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Guzel Polat O, Ugucu G, Akdeniz Uysal D, Polat N, Tuzun O, Sonmez Duzkaya D, Celebioglu A. Effects of using an adhesive remover spray and squeezing a stress ball on pain and fear of pain during peripheral intravenous cannula removal in children aged 6-9 years: A randomized controlled trial. J Pediatr Nurs 2025; 84:23-29. [PMID: 40381428 DOI: 10.1016/j.pedn.2025.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 05/12/2025] [Accepted: 05/12/2025] [Indexed: 05/20/2025]
Abstract
PURPOSE To determine the effects of using an alcohol-free, silicone-based adhesive remover spray and squeezing a stress ball on pain and fear of pain during the removal of peripheral intravenous cannulas and fixation materials (acrylate-based hypoallergenic adhesives) in children aged 6-9 years. DESIGN AND METHODS This trial was structured as a randomized controlled parallel-group experimental study at a single-center. This study was conducted with 90 children aged 6-9 years (routine care group = RCG; n = 30, adhesive remover spray group = ARSG; n = 30, ball squeezing + adhesive remover spray group = BS + ARGS; n = 30) admitted to the pediatrics service of a university hospital between May and July 2024. The Wong-Bakers FACES® Pain Rating Scale and the Children's Fear Scale were used as data collection tools. The children's pain and fear of pain were assessed 2 min before, during and 2 min after the procedure. RESULTS The mean age of the children (N = 90) was 8.28 ± 1.70 years. The pain scores of the RCG were higher than those of the BS + ARSG and ARSG. The fear of pain scores of the BS + ARSG were lower than for RCG. CONCLUSIONS Using an alcohol-free, silicone-based adhesive remover spray with ball squeeze to remove peripheral intravenous cannula and fixation material was found to be effective in shortening procedure time and reducing pain and fear of pain in children. PRACTICE IMPLICATIONS Using an alcohol-free, silicone-based adhesive remover spray during peripheral intravenous cannula removal in children reduces pain and fear of pain in children and increases their comfort. It reduced the nurses' workload by reducing the time spent on the procedure.
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Affiliation(s)
| | - Guzide Ugucu
- Mersin University, Faculty of Nursing, Department of Pediatric Nursing, Turkey.
| | | | | | - Ozlem Tuzun
- Mersin University Hospital, 33343 Mersin, Turkey.
| | | | - Ayda Celebioglu
- Mersin University, Faculty of Nursing, Department of Pediatric Nursing, Turkey.
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Yang TY, Park JE, Kim JB, Lee NH. Incidence and Characteristics of Medical Adhesive-Related Skin Injuries in Patients Following Spinal Surgery: A Prospective Observational Study. Int Wound J 2025; 22:e70457. [PMID: 40240309 PMCID: PMC12003050 DOI: 10.1111/iwj.70457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Revised: 01/15/2025] [Accepted: 03/03/2025] [Indexed: 04/18/2025] Open
Abstract
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.
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Affiliation(s)
- Tae Yeong Yang
- Department of NursingKangbuk Samsung HospitalSeoulRepublic of Korea
- College of Nursing ScienceKyung Hee UniversitySeoulRepublic of Korea
| | - Jung Eun Park
- College of Nursing ScienceKyung Hee UniversitySeoulRepublic of Korea
- Review & Assessment Research DepartmentHealth Insurance Review & Assessment ServiceWonju‐siGangwon‐doRepublic of Korea
| | - Joon Bum Kim
- College of Nursing ScienceKyung Hee UniversitySeoulRepublic of Korea
| | - Na Hyun Lee
- Department of NursingKangbuk Samsung HospitalSeoulRepublic of Korea
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Faust E. Complications of Wounds in the Acute Care Setting. Nurs Clin North Am 2025; 60:27-47. [PMID: 39884794 DOI: 10.1016/j.cnur.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2025]
Abstract
There is a significant care burden on wound care patients in the acute care space. During hospitalization, additional risk factors can cause wounds to develop, particularly in the emergency room, operating room, and intensive care units. This article will highlight common wound types, their potential complications in the acute care setting, and implications for practice.
