Incidence and risk factors for medical adhesive-related skin injury in catheters of critically ill patients: A prospective cohort study

Incidence and risk factors of medical adhesive-related skin injuries in outpatients with peripherally inserted central catheters

AIMS

Skin exposed to the adhesives to protect catheters is prone to Medical Adhesive-Related Skin Injuries (MARSI). Occurrence of these injuries and the risk factors have not been estimated previously in outpatients with peripherally inserted central catheters. The primary aim of this study was to delineate the characteristics of MARSI and quantify 3 types of incidence rates of MARSI among outpatients with PICC placements.

METHODS

The study sample included 299 outpatients with PICC placements from October to December 2020. The data were collected at the Sichuan Academy of Medical Sciences&Sichuan Provincial People's Hospital in Chengdu, China.A three-month cross-sectional survey was conducted at the PICC center of a tertiary general hospital in Western China to analyze the occurrence of MARSI at the catheterization site and related factors. Professional nurses observed and assessed skin conditions during catheter maintenance and collected patient data that could be associated with MARSI occurrence. The relationship between independent variables and MARSI was statistically analyzed using multivariate analysis.

RESULTS

Among outpatients with peripherally inserted central catheters,the incidence rate of MARSI was 14.7 %. Statistical analysis revealed that maintenance personnel (χ2 = 8.683, P = 0.003), MARSI history (χ2 = 4.332, P = 0.037), external fixation devices (χ2 = 4.227, P = 0.04) were significantly associated with the occurrence of MARSI. Moreover, patients over the age of 50 (χ2 = 4.183, P = 0.041) and the use of transparent dressing (χ2 = 6.782, P = 0.009) were found to be associated with tension injuries. A multivariate analysis showed that the use of external fixation devices (OR, 2.987; 95 % CI, 1.044 to 8.547; P = 0.041) was an independent risk factor for MARSI.

CONCLUSIONS

Patients with PICC in the outpatient department are at a high risk of developing MARSI. To prevent and control MARSI,it is essential to enhance the professional skills of maintenance staff and to pay special attention to patients with a history of MARSI and those over the age of 50. Additionally,the use of external fixation devices and transparent dressings should also be considered.

The prevalence and risk factors of medical adhesive-related skin injury in cancer patients with peripherally inserted central catheter: A systematic review and meta-analysis

BACKGROUND

Medical adhesive-related skin injury (MARSI) is a significant but underreported complication, particularly in cancer patients with peripherally inserted central catheters (PICC). This systematic review and meta-analysis aimed to estimate the prevalence of MARSI and identify key risk factors in this patient population.

METHODS

A systematic search of PubMed, Embase, the Cochrane Library, CNKI, Wanfang, and VIP was conducted to identify studies reporting MARSI prevalence and risk factors in cancer patients with PICC. Pooled prevalence estimates and odds ratios (ORs) for risk factors were calculated using a random-effects model. Heterogeneity was assessed using the I2 statistic, and subgroup analyses were performed to explore potential sources of heterogeneity. Publication bias was assessed using funnel plots and Egger's test.

RESULTS

A total of 20 studies met the inclusion criteria, encompassing 8411 patients. The pooled prevalence of MARSI was 22% (95% CI: 18-26), with substantial heterogeneity across studies (I2 = 96.3%). Subgroup analysis revealed that retrospective studies reported higher prevalence (25%) compared to prospective studies (16%). Key risk factors included advanced age (OR: 2.593, 95% CI: 1.322-5.089), higher BMI (OR: 2.927, 95% CI: 2.029-4.223), pre-existing skin conditions (OR: 2.487, 95% CI: 1.693-3.650), and the use of transparent film dressings (OR: 3.228, 95% CI: 2.086-5.001). Funnel plot and Egger's test showed no significant publication bias.

CONCLUSIONS

MARSI is prevalent in cancer patients with PICC. Modifiable risk factors should guide prevention strategies, including careful adhesive selection and regular skin assessments to improve patient outcomes.

Incidence and Characteristics of Medical Adhesive-Related Skin Injuries in Patients Following Spinal Surgery: A Prospective Observational Study

This single-center prospective observational study aimed to compare the incidence, types, and characteristics of medical adhesive-related skin injuries (MARSI) in spinal surgery patients based on the type of dressing used. All adult patients who were scheduled for spinal surgery within a one-year period in a single institution were included. A structured case report form was created to collect data; a single assessor evaluated MARSI for eligible patients. Group differences were analysed with an independent t-test or Mann-Whitney U test, and survival analysis was conducted using Kaplan-Meier analysis, the log-rank test, and Cox proportional hazard regression analysis. Within 10 days of surgery, 45% of 140 study participants developed MARSI, with contact dermatitis being the most common type (41.4%). The acrylate-dressing group had a higher cumulative incidence (56.8%) than the silicone group (31.8%) (p = 0.003) as well as a shorter time to the first MARSI (p < 0.001), longer MARSI duration (p < 0.001), and a 2.55-time higher risk of MARSI (p < 0.001). In summary, the use of post-operative dressings with silicone adhesives post-spinal surgery was associated with a lower incidence, longer time to the occurrence, shorter duration, and lower risk of MARSI compared to the use of acrylate dressings.

