What can be used to secure the intravenous site in older adults? Exploring options for fragile skin

Oct 26, 2025 3 min read •

Geriatric Care Medical Devices IV Therapy

Over 40% of peripheral intravenous catheters fail before treatment completion, an issue exacerbated in older adults due to fragile skin and delicate veins. Finding the right methods and products for what can be used to secure the intravenous site in older adults is critical for preventing complications like infiltration, infection, and skin damage. This guide explores modern securement devices and alternative materials designed specifically for the unique needs of geriatric patients.

Quick Summary

Several methods and products are available to secure intravenous sites in older adults, including specialized dressings, sutureless devices, and protective sleeves. Techniques must prioritize the patient's fragile skin and risk for dislodgment, focusing on gentle, non-irritating materials and stabilization to minimize complications and increase catheter dwell time.

Key Points

Silicone-based adhesive dressings: Provide gentle adhesion and are less traumatic upon removal, ideal for fragile skin.
Sutureless securement devices: Mechanically stabilize the IV catheter at the hub, minimizing micro-movement and reducing skin irritation caused by adhesives.
Protective sleeves and splints: Geri-sleeves shield fragile skin from abrasions, while padded splints stabilize IV sites in areas of flexion to prevent accidental dislodgement.
Skin barrier films: These prep products create a protective layer on the skin before applying adhesive dressings, preventing damage and simplifying removal.
Gentle insertion technique: Using smaller gauge catheters (22–24G) and a shallower insertion angle is recommended to protect delicate veins.
Careful removal process: Use adhesive removers and the 'low and slow' technique to prevent skin tears when changing dressings.
Avoid tight tourniquets: Opt for a blood pressure cuff instead for better pressure control during insertion to prevent bruising and vessel rupture.

Understanding Challenges with Geriatric Skin

Older adults frequently have fragile, delicate skin with reduced elasticity and less subcutaneous tissue, making traditional adhesives problematic. Nurses must adapt their securement strategies to prevent skin tears, bruising, and adhesive-related injuries. Proper securement is crucial for preventing catheter-related complications, ensuring patient comfort, and extending the life of the IV line.

Advanced Dressings and Protective Barriers

Many modern dressings are designed to be gentler on sensitive skin while providing a secure hold. Silicone-based adhesive dressings are known for their gentle adherence and pain-free removal, making them ideal for delicate skin. Some advanced dressings include a chlorhexidine gluconate (CHG) gel pad for antimicrobial protection. Transparent film dressings with special adhesives for fragile skin, like those from 3M Tegaderm, allow for continuous visual inspection while protecting the site. Bordered transparent dressings with a soft, fabric border and absorbent pad can also be used. Applying skin barrier films before dressing application protects skin from irritation.

Sutureless Securement Devices

Sutureless securement devices offer enhanced stability without adhesives or sutures. These devices mechanically secure the catheter hub to an adhesive pad. The Infusion Nurses Society (INS) recommends Engineered Stabilization Devices (ESDs) to minimize catheter movement. Devices like StatLock and Grip-Lok clip onto the catheter hub and anchor with a skin-friendly adhesive pad, reducing tension on the insertion site.

Protective Garments and Splints

For active or disoriented older adults, additional protection can prevent accidental dislodgement without relying heavily on tape. Non-compression arm sleeves, or geri-sleeves, shield skin from tears and bruising. Padded splints and armboards, such as the TLC Splint, stabilize IV sites in flexion areas like the wrist or elbow, reducing complication risk. Protective domes and wraps, like the I.V. House UltraDressing, cover and protect the site without tape.

