Dear Dr. Masouros,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Dec 31 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Federica Canzan

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. When completing the data availability statement of the submission form, you indicated that you will make your data available on acceptance. We strongly recommend all authors decide on a data sharing plan before acceptance, as the process can be lengthy and hold up publication timelines. Please note that, though access restrictions are acceptable now, your entire data will need to be made freely accessible if your manuscript is accepted for publication. This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If you are unable to adhere to our open data policy, please kindly revise your statement to explain your reasoning and we will seek the editor's input on an exemption. Please be assured that, once you have provided your new statement, the assessment of your exemption will not hold up the peer review process.

3. Thank you for stating the following in the Acknowledgments Section of your manuscript:

The consumables, arm rest, and devices used in this study were provided courtesy of Javelo Health. GM was supported by a DTP studentship from the Engineering and Physical Sciences Research Council (EP/T51780X/1). The mechanical testing was conducted in the EPSRC Injury and Reconstruction Biomechanics Test Suite (EP/S021752/1). For the purpose of open access, the authors have applied a Creative Commons Attribution (CC BY) license to any Author Accepted Manuscript version arising.

We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form.

Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows:

The consumables, arm rest, and devices used in this study were provided courtesy of Javelo Health. GM was supported by a DTP studentship from the Engineering and Physical Sciences Research Council (EP/T51780X/1). The mechanical testing was conducted in the EPSRC Injury and Reconstruction Biomechanics Test Suite (EP/S021752/1).

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

4. Please amend your authorship list in your manuscript file to include author Spyros Masouros.

5. Please amend the manuscript submission data (via Edit Submission) to include author Spyros D. Masouros.

6. Please amend your list of authors on the manuscript to ensure that each author is linked to an affiliation. Authors’ affiliations should reflect the institution where the work was done (if authors moved subsequently, you can also list the new affiliation stating “current affiliation:….” as necessary).

7. We note that Figure(s) 1, 2, 3, 4 in your submission contain copyrighted images. All PLOS content is published under the Creative Commons Attribution License (CC BY 4.0), which means that the manuscript, images, and Supporting Information files will be freely available online, and any third party is permitted to access, download, copy, distribute, and use these materials in any way, even commercially, with proper attribution. For more information, see our copyright guidelines: http://journals.plos.org/plosone/s/licenses-and-copyright.

We require you to either (1) present written permission from the copyright holder to publish these figures specifically under the CC BY 4.0 license, or (2) remove the figures from your submission:

a. You may seek permission from the original copyright holder of Figure(s) 1, 2, 3, 4 to publish the content specifically under the CC BY 4.0 license.

We recommend that you contact the original copyright holder with the Content Permission Form (http://journals.plos.org/plosone/s/file?id=7c09/content-permission-form.pdf) and the following text:

“I request permission for the open-access journal PLOS ONE to publish XXX under the Creative Commons Attribution License (CCAL) CC BY 4.0 (http://creativecommons.org/licenses/by/4.0/). Please be aware that this license allows unrestricted use and distribution, even commercially, by third parties. Please reply and provide explicit written permission to publish XXX under a CC BY license and complete the attached form.”

Please upload the completed Content Permission Form or other proof of granted permissions as an "Other" file with your submission.

In the figure caption of the copyrighted figure, please include the following text: “Reprinted from [ref] under a CC BY license, with permission from [name of publisher], original copyright [original copyright year].”

b. If you are unable to obtain permission from the original copyright holder to publish these figures under the CC BY 4.0 license or if the copyright holder’s requirements are incompatible with the CC BY 4.0 license, please either i) remove the figure or ii) supply a replacement figure that complies with the CC BY 4.0 license. Please check copyright information on all replacement figures and update the figure caption with source information. If applicable, please specify in the figure caption text when a figure is similar but not identical to the original image and is therefore for illustrative purposes only.

8. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Partly

Reviewer #2: Partly

**********

2. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: I Don't Know

Reviewer #2: No

**********

3. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: No

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

**********

Reviewer #1: General comment:

Effective stabilisation and securement of intravenous peripheral vascular access devices (PVAD - the cannula, insertion needle, integrated components – wings, needle-free connectors etc.) can help to reduce therapy failure and have become important topics of research and feature in preventative care bundles.

Infusion lines when connected to PVADs and infusion line ‘addons’ (in-line filters, stopcocks etc.) are implicated in complications like mechanical phlebitis and accidental dislodgment, particularly amongst mobile, physically active or confused patients. However, unless they are part of a closed infusion system, they are not generally considered as the PVAD itself.

Confusingly the article refers to PVAD stabilisation/securement and the securement of the associated infusion lines as the same. Whilst intimately related the two are not the same and should be differentiated. Whilst I accept that this situation might reflect the relative sparsity of research literature on the securement of infusion lines (as acknowledged in the article - many of the supporting citations refer to PVAD stabilisation or securement) it should be clarified by the authors that the study is about infusion line securement and not PVAD securement.

Specific comments:

Title:

Rather than referring to’ access line’ in the title it might be better phrased as ‘infusion line’ to clarify you are not referring to needle-free connectors or other.

Abstract:

Lines 35-37 I am not sure if the conclusions can be stated as unqualified as the text suggests. It might be better phrased more tentatively as this example: ‘The results highlight the need for incorporating realistic loading conditions and comfort metrics when evaluating the performance of infusion line securement aids. Furthermore, the results provide evidence that using a non-adhesive based device, particularly in patients with marked diaphoresis might provide more infusion line security, though further study is required.

Introduction:

Line 52-54, needs supporting citations (lots available) which will support the importance of your research.

Lines 56- 57, citation number 7 is incorrect in the reference list. Angie Malone was one of the reviewers for the Infusion Nurses Society standards publication. The correct citation is probably: Nickel B, Gorski L, Kleidon T, Kyes A, DeVries M, Keogh S, et al., Infusion therapy standards of practice. 9th ed. J Inf Nurs, 2024. 47(1S): p. S1-285. doi:10.1097/NAN.0000000000000532. Please check and clarify.

citation number 8 is concerned with central vascular access and not peripheral vascular access – does it also consider the securement of infusion lines? Clarify.

Methods:

Line 80, presumably healthy adult patients (they were asked to undergo physical activity to create sweating – clarify.

Line 84 stage 1 and line 109, of the four devices applied to all 10 participants were they distributed between both left and right arms or was one used in preference? Clarification might support decision in line 127.

Lines 85-87, it might be required to recognise trademarks™® and copyright© in the text, check journal author guidelines. 3M products are now marketed under the company name Solventum in the UK.

Line 88, Figure 1 suggests that all the devices were testing with a linear line securement arrangement – this is fine for the experimental set up, but some important confounding variables are introduced with this approach. For example, many using adhesive based aids in practice loop the lines to ensure better and more comfortable line security. In addition, the IV bracelet instructions for clinical use suggest looping the line back though the holder. This might impact on pull resistance. Please expand on this in a consideration of study limitations in your discussion.

Line 94, State the outer diameter of the experimental infusion line to confirm that it is compatible with the design parameters of the tested devices.

Line 113, why was this done? Time practicalities of the experimental set up, availability of participants or do you have any evidence (or theory) that devices that perform less will under uniaxial forces also perform less well under angular (135, 90 degree forces)? Comment.

Line 127, did stage 1 results support a view that there were no differences between either arm (hairiness reported to affect tape adhesion -line 226 – arms might not be equally hirsute). Comment.

Results:

Line 189, more information about the ‘questionnaire’/ ‘comfort survey’ would be welcome. For example, how sophisticated was this tool? How were participants asked about comfort to enable them to rank it? Comfort during application, wearing, removal, visual appearance etc.

Discussion:

Please add a more detailed consideration of ‘Study limitations and recommendations for future work’ to the discussion.

Conclusion:

Please see comments re abstract.

References:

Require revision to presented in the journal style.

Infusion line securement when done effectively can ensure infusion system integrity, prevent entanglements and reduce PVAD and infusion related complications. It is an understudied and underappreciated aspect of safe infusion therapy and articles like this are to be welcomed.

Whilst many clinical settings will have preferred products and arrangements for peripheral infusion scenarios studies like this one can add to the development of meaningful evidence to enable clinicians to compare experimental outcomes with (future) real world performance of their approaches.

Reviewer #2: The research titled “Evaluation of Peripheral Vascular Access Line Securement Devices Under Clinically Relevant Loading and Perspiratory Conditions” addresses a highly relevant and important topic that warrants further investigation.

However, the study seems small-scale experiments rather than a comprehensive research effort. In the introduction, the authors note that “the effective securement of PVADs to patients remains a clinical challenge,” citing PVAD failure rates of approximately 38–43%, primarily due to occlusion, infiltration, dislodgement, and phlebitis. Despite this, the study focuses primarily on resistance to load and patient comfort, which only partially reflect the broader clinical challenges identified. Consequently, the problem statement, research objectives, and results appear misaligned.

Furthermore, the sample size, including both the number of participants and the types of tests performed, seems insufficient to draw meaningful conclusions about the overall effectiveness of PVAD securement devices.

In the results section, the authors report that “the mean peak force of the Javelo was significantly greater (p-adj < 0.05; p-value adjusted using the Benjamini–Hochberg correction procedure for multiple comparisons) than that of the Grip-Lok for the peel-off and perspirant pull-out tests. There was no significant difference between the devices in the 90° and 135° angled pull-out tests.” However, these reported significant differences were not clearly reflected in Figure 6

Overall, while the research topic is both interesting and potentially impactful, the study’s methodology, experimental design, and data interpretation appear weak and require substantial improvement to support the stated conclusions.

**********

what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy

Reviewer #1: No

Reviewer #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures

You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation.

NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

Evaluation of peripheral intravenous line securement devices under clinically relevant loading and perspiratory conditions

PONE-D-25-39960R1

Dear Dr. Masouros,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager®  and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support .

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Federica Canzan

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #1: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

**********

Reviewer #1: General comment:

Thank you for submitting your revised manuscript and responding to my previous reviewer comments. There are a few minor specific items, shown below that require consideration before publication.

Specific comments:

I note your response to my previous review suggestion stating that you have changed the title to use ‘infusion line’. However, this is not evident in the revised clean and track changes copy of the manuscript. The word ‘infusion’ is missing, consider revising the title to use the phrase ‘intravenous infusion line securement’ as to my mind this adds further clarity for readers.

Line 60 track changes (line 54 clean copy), I wonder if a minor revision to the sentence beginning: ‘Accordingly ….’ might better set the scene for readers and delineate your use of the word ‘securement’ to refer to infusion line securement in the rest of the manuscript. Perhaps: ‘Accordingly adjunct IV infusion line securement devices and techniques are widely used to anchor IV lines to the patient to reduce the risk of PVAD failure’.

Line 272 track changes (line 260 clean copy), perhaps additional sub-populations that present additional challenges for real world care complexities when securing IV infusion lines could be identified here – think about ambulant patients, confused/noncompliant patients, and children.

**********

what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy

Reviewer #1: No

**********