Incidence, characteristics and influencing factors of medical adhesive-related skin injury in the indwelling urinary catheter attachment region in critically ill patients: A longitudinal study

BACKGROUND

Medical adhesives are potentially harmful to the skin, depending on the patient's condition, the adhesive agent and the adhesive application and removal technique.

AIM

The objective of the study was to determine the incidence, characteristics and influencing factors of medical adhesive-related skin injury from the indwelling urinary catheter attachment in critically ill patients.

STUDY DESIGN

This is a longitudinal study. Data were collected in an adult intensive care unit of a university hospital, a sample size of 132. The socio-demographic and clinical data were obtained from the medical records. Skin exposed to indwelling urinary catheter adhesive tapes was examined daily by trained field researchers. The association between independent variables and medical adhesive-related skin injury was investigated by bivariate statistical analysis and multiple logistic regression.

RESULTS

The medical adhesive-related skin injury incidence was 28%. The association between independent variables and medical adhesive-related skin injury was mechanical (91.8%): skin peeling (56.7%), skin breakdown (18.9%) and tension injury or blister (16.2%); followed by irritant contact dermatitis (21.6%), with no statistical difference between the groups. More than one type of medical adhesive-related skin injury was concomitantly located in 16% of patients, with skin peeling present in all of these cases. The length of stay in the intensive care unit was an independent risk factor for medical adhesive-related skin injury (odds ratio [OR]: 1.072; 95% confidence interval [2.1-12.5]) and the Braden Scale score was a predictive factor (OR: 0.711; 95% CI: 0.3-49.3), with higher scores indicating lower risk.

CONCLUSIONS

Medical adhesive-related skin injury at the indwelling urinary catheter fixation site is a relevant problem, its mechanical aetiology is predominant and most of the risk factors are modifiable.

RELEVANCE TO CLINICAL PRACTICE

This evidence contributes to the epidemiological and clinical knowledge of medical adhesive-related skin injury at the indwelling urinary catheter attachment site, as well as to recognizing the problem as relevant and implementing preventive care.

Medical Adhesive-related Skin Injuries Caused by Eye Taping: A Case Report

This case report discusses medical adhesive-related skin injuries (MARSIs) caused by eye taping during an emergency open reduction internal fixation surgery under general anesthesia. The presented case involves a 72-year-old woman with a proximal humeral fracture, where 3M Transpore adhesive tape caused blisters on both eyelids. This tape is an acrylic-based medical adhesive and is commonly used to keep eyelids closed during general anesthesia. MARSIs can largely be prevented through evidence-based clinical guidance. Enhancing awareness of MARSIs among anesthesia providers and perianesthesia nurses is crucial to prevent and manage such injuries effectively.

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

OBJECTIVES

Central venous catheters (CVCs) are vital for treating ICU patients. However, up to a quarter of CVCs fail from mechanical or infective complications. Poor securement of CVCs to the skin contributes to catheter failure, particularly CVCs placed in the jugular vein, which are highly vulnerable to pullout forces. This study evaluated the effectiveness of medical liquid adhesive (MLA) for improving jugular CVC dressing adhesion.

DESIGN

Multisite parallel group, superiority, randomized controlled trial.

SETTING

Four metropolitan Australian ICUs.

PATIENTS

Eligible patients were 18 years old or older, within 12 hours of jugular CVC insertion, expected to need the CVC for greater than or equal to 72 hours, and remain in ICU for greater than or equal to 24 hours.

INTERVENTIONS

Patients were randomly allocated (stratified by hospital and gender) to standard CVC dressings with the application of MLA to skin under the dressing border (intervention) or standard care CVC dressings (control).

MEASUREMENTS AND MAIN RESULTS

The primary endpoint was dressing failure within 7 days due to lifting edges. Secondary outcomes included the total number of dressing changes, skin injury, and CVC failure. 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. Three skin injuries occurred: one in the intervention (blister) and two in the control (maceration and skin tear) groups.

CONCLUSIONS

MLA is associated with significantly decreased jugular CVC dressing failure and longer dressing dwell, with an acceptable safety profile. MLA should be considered to preserve jugular CVC dressings in ICU.

The prevalence, incidence and risk factors of medical adhesive-related skin injury in adult inpatients: A systematic review and meta-analysis

BACKGROUND

MARSI can occur in any population and clinical setting and is prevalent among patients who are frequently exposed to medical adhesives. It can disrupt the skin barrier and cause pain and infection, confusing patients and medical staff and making it necessary to understand its prevalence, incidence, and risk factors to improve patient health and medical safety.