Comparison of IV Securement Methods for Older Adults


Feature	Standard Tape Securement	Silicone Dressings	Sutureless Securement Devices	Protective Sleeves/Splints
Skin Impact	High risk of skin tears, bruising, and irritation.	Very gentle, with minimal trauma on removal.	Gentle, with adhesive applied to the device rather than the catheter itself.	Gentle, offering a protective layer with no direct adhesive on the skin.
Securement Strength	Can lose adherence with moisture; security depends on taping technique.	Strong, but depends on skin integrity and moisture levels.	High mechanical stability that resists pull and dislodgement effectively.	Good for preventing accidental bumping and snagging; works best in conjunction with a primary dressing.
Cost	Generally low cost.	Higher cost than standard dressings but can reduce dressing change frequency.	Higher initial cost but may reduce overall costs by preventing catheter failure.	Generally a one-time purchase for a reusable item.
Visibility	Variable, depending on tape and dressings used.	Transparent dressings allow continuous monitoring of the site.	May obscure the hub but is often used with a transparent dressing for visibility.	Clear domes allow for inspection while providing protection.
Patient Comfort	Can be irritating and painful upon removal.	More comfortable and gentle on sensitive skin.	Minimizes catheter movement, reducing irritation and increasing comfort.	Soft, breathable fabric prevents skin irritation and friction.

Nursing Best Practices for IV Securement in Older Adults

Adapting nursing techniques is crucial for securing IV sites in older adults and minimizing trauma.

Select the Right Catheter and Site: Use the smallest gauge catheter possible for the therapy (e.g., 22–24 gauge) and prefer the forearm over the hand or wrist.
Use Vein Stabilization Techniques: Use gentle traction to stabilize the vein. Avoid tight tourniquets; a blood pressure cuff can be used for more regulated pressure.
Prepare the Skin with Care: Avoid excess friction when cleaning. Use a skin prep barrier film on intact skin before applying adhesives.
Practice Careful Dressing Application and Removal: Apply dressings gently without stretching. Use a medical adhesive remover and peel slowly and low over itself, pulling in the direction of hair growth to prevent skin tears.

Conclusion

Securing an intravenous site in an older adult requires considering the patient's unique needs, such as fragile skin and delicate veins. By using gentle techniques and specialized products like silicone dressings, sutureless securement devices, and protective arm sleeves, healthcare providers can improve securement, reduce complications, and enhance patient comfort. Moving away from traditional tape-based methods in favor of newer, less-traumatic technologies is key to protecting the skin and ensuring IV catheter integrity for geriatric patients receiving IV therapy. The use of specialized products with careful technique provides a safer and more comfortable experience.

For more on peripheral vascular access best practices, consult the Infusion Nurses Society (INS) Standards of Practice.

Frequently Asked Questions

Securing an IV site on an older adult is challenging because their skin becomes thinner, loses elasticity, and is more prone to bruising and tearing with age. Additionally, their veins are more fragile and can roll or rupture more easily during insertion.

Excellent alternatives to traditional tape include silicone-based adhesive dressings, hypoallergenic tapes like Hy-Tape, and sutureless securement devices. These options are gentler on sensitive skin and minimize trauma during application and removal.

To protect an IV site in an area of flexion, use a padded armboard or splint to stabilize the joint and prevent bending that could dislodge the catheter. For additional protection, a protective wrap with a transparent, ventilated dome can be used.

Yes, for patients with cognitive deficits, protective garments like arm sleeves (geri-sleeves) and IV site protection devices with domes can prevent them from picking or pulling at the IV site. Adjustments to the securement method and site location may also be necessary.

A skin barrier film is a liquid or wipe applied to the skin before an adhesive dressing. It creates a protective layer that shields delicate skin from the adhesive and reduces friction during removal, which helps prevent skin tears and irritation.

To prevent skin tears, remove IV dressings slowly and gently. Use a medical adhesive remover to dissolve the adhesive and pull the dressing back over itself at a low angle, supporting the skin with your other hand. Never pull vertically or quickly.

While medical-grade tissue adhesives can be used to add securement, recent studies suggest there may be no significant benefit over standard care for patients over 65 without specific risk factors and potentially higher costs. Professional guidelines should always be followed.

References

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.