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Wang L, Ma J, Li J, Fang L, Liu C. Transdermal patch based on pressure-sensitive adhesive: the importance of adhesion for efficient drug delivery. Expert Opin Drug Deliv 2025; 22:405-420. [PMID: 39881563 DOI: 10.1080/17425247.2025.2460650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 12/12/2024] [Accepted: 01/27/2025] [Indexed: 01/31/2025]
Abstract
INTRODUCTION Transdermal patches offer a unique advantage by providing extended therapeutic benefits while maintaining stable plasma drug concentration. The efficacy and safety of patches depend significantly on their ability to adhere to the skin, a feature influenced by various external and internal factors. AREAS COVERED The review primarily focuses on the fundamental aspects of adhesion in transdermal patches, including basic information about the skin, the underlying principles of adhesion, drug delivery, and adhesion characteristics of pressure sensitive adhesives (PSAs), adhesion issues, impact factors, strategies to improve patch adhesion, and relevant molecular mechanisms. EXPERT OPINION The development of transdermal patches with sufficient adhesion for consistent and extended drug delivery remains a challenging task. Challenges in adhesion stem from the complex interplay among PSAs, permeation enhancers, active pharmaceutical ingredients (APIs), and other excipients in current patch compositions, further complicated by variations arising from dermatological factors. These intricacies significantly impede the consistent effectiveness of patches. Progress in the exploration of new PSA polymers, in conjunction with innovative patch compositions, is crucial for establishing an optimal equilibrium between drug utilization rate, drug-loading, drug release, and adhesion, thus effectively addressing the challenges related to adhesion.
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Affiliation(s)
- Liuyang Wang
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, Liaoning, China
| | - Junyao Ma
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, Liaoning, China
| | - Jiaxin Li
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, Liaoning, China
| | - Liang Fang
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, Liaoning, China
| | - Chao Liu
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, Liaoning, China
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Frota OP, Paula FM, Ferreira DN, Ferreira-Júnior MA, Domingues EAR, Ruiz JS, Gonçalves FCDN. 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. Nurs Crit Care 2025; 30:e13253. [PMID: 40068956 DOI: 10.1111/nicc.13253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 11/24/2024] [Accepted: 01/06/2025] [Indexed: 05/13/2025]
Abstract
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.
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Affiliation(s)
- Oleci P Frota
- School of Nursing Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Fabiana M Paula
- School of Nursing Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | | | | | - Elaine A R Domingues
- School of Nursing Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Juliana Silva Ruiz
- School of Nursing Federal University of Mato Grosso do Sul, Campo Grande, Brazil
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Xu H(G, Campbell J, Takashima M, Larsen E, Coyer F, August D, Dean A, Pitt C, Griffin B, Marsh N, Rickard CM, Ullman A. Development and Preliminary Validation of a Central Venous Access Device-Associated Skin Impairment Classification Tool Using Modified Delphi and Clinimetric Methods. J Adv Nurs 2025; 81:1095-1112. [PMID: 39258848 PMCID: PMC11730755 DOI: 10.1111/jan.16416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 07/31/2024] [Accepted: 08/11/2024] [Indexed: 09/12/2024]
Abstract
BACKGROUND An evidence and consensus-based instrument is needed to classify central venous access device-associated skin impairments. AIM The aim of this study was to design and evaluate the central venous access device-associated skin impairment classification tool. DESIGN A two-phase modified Delphi study. METHODS This two-phase study consisted of a literature review, followed by the development and validation of a classification instrument, by experts in the fields of central venous access devices and wound management (Phase 1). The instrument was tested (Phase 2) using 38 clinical photographs of a range of relevant skin impairments by the same expert panel. The expert panel consisted of registered nurses who were clinical researchers (n = 4) and clinical experts (n = 3) with an average of 24 years of nursing and research experience and 11 years of experience in wound management. Measures to assess preliminary content validity and inter-rater reliability were used. RESULTS The instrument consists of five overarching aetiological classifications, including contact dermatitis, mechanical injury, infection, pressure injury and complex clinical presentation, with 14 associated subcategory diagnoses (e.g., allergic dermatitis, skin tear and local infection), with definitions and signs and symptoms. High agreement was achieved for preliminary scale content validity and item content validity (I-CVI = 1). Inter-rater reliability of aetiologies was high. The overall inter-rater reliability of individual definitions and signs and symptoms had excellent agreement. CONCLUSION The development and preliminary validation of this classification tool provide a common language to guide the classification and assessment of central venous access device-associated skin impairment. IMPACT The comprehensive and validated classification tool will promote accurate identification of central venous access device-associated skin impairment by establishing a common language for healthcare providers. The availability of this tool can reduce clinical uncertainty, instances of misdiagnosis and the potential for mismanagement. Consequently, it will play a pivotal role in guiding clinical decision-making, ultimately enhancing the quality of treatment and improving patient outcomes. REPORTING METHOD The Guidance on Conducting and Reporting Delphi Studies (CREDES) was adhered to. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Hui (Grace) Xu
