dressings covering jugular venous central lines is a common occurrence in ICU patients. “Finding a dressing that provides security and stability at this challenging anatomical location is difficult.2 Traditionally, polyurethane dressings, with or without sutures or stabilization devices, have been used. However, poor adherence to the skin can cause these dressings to fail from lifting edges or complete detachment, increasing the opportunity for extrinsic contamination of the insertion wound and causing local infection or CLABSI.”1 “A latex-free, medical liquid adhesive (MLA) (Mastisol®), applied to the skin following antisepsis but before dressing application, may improve dressing integrity. This nonwater-soluble gum mastic, manufactured from Pistacia lentiscus tree resin, is purported to reduce unnecessary dressing changes.”1 “In this randomized controlled trial, the authors tested the effectiveness and safety of MLA, compared with usual care, for jugular CVC securement in ADULT ICU patients. Our aim was to provide clinicians and policy makers the best evidence to support decisions for dressing securement.”1
What did they find? “In total, 160 participants (82 control; 78 intervention) were enrolled. There were 22 (28%) and 41 (50%) cases of premature dressing failure in the intervention and control groups respectively (odds ratio, 0.39; 95% CI, 0.20–0.76; p = 0.005). The intervention group had fewer dressing changes (incidence rate ratio [IRR], 0.74; 95% CI, 0.55–0.99). Time to dressing failure (log-rank test; p = 0.12) and all-cause CVC failure (IRR, 1.44; 95% CI, 0.36–5.79) did not differ between groups.”1
Are any of you surprised by these findings? We aren’t. We’ve been using Mastisol® to secure the edges of dressings for decades…not only for IVs but for peripheral nerve catheters and epidural catheters as well. So the findings that Mastisol® significantly improved the adhesion of securement dressings is hardly surprising. Nevertheless, it’s a simple reminder to all of you to do this in your practice.
Send your thoughts and comments to Myron who will post in a Friday reader response.
References
1. Marsh N, O'Brien C, Larsen EN, et al. Securing Jugular Central Venous Catheters With Dressings Fixed to a Liquid Adhesive to Prevent Dressing Failure in Intensive Care Patients (the STICKY Trial): A Randomized Controlled Trial. Critical care medicine 2025;53(2):e282-e293. (In eng). DOI: 10.1097/ccm.0000000000006533.
2. Xu H, Hyun A, Mihala G, et al. The effectiveness of dressings and securement devices to prevent central venous catheter-associated complications: A systematic review and meta-analysis. International Journal of Nursing Studies 2024;149:104620.