What Is the Best Way to Secure a Peripheral Intravenous Catheter?

Hospital vs EMS vs Tactical Combat Casualty Care (TCCC): Evidence Changes with the Operational Environment

DrRamonReyesMD ⚕️
EMS Solutions International
TACMED Spain

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Introduction

Accidental dislodgement of a peripheral intravenous catheter (PIVC) remains one of the most common complications in vascular access management. Studies estimate that up to 24% of peripheral IV catheters become dislodged or are unintentionally removed, leading to repeated cannulation attempts, delayed treatment, increased costs, and unnecessary patient discomfort.

However, one fundamental question is often overlooked:

Are we discussing a stable hospitalized patient, a critically ill patient inside an ambulance, a helicopter evacuation, or a Tactical Combat Casualty Care (TCCC) scenario?

The answer matters because the optimal securement strategy depends on the operational environment.

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The Most Common Mistake

One of the biggest mistakes in clinical practice is applying hospital-based vascular access protocols to prehospital, austere, or tactical environments.

These are fundamentally different settings.

A patient resting in an emergency department for 30 minutes does not require the same IV securement strategy as:

• a trauma patient during ground transport,
• a helicopter evacuation,
• a prolonged field care casualty,
• or a Special Operations operator under hostile conditions.

Operational context determines the appropriate securement method.

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What Did Schmutz et al. Actually Study?

In 2020, Schmutz and colleagues published a randomized controlled trial in the Journal of Clinical Medicine evaluating four different peripheral IV securement methods.

The study compared:

A. Elastic gauze

B. Cohesive gauze (Coban®-type)

C. Plastic cling film

D. Raptor IV Securement Device

A total of 175 healthy volunteers participated.

The investigators measured the amount of traction force required to produce significant catheter displacement.

Importantly, the study evaluated mechanical resistance, not long-term clinical performance.

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Key Findings

Among the four techniques tested, plastic cling film demonstrated the greatest resistance to catheter displacement.

This finding challenged traditional teaching, which has generally discouraged circumferential wrapping because of concerns regarding possible tourniquet effects.

When properly applied without excessive tension, the cling film tolerated substantially greater pulling forces before catheter movement occurred.

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What the Study Does NOT Show

This is perhaps the most important point.

The study does not demonstrate that cling film should replace transparent sterile dressings in routine clinical practice.

The investigators did not evaluate:

• catheter-related infections;
• phlebitis;
• infiltration or extravasation;
• catheter dwell time;
• critically ill patients;
• trauma patients;
• ambulance transport;
• helicopter transport;
• military operations;
• Tactical Combat Casualty Care (TCCC);
• prolonged field care.

The study evaluated mechanical securement performance only, not overall clinical superiority.

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Hospital Environment

Primary Objective

In hospitals, the primary goals are:

• infection prevention;
• continuous visualization of the insertion site;
• early recognition of phlebitis or infiltration;
• maintenance of sterile technique.

Current best practice remains:

• transparent sterile dressing (Tegaderm®, IV3000®, or equivalent);
• appropriate catheter stabilization;
• routine inspection;
• dressing replacement according to institutional protocols.

Within the hospital, visibility of the insertion site is just as important as mechanical stability.

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Emergency Medical Services (EMS)

Once the patient leaves the hospital, priorities begin to change.

Prehospital providers must contend with:

• vehicle vibration;
• acceleration and deceleration;
• patient movement;
• extrication;
• CPR;
• confined working environments;
• rain;
• sweat;
• blood contamination.

In EMS, maintaining catheter function throughout transport becomes a major priority.

Recommended practice includes:

• transparent sterile dressing;
• stress loop (strain-relief loop);
• stabilization device (Grip-Lok®, StatLock®, Raptor®, or equivalent);
• additional reinforcement whenever accidental dislodgement risk is high.

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Tactical Medicine, TCCC, TECC and Austere Medicine

The operational priorities change dramatically in tactical environments.

The primary threat is often not infection.

Instead, the greatest concern is losing the only available vascular access during the mission.

Combat casualties may require evacuation through:

• mud;
• sand;
• water;
• dense vegetation;
• armored vehicles;
• helicopters;
• rope rescue operations;
• prolonged casualty movement;
• hostile fire.

Re-establishing IV access may be impossible for hours.

Under these conditions, mechanical securement becomes mission-critical.

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Does Cling Film Have a Role in Tactical Medicine?

Yes—but not as a replacement for sterile transparent dressings.

Rather, cling film should be considered an additional reinforcement option when operational conditions significantly increase the risk of catheter dislodgement.

Potential advantages include:

• greater resistance to traction;
• protection against moisture;
• improved catheter stabilization;
• reduced movement during prolonged evacuation.

Whenever circumferential reinforcement is used, providers should continuously assess:

• distal pulses;
• capillary refill;
• skin color;
• temperature;
• distal sensation;
• evidence of excessive compression.

Maintaining distal perfusion remains essential.

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Practical Comparison

Feature	Hospital	EMS	Tactical / Austere Medicine
Primary Goal	Infection prevention	Maintain IV during transport	Preserve vascular access throughout the mission
Sterility	⭐⭐⭐⭐⭐	⭐⭐⭐⭐	⭐⭐⭐
Mechanical resistance	⭐⭐⭐	⭐⭐⭐⭐	⭐⭐⭐⭐⭐
Visualization of insertion site	⭐⭐⭐⭐⭐	⭐⭐⭐⭐	⭐⭐
Water and environmental protection	⭐⭐	⭐⭐⭐⭐	⭐⭐⭐⭐⭐
Risk of accidental dislodgement	Low	Moderate	Very High

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Practical Recommendations

Hospital

• Transparent sterile dressing.
• Standard stabilization.
• Routine inspection.

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EMS

• Transparent sterile dressing.
• Stress loop.
• Commercial stabilization device.
• Reinforcement when transport conditions require.

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Tactical Medicine / TCCC / Austere Medicine

• Transparent sterile dressing.
• Stress loop.
• Mechanical stabilization device.
• Additional reinforcement using cohesive wrap or cling film when operationally justified.
• Frequent reassessment of distal circulation.

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Conclusion

There is no universal IV securement technique suitable for every environment.

The optimal approach depends entirely on the operational context.

A securement strategy that performs well in a hospital ward may fail during ambulance transport, while techniques essential for Tactical Combat Casualty Care may be unnecessary in routine inpatient care.

Current evidence demonstrates that plastic cling film provides superior mechanical resistance to catheter dislodgement, but this finding does not justify replacing transparent sterile dressings in standard clinical practice.

For EMS, Tactical Combat Casualty Care (TCCC), Tactical Emergency Casualty Care (TECC), Prolonged Field Care (PFC), and Austere Medicine, the strongest approach is a multimodal securement strategy that combines sterile dressings, mechanical stabilization, environmental protection, and continuous monitoring of distal perfusion.

Ultimately, the best intravenous catheter is not the one inserted the fastest—it is the one that remains functional when the patient's life depends on it.

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References

1. Schmutz A, Menz L, Schumann S, Heinrich S. Dislodgement Forces and Cost Effectiveness of Dressings and Securement for Peripheral Intravenous Catheters: A Randomized Controlled Trial. Journal of Clinical Medicine. 2020;9(10):3192. DOI: https://doi.org/10.3390/jcm9103192

2. Schmutz A, Heinrich S, et al. Current Concepts in Peripheral Intravenous Catheter Securement and Dressing. European Journal of Trauma and Emergency Surgery. 2026.

3. Committee on Tactical Combat Casualty Care (CoTCCC). Tactical Combat Casualty Care Guidelines. https://health.mil/Military-Health-Topics/Combat-Support-and-Evacuation/Combat-Medicine/CoTCCC

4. Prolonged Field Care Working Group. Clinical Practice Guidelines. https://prolongedfieldcare.org

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© DrRamonReyesMD ⚕️ | EMS Solutions International | TACMED Spain