- Nursing and Midwifery Research CentreRoyal Brisbane and Women's HospitalHerston, BrisbaneQueenslandAustralia
- School of Nursing and MidwiferyQueensland University of TechnologyKelvin Grove, BrisbaneQueenslandAustralia
- Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Alliance for Vascular Access Teaching and Research (AVATAR)Griffith UniversityBrisbaneQueenslandAustralia
- National Health and Medical Research Council Centre of Research Excellence (CRE) in Wiser Wound Care, Menzies Health Institute, QueenslandGriffith UniversityNathan, BrisbaneQueenslandAustralia
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneQueenslandAustralia
| | - Jill Campbell
- National Health and Medical Research Council Centre of Research Excellence (CRE) in Wiser Wound Care, Menzies Health Institute, QueenslandGriffith UniversityNathan, BrisbaneQueenslandAustralia
| | - Mari Takashima
- Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Alliance for Vascular Access Teaching and Research (AVATAR)Griffith UniversityBrisbaneQueenslandAustralia
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneQueenslandAustralia
| | - Emily Larsen
- Nursing and Midwifery Research CentreRoyal Brisbane and Women's HospitalHerston, BrisbaneQueenslandAustralia
- Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Alliance for Vascular Access Teaching and Research (AVATAR)Griffith UniversityBrisbaneQueenslandAustralia
| | - Fiona Coyer
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneQueenslandAustralia
| | - Deanne August
- Nursing and Midwifery Research CentreRoyal Brisbane and Women's HospitalHerston, BrisbaneQueenslandAustralia
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneQueenslandAustralia
- Children's Health Queensland Hospital and Health ServiceBrisbaneQueenslandAustralia
| | - Anna Dean
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneQueenslandAustralia
- Children's Health Queensland Hospital and Health ServiceBrisbaneQueenslandAustralia
| | - Colleen Pitt
- Children's Health Queensland Hospital and Health ServiceBrisbaneQueenslandAustralia
| | - Bronwyn Griffin
- School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia
| | - Nicole Marsh
- Nursing and Midwifery Research CentreRoyal Brisbane and Women's HospitalHerston, BrisbaneQueenslandAustralia
- Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Alliance for Vascular Access Teaching and Research (AVATAR)Griffith UniversityBrisbaneQueenslandAustralia
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneQueenslandAustralia
| | - Claire M. Rickard
- Nursing and Midwifery Research CentreRoyal Brisbane and Women's HospitalHerston, BrisbaneQueenslandAustralia
- Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Alliance for Vascular Access Teaching and Research (AVATAR)Griffith UniversityBrisbaneQueenslandAustralia
- National Health and Medical Research Council Centre of Research Excellence (CRE) in Wiser Wound Care, Menzies Health Institute, QueenslandGriffith UniversityNathan, BrisbaneQueenslandAustralia
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneQueenslandAustralia
- Herston Infectious Diseases InstituteMetro North HealthHerston, BrisbaneQueenslandAustralia
| | - Amanda Ullman
- Nursing and Midwifery Research CentreRoyal Brisbane and Women's HospitalHerston, BrisbaneQueenslandAustralia
- Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Alliance for Vascular Access Teaching and Research (AVATAR)Griffith UniversityBrisbaneQueenslandAustralia
- National Health and Medical Research Council Centre of Research Excellence (CRE) in Wiser Wound Care, Menzies Health Institute, QueenslandGriffith UniversityNathan, BrisbaneQueenslandAustralia
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneQueenslandAustralia
- Children's Health Queensland Hospital and Health ServiceBrisbaneQueenslandAustralia
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Li S, Liu Y, Wang B, Ning Y. PICC management for bladder tumor patient with toxic epidermal necrolysis: A crisis intervention case report. J Vasc Access 2024:11297298241307780. [PMID: 39725875 DOI: 10.1177/11297298241307780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2024] Open
Abstract
Crisis intervention is crucial in managing acute medical crises to improve outcomes. Toxic Epidermal Necrolysis (TEN), a severe skin reaction often triggered by drug exposure, poses challenges, especially in chemotherapy patients. Evidence on nursing care for TEN patients with Peripherally Inserted Central Catheter (PICC) retention during chemotherapy is limited. We present a 69-year-old male with recurrent bladder tumor receiving atezolizumab via PICC, developing TEN and catheter-associated skin impairment (CASI). Despite extensive skin breakdown, PICC retention was essential and innovative PICC care was necessary. A crisis management team implemented a six-step crisis intervention model, ensuring safety and treatment adherence. A three-layer dressing protocol was used to optimize wound care, prevent further CASI, and ensure the patient's comfort. This case underscores the efficacy of crisis intervention in managing TEN with PICC during chemotherapy, highlighting interdisciplinary collaboration and innovation in complex medical scenarios.
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Affiliation(s)
- Shanquan Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Yeqing Liu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Bo Wang
- Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, China
| | - Yanting Ning
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
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Bliss DZ, McNichol L, Borchert K, Garcia AF, Jinbo AK, McElveen-Edmonds K, Brathwaite S, Sibbald RG, Ayello EA. Irritant Contact Dermatitis Due to Fecal, Urinary, or Dual Incontinence: It Is Time to Focus on Darkly Pigmented Skin. Adv Skin Wound Care 2024; 37:579-593. [PMID: 39792509 DOI: 10.1097/asw.0000000000000238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2025]
Abstract
GENERAL PURPOSE To review best practices related to the assessment of irritant contact dermatitis due to fecal, urinary, or dual incontinence (ICD-FIUIDI) among patients with darkly pigmented skin. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Identify risk factors for the development of ICD-FIUIDI.2. Describe clinical features and manifestations of ICD-FIUIDI.3. Propose recommendations to improve care related to ICD-FIUIDI.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Elizabeth A Ayello
- President, Ayello, Harris & Associates, Inc, New York, New York, United States
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Wang P, Luo X, Chen H, Feng Q, Song H. The prevalence, incidence and risk factors of medical adhesive-related skin injury in adult inpatients: A systematic review and meta-analysis. J Tissue Viability 2024; 33:960-967. [PMID: 39462698 DOI: 10.1016/j.jtv.2024.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 10/02/2024] [Accepted: 10/22/2024] [Indexed: 10/29/2024]
Abstract
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.
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Affiliation(s)
- Ping Wang
- Nanfang Hospital, Southern Medical University, China.
| | - Xinyue Luo
- Nanfang Hospital, Southern Medical University, China.
| | - Huijie Chen
- Nanfang Hospital, Southern Medical University, China.
| | - Qian Feng
- Nanfang Hospital, Southern Medical University, China.
| | - Huijuan Song
- Nanfang Hospital, Southern Medical University, China.
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August D, Hall S, Marsh N, Coyer F. A scoping review and narrative synthesis of neonatal skin injury severity scales. Nurs Crit Care 2024; 29:1687-1705. [PMID: 38355874 DOI: 10.1111/nicc.13018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/17/2023] [Accepted: 12/05/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Mechanical force skin injuries are common for critical care patients, especially neonates. Currently, identification and severity assessments of injuries are dependent on clinical experience and/or utilization of severity tools. Compared with adults, neonates sustain skin injuries in different anatomical locations and have decreased layers of healthy tissue (from 0.9 to 1.2 mm) creating questions around direct application of adult injury severity scales reliant on visual assessment. AIM The aim of this scoping review (ScR) was to investigate severity scales used to report hospital acquired skin injuries for neonates. METHODS This study utilized the 2015 Joanna Briggs Institute methodology for scoping reviews and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews extension. PubMed, CINAHL, COCHRANE Central, Scopus, and the reference lists of included studies were searched for studies published between 2001 and 2023, that included severity scales use within neonatal population. Two authors independently identified studies for full review, data extraction, and quality assessment. RESULTS A systematic database search returned 1163 records. After full test review of 109 studies, 35 studies were included. A majority of studies included were cohort or action research and conducted in the United States of America. Most studies (57%, n = 20) reported skin injuries acquired throughout the body, 14 (40%) of the studies reported the nasal area alone and one study reported no anatomical location. A total of nine severity scales or combination of scales were utilized within studies (n = 31) and four studies did not report a scale. Various versions of scales from the National Pressure Ulcer Advisory Panel (n = 16), European Pressure Ulcer Advisory Panel (n = 8) or Neonatal Skin Condition Score (n = 4) were reported, compared with locally developed classifications/scales (n = 4). Scales were predominantly of ordinal grouping (74%, n = 26) or categorical assessment (14%, n = 5). Only one scale from 2004 was validated for neonates. CONCLUSION Neonatal skin injuries will continue to be reported subjectively until severity scales are consistently applied or other measurements are identified to support assessment. Additionally, without skin injury assessment uniformity, critical examination of effectiveness of skin care treatment practices will have subjective comparison. This review suggests there is a need for consistent skin assessment and severity scales that are valid for the neonatal population and their unique skin considerations. RELEVANCE TO CLINICAL PRACTICE In the context of neonatal skin, with its unique characteristics and heightened risk for injury, clinicians must stage, categorise, and describe injury locations to provide objective information on injury severity. Given the risk for injuries across the entire body, including mucous membranes, describing the depth of the injury is essential regardless of the anatomical site. Although not originally designed for this population, a modified version of the National Pressure Injury Advisory Panel (NPIAP) classification system, which incorporates additional classifications (e.g., skin tears), remains the most applicable severity assessment system currently available. This should be supplemented by clinical images or detailed descriptive language (e.g., subtle redness) until rigorously validated severity and assessment scales, based on neonatal data, are developed-particularly for infants born at less than 27 weeks gestation. [Correction added on 25 October 2024, after first online publication: The Relevance to Clinical Practice subsection in Abstract has been added on this version.].
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Affiliation(s)
- Deanne August
- Department Neonatology, Royal Brisbane and Women's Hospital (Neonatal Unit), Herston, Queensland, Australia
- Royal Brisbane and Women's Hospital (Nursing and Midwifery Research Centre), Herston, Queensland, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
| | - Stephanie Hall
- Department Neonatology, Royal Brisbane and Women's Hospital (Neonatal Unit), Herston, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Nicole Marsh
- Royal Brisbane and Women's Hospital (Nursing and Midwifery Research Centre), Herston, Queensland, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Fiona Coyer
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Royal Brisbane and Women's Hospital (Intensive Care Services), Herston, Queensland, Australia
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11
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Tang H, Zhong X, Wu C, Fan Y, Li Q, Chen Q, Li X, Ruan J, Xia C. Prevention and management of medical adhesive-related skin injuries in tumor patients with peripheral central venous catheters: a best practice implementation project. JBI Evid Implement 2024:02205615-990000000-00144. [PMID: 39445580 DOI: 10.1097/xeb.0000000000000476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2024]
Abstract
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.
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Affiliation(s)
- Huang Tang
- Department of Breast, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Xuemei Zhong
- Department of Breast, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Caixia Wu
- Department of Breast, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Yunfei Fan
- Department of Breast, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Qinghua Li
- Department of Breast, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Qingxia Chen
- Department of Breast, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Xiaojin Li
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- The Nanfang Nursing Centre for Evidence-based Practice: A JBI Centre of Excellence, Guangzhou, Guangdong, China
| | - Jing Ruan
- Department of Nursing, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Chunxia Xia
- Department of Breast, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
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12
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Altamimi AM, Mortada H, Alqarni AA, Alsubaie AA, Alsafar RJ. Risk factors and characteristics of intraoperative pressure injuries caused by medical devices and adhesives: A case-control retrospective study. Saudi J Anaesth 2024; 18:482-487. [PMID: 39600464 PMCID: PMC11587975 DOI: 10.4103/sja.sja_228_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 11/29/2024] Open
Abstract
Background Undesirable injuries during the intraoperative period, such as pressure injuries caused by improper positioning, medical devices, or adhesive tapes, can lead to patient harm and decreased satisfaction. This study aims to identify the risk factors of pressure injuries during the intraoperative period and the characteristics of these injuries. Methods A retrospective case-control study was conducted at King Khaled University Hospital in Riyadh, Saudi Arabia. Data were collected from the hospital incident reporting system and electronic medical records for incidents reported from January 1, 2022 to December 31, 2022. Inclusion criteria consisted of all patients with a reported pressure injury, including pressure ulcers, medical adhesive-related skin injuries, or medical device-related pressure injuries, occurring at least once during surgery. Results Among the 113 patients, 57 (50.44%) had intraoperative pressure injuries (cases), while 56 (49.56%) did not (controls). The most common locations for pressure injuries were the lips (33.33%). Most of these injuries were classified as Medical Adhesive-Related Skin Injury (61.40%). Stage 1 injuries were observed in 47 cases (82.46%), while Stage 2 injuries were observed in 10 cases (17.54%). Duration of surgery and device tightness were identified as significant risk factors (P < 0.001). Conclusion This case-control study identified the duration of surgery and device tightness as significant risk factors for intraoperative pressure injuries. The findings emphasize the importance of implementing evidence-based prevention strategies. Healthcare professionals should prioritize staff education and training, while future research should focus on conducting prospective, multicenter studies and developing risk assessment tools and innovative medical devices.
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Affiliation(s)
- Abdulrhman M. Altamimi
- Department of Anesthesia, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Anesthesia, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Plastic Surgery and Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | - Adel A. Alqarni
- Department of Anesthesia, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Anesthesia, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ali A. Alsubaie
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Reem J. Alsafar
- Department of Anesthesia, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Anesthesia, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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13
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Barton A, Broadhurst D, Hitchcock J, Lund C, McNichol L, Ratliff CR, Moraes JT, Yates S, Gray M. Medical Adhesive-Related Skin Injury at 10 Years: An Updated Consensus. J Wound Ostomy Continence Nurs 2024; 51:S2-S8. [PMID: 39313961 DOI: 10.1097/won.0000000000001116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
Awareness of medical adhesive-related skin injury (MARSI) has increased in the decade since a foundational consensus report was published in 2013. Additional research has provided greater knowledge of the epidemiology of MARSI, along with its assessment, prevention, and management. To summarize knowledge generated in the past decade and review our current understanding of MARSI, a panel of nine clinical experts from four countries (United States of America, United Kingdom, Canada, and Brazil) convened to discuss the literature published since the initial 2013 document and develop updated recommendations for clinical practice. The group formulated 20 updated consensus statements covering the assessment, prevention, and management of skin injuries related to adhesive medical devices and proposed next steps to address remaining gaps in research and knowledge of this complex and clinically relevant condition.
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Affiliation(s)
- Andrew Barton
- Andrew Barton, RN, Frimley Health NHS Foundation Trust, Frimley, United Kingdom
- Daphne Broadhurst, RN, MN, Nipro Canada, Ottawa, Ontario, Canada
- Jan Hitchcock, RN, MSc, Imperial College Healthcare NHS Trust, United Kingdom
- Carolyn Lund, RN, MS, UCSF School of Nursing, San Francisco, California
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, WOCNF, FAAN, Cone Health, Greensboro, North Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, UVA Health, Charlottesville, Virginia
- Juliano Teixeira Moraes, RN, CETN, MD, PhD, Federal University of São João, São João del-Rei, Brazil
- Stephanie Yates, MSN, RN, ANP-BC, CWOCN, Duke University Medical Center, Durham, North Carolina
- Mikel Gray, PhD, FNP, PNP, CUNP, CCCN-AP, WOCNF, FAANP, FAAN, University of Virginia Health System, Charlottesville, Virginia
| | - Daphne Broadhurst
- Andrew Barton, RN, Frimley Health NHS Foundation Trust, Frimley, United Kingdom
- Daphne Broadhurst, RN, MN, Nipro Canada, Ottawa, Ontario, Canada
- Jan Hitchcock, RN, MSc, Imperial College Healthcare NHS Trust, United Kingdom
- Carolyn Lund, RN, MS, UCSF School of Nursing, San Francisco, California
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, WOCNF, FAAN, Cone Health, Greensboro, North Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, UVA Health, Charlottesville, Virginia
- Juliano Teixeira Moraes, RN, CETN, MD, PhD, Federal University of São João, São João del-Rei, Brazil
- Stephanie Yates, MSN, RN, ANP-BC, CWOCN, Duke University Medical Center, Durham, North Carolina
- Mikel Gray, PhD, FNP, PNP, CUNP, CCCN-AP, WOCNF, FAANP, FAAN, University of Virginia Health System, Charlottesville, Virginia
| | - Jan Hitchcock
- Andrew Barton, RN, Frimley Health NHS Foundation Trust, Frimley, United Kingdom
- Daphne Broadhurst, RN, MN, Nipro Canada, Ottawa, Ontario, Canada
- Jan Hitchcock, RN, MSc, Imperial College Healthcare NHS Trust, United Kingdom
- Carolyn Lund, RN, MS, UCSF School of Nursing, San Francisco, California
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, WOCNF, FAAN, Cone Health, Greensboro, North Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, UVA Health, Charlottesville, Virginia
- Juliano Teixeira Moraes, RN, CETN, MD, PhD, Federal University of São João, São João del-Rei, Brazil
- Stephanie Yates, MSN, RN, ANP-BC, CWOCN, Duke University Medical Center, Durham, North Carolina
- Mikel Gray, PhD, FNP, PNP, CUNP, CCCN-AP, WOCNF, FAANP, FAAN, University of Virginia Health System, Charlottesville, Virginia
| | - Carolyn Lund
- Andrew Barton, RN, Frimley Health NHS Foundation Trust, Frimley, United Kingdom
- Daphne Broadhurst, RN, MN, Nipro Canada, Ottawa, Ontario, Canada
- Jan Hitchcock, RN, MSc, Imperial College Healthcare NHS Trust, United Kingdom
- Carolyn Lund, RN, MS, UCSF School of Nursing, San Francisco, California
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, WOCNF, FAAN, Cone Health, Greensboro, North Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, UVA Health, Charlottesville, Virginia
- Juliano Teixeira Moraes, RN, CETN, MD, PhD, Federal University of São João, São João del-Rei, Brazil
- Stephanie Yates, MSN, RN, ANP-BC, CWOCN, Duke University Medical Center, Durham, North Carolina
- Mikel Gray, PhD, FNP, PNP, CUNP, CCCN-AP, WOCNF, FAANP, FAAN, University of Virginia Health System, Charlottesville, Virginia
| | - Laurie McNichol
- Andrew Barton, RN, Frimley Health NHS Foundation Trust, Frimley, United Kingdom
- Daphne Broadhurst, RN, MN, Nipro Canada, Ottawa, Ontario, Canada
- Jan Hitchcock, RN, MSc, Imperial College Healthcare NHS Trust, United Kingdom
- Carolyn Lund, RN, MS, UCSF School of Nursing, San Francisco, California
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, WOCNF, FAAN, Cone Health, Greensboro, North Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, UVA Health, Charlottesville, Virginia
- Juliano Teixeira Moraes, RN, CETN, MD, PhD, Federal University of São João, São João del-Rei, Brazil
- Stephanie Yates, MSN, RN, ANP-BC, CWOCN, Duke University Medical Center, Durham, North Carolina
- Mikel Gray, PhD, FNP, PNP, CUNP, CCCN-AP, WOCNF, FAANP, FAAN, University of Virginia Health System, Charlottesville, Virginia
| | - Catherine R Ratliff
- Andrew Barton, RN, Frimley Health NHS Foundation Trust, Frimley, United Kingdom
- Daphne Broadhurst, RN, MN, Nipro Canada, Ottawa, Ontario, Canada
- Jan Hitchcock, RN, MSc, Imperial College Healthcare NHS Trust, United Kingdom
- Carolyn Lund, RN, MS, UCSF School of Nursing, San Francisco, California
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, WOCNF, FAAN, Cone Health, Greensboro, North Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, UVA Health, Charlottesville, Virginia
- Juliano Teixeira Moraes, RN, CETN, MD, PhD, Federal University of São João, São João del-Rei, Brazil
- Stephanie Yates, MSN, RN, ANP-BC, CWOCN, Duke University Medical Center, Durham, North Carolina
- Mikel Gray, PhD, FNP, PNP, CUNP, CCCN-AP, WOCNF, FAANP, FAAN, University of Virginia Health System, Charlottesville, Virginia
| | - Juliano Teixeira Moraes
- Andrew Barton, RN, Frimley Health NHS Foundation Trust, Frimley, United Kingdom
- Daphne Broadhurst, RN, MN, Nipro Canada, Ottawa, Ontario, Canada
- Jan Hitchcock, RN, MSc, Imperial College Healthcare NHS Trust, United Kingdom
- Carolyn Lund, RN, MS, UCSF School of Nursing, San Francisco, California
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, WOCNF, FAAN, Cone Health, Greensboro, North Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, UVA Health, Charlottesville, Virginia
- Juliano Teixeira Moraes, RN, CETN, MD, PhD, Federal University of São João, São João del-Rei, Brazil
- Stephanie Yates, MSN, RN, ANP-BC, CWOCN, Duke University Medical Center, Durham, North Carolina
- Mikel Gray, PhD, FNP, PNP, CUNP, CCCN-AP, WOCNF, FAANP, FAAN, University of Virginia Health System, Charlottesville, Virginia
| | - Stephanie Yates
- Andrew Barton, RN, Frimley Health NHS Foundation Trust, Frimley, United Kingdom
- Daphne Broadhurst, RN, MN, Nipro Canada, Ottawa, Ontario, Canada
- Jan Hitchcock, RN, MSc, Imperial College Healthcare NHS Trust, United Kingdom
- Carolyn Lund, RN, MS, UCSF School of Nursing, San Francisco, California
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, WOCNF, FAAN, Cone Health, Greensboro, North Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, UVA Health, Charlottesville, Virginia
- Juliano Teixeira Moraes, RN, CETN, MD, PhD, Federal University of São João, São João del-Rei, Brazil
- Stephanie Yates, MSN, RN, ANP-BC, CWOCN, Duke University Medical Center, Durham, North Carolina
- Mikel Gray, PhD, FNP, PNP, CUNP, CCCN-AP, WOCNF, FAANP, FAAN, University of Virginia Health System, Charlottesville, Virginia
| | - Mikel Gray
- Andrew Barton, RN, Frimley Health NHS Foundation Trust, Frimley, United Kingdom
- Daphne Broadhurst, RN, MN, Nipro Canada, Ottawa, Ontario, Canada
- Jan Hitchcock, RN, MSc, Imperial College Healthcare NHS Trust, United Kingdom
- Carolyn Lund, RN, MS, UCSF School of Nursing, San Francisco, California
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, WOCNF, FAAN, Cone Health, Greensboro, North Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, UVA Health, Charlottesville, Virginia
- Juliano Teixeira Moraes, RN, CETN, MD, PhD, Federal University of São João, São João del-Rei, Brazil
- Stephanie Yates, MSN, RN, ANP-BC, CWOCN, Duke University Medical Center, Durham, North Carolina
- Mikel Gray, PhD, FNP, PNP, CUNP, CCCN-AP, WOCNF, FAANP, FAAN, University of Virginia Health System, Charlottesville, Virginia
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Holm D, Schommer K, Kottner J. Review of Medical Adhesive Technology in the Context of Medical Adhesive-Related Skin Injury. J Wound Ostomy Continence Nurs 2024; 51:S9-S17. [PMID: 39313962 DOI: 10.1097/won.0000000000001115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
In clinical practice, a large variety of medical devices adhere to skin to perform their function. The repeated application and removal of these devices can lead to skin damage or medical adhesive-related skin injury. Awareness of this problem has increased in the past decade, and this adverse event can be prevented with appropriate selection of adhesive products and the appropriate techniques for application and removal. A wide variety of adhesives and backing systems have been developed to create medical devices with an array of attributes, so they can accomplish many different indications in the clinical setting and meet various needs, including doing the clinical job without damaging the skin and causing further patient complications. The selection of an adhesive product should take into consideration a patient's skin assessment and history of medical adhesive-related skin injury, and using only the minimal adhesive strength needed to perform the function while protecting the skin from damage.
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Affiliation(s)
- David Holm
- David Holm, