Advice
The technology
The technology
SecurAcath (Interrad Medical) is a securement device that uses an anchor below the skin to hold cerebrospinal fluid (CSF) drainage catheters in place. It comprises a base and a cover: the base contains 2 metal, blunt, flexible securement feet (which form the anchor) and 2 foldable arms; the cover holds the catheter shaft in place. The anchor sits just beneath the skin at the catheter insertion site. A YouTube video produced by the manufacturer illustrates the device's mechanism of action and mode of use.
SecurAcath is designed to remain in place for as long as the catheter needs to be secured, and does not need replacing. It is removed at the same time as the catheter by removing the cover from the anchor base, then removing the catheter. The anchor base can then either be cut lengthways and each half removed separately, or the base can be folded and the anchors removed. Local anaesthesia may be used before removal to reduce pain.
There are 6 versions of SecurAcath, used with 3, 4, 5, 6, 7 and 8 French (Fr) size (the unit of measurement for the outer diameter of a catheter) catheters. All sizes have the same functionality and the anchor base and anchor sizes are the same; only the channel diameter changes. Typically, catheters used for CSF drainage are 6 or 8 Fr.
SecurAcath can also be used to secure catheters for other purposes, such as for venous access. These indications are beyond the scope of this briefing.
Innovations
SecurAcath is designed to reduce the risk of accidentally moving the catheter. Accidental dislocation or removal of external CSF drainage may need emergency surgery to replace the catheter.
SecurAcath can be lifted away to clean around the insertion site without detaching the catheter, which may allow for easier cleaning compared with adhesive securement devices.
Current NHS pathway
CSF drainage is done to treat hydrocephalus. Congenital and acquired hydrocephalus need prompt treatment to reduce pressure on the brain and avoid brain damage.
To diagnose hydrocephalus a lumbar puncture is done. This is where a sample of CSF is taken from the lower part of the spine and the pressure of the CSF sample is then checked. Removing some CSF in this way may also help improve symptoms. A spinal or lumbar drain may be done if a puncture does not improve the symptoms of hydrocephalus. This is carried out over a few days to see whether symptoms improve. The procedure is usually done using a local anaesthetic.
Longer-term treatments for hydrocephalus are shunt surgery or endoscopic third ventriculostomy (NHS Choices 2015). Alternatively, external ventricular drainage (EVD) can be used to temporarily drain CSF out of the body, away from the ventricles of the brain.
EVD allows the temporary drainage of CSF to relieve raised intracranial brain pressure. In this procedure a catheter is placed in the ventricle of the brain and connected to an external drainage system. Once the system is in place, the catheter can be secured with a suture or staple, or with adhesive devices, depending on local clinical practice. EVDs can stay in place for up to 3 weeks, but around 1 week is most common. SecurAcath provides an alternative method to secure the catheter for this drainage system.
Population, setting and intended user
SecurAcath would be used in secondary care settings in place of current securement methods for CSF drainage catheters. It can be used in people of all ages but is not suitable for people with an allergy to nickel.
Clinicians must be trained in placing and removing SecurAcath, as well as maintenance of the insertion site.
Costs
Technology costs
According to the manufacturer, the device can be purchased in boxes of 10 at a list price of £200, which amounts to £20 per device. The manufacturer provides training at no additional cost. SecurAcath devices cannot be reused, so the per-treatment (device only) cost amounts to £20 irrespective of how long the catheter remains in place (the dwell time).
Costs of standard care
Standard care can include sutures, staples and adhesive devices. The manufacturer has estimated, based on a US study of peripherally inserted central catheters (PICCs), that the equipment-only cost for applying sutures is £5, inclusive of suture, needle and removal kit (Interrad Medical et al. 2015). A review of studies comparing sutures with staples for treating cuts gives a range of equipment costs for stapling that are very similar to the equipment cost for suturing (Hogg and Carley et al. 2002). Surgery to insert the catheters to begin CSF drainage is done in a theatre setting and labour costs will depend on the professional that is involved.
Resource consequences
SecurAcath would be an additional cost compared with current securement methods, assuming that maintenance times and labour costs are similar. SecurAcath may be cost saving for longer dwell times because adhesive devices often need to be replaced, whereas 1 SecurAcath device is suitable for the entire dwell time.
According to the manufacturer, 23 NHS trusts currently use SecurAcath for a range of indications. The manufacturer is not aware of any NHS trusts currently using SecurAcath for CSF drainage catheters. No practical difficulties have been identified in using or adopting SecurAcath.
No published evidence on the resource consequences of adopting SecurAcath were identified. There may be differences in long-term resource use and costs between SecurAcath and standard care if its use were shown to result in differences in complication rates such as dislocation or infection.