OBJECTIVE

To systematically evaluate the prevalence, incidence and risk factors of medical adhesive-related skin injury in adult inpatients.

DESIGN

Systematic literature review and meta-analysis.

METHODS

A computer search was conducted on nine databases in both Chinese and English, covering studies from inception to July 10, 2024, evaluating the prevalence, incidence and risk factors of medical adhesive-related skin injuries. Meta-analyses were performed using Review Manager 5.4 and Stata 14 software.

RESULTS

The analysis included 22 studies, involving a total of 10510 research subjects. The meta-analysis of fourteen cross-sectional studies showed that the prevalence of medical adhesive-related skin injury in adult inpatients was 16 % [95 % CI: 13-18 %, Z = 10.95, P < 0.00001]. In the other seven additional cohort studies, the meta-analysis of incidence was 25 % [95 % CI: 17-33 %, Z = 5.90, P < 0.00001]. The results of the meta-analysis of risk factors showed that the following six factors: age>50 years (OR = 1.21, 95%CI: 1.05-1.41), dry skin (OR = 3.51, 95%CI: 1.55-7.95), history of MARSI (OR = 6.78, 95%CI: 1.69-27.15), history of skin allergies (OR = 3.82, 95%CI: 1.92-7.57), skin edema(OR = 3.59,95%CI:1.52-8.47), wet skin(OR = 3.57,95%CI:1.65-13.35) were risk factors.

Prevention and management of medical adhesive-related skin injuries in tumor patients with peripheral central venous catheters: a best practice implementation project

INTRODUCTION

Peripheral central venous catheters are common vascular access devices used in patients with tumors. To prevent catheter shedding and displacement, it is essential to use medical adhesives to secure the catheters. Repeated adhesion and removal of medical adhesives can weaken the barrier function of the skin, leading to medical adhesive-related skin injuries (MARSI), which can increase the patients' pain and medical expenses.

OBJECTIVES

The objective of this project was to utilize the best evidence to prevent and manage MARSI in tumor patients with peripheral central venous catheters.

METHODS

This evidence-based audit and feedback project was theoretically informed by the JBI Evidence Implementation Framework. The framework involves seven phases in which a project team was established; measurable criteria were selected; baseline data were collected; improvement strategies were implemented to address gaps in compliance; a follow-up audit was conducted to assess improvements in compliance; and sustainability measures were considered. The project also used the JBI Practical Application of Clinical Evidence System (PACES) for project management, including data collection and analysis. The JBI Getting Research into Practice (GRiP) approach was also used to support implementation and compliance.

RESULTS

In the baseline audit, the compliance rate for the nine audit criteria was low. In the follow-up audit, the compliance rate significantly improved, with each audit criterion exceeding a minimum of 80%, and four audit criteria reaching 100%. Knowledge of MARSI among nurses and patients significantly improved (p  < 0.05) and the incidence of MARSI among patients with peripheral central venous catheters decreased.

CONCLUSIONS

This project successfully enhanced nurses' compliance with MARSI prevention and management and increased the knowledge and skills of both nurses and patients about MARSI.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A285.

Safety and efficacy of silicone tape for indwelling urinary catheter fixation in intensive care patients-A randomized clinical trial

BACKGROUND

Critically ill patients are more vulnerable to medical adhesive-related skin injuries (MARSI), whose prevention is a constant challenge and one of the main quality indicators of nursing care. MARSI associated with indwelling urinary catheter (IUC) fixation is a relevant adverse event, mainly because of the constant involuntary traction and high skin vulnerability of the fixation site. Silicone adhesive tape has appreciable qualities for fragile skin among the range of adhesives, leading to the inference that it reduces the risk of MARSI.

AIM

To compare silicone adhesive tape for IUC fixation with acrylate tape regarding its safety and efficacy.

STUDY DESIGN

This was a randomized controlled trial blinded to the patients and evaluator. Data were collected from an intensive care unit (ICU) of a tertiary university hospital in Brazil. Patients with IUC and no MARSI at the fixation site were considered eligible. The omega (Ω) fixation technique was used for IUC fixation. A total of 132 participants were enrolled and divided into two research groups: 66 patients in the intervention group (silicone tape) and 66 in the control group (acrylate tape). Outcomes were the incidence of MARSI, patient outcome in the ICU and hospital and partial, total and overall spontaneous detachment of the tapes.

RESULTS

The overall incidence of MARSI was 28%, with 21% in the silicone group and 35% in the acrylate group, with no statistically significant difference (p = .121), including the severity of the lesions (p = .902). However, partial (p = .003) and overall (p < .001) detachment of the tapes were more frequent in the silicone group.

CONCLUSIONS

Silicone tape is no safer than acrylate tape for IUC fixation and is less adhesively effective.

RELEVANCE TO CLINICAL PRACTICE

There is no evidence to support the extensive use of silicone tape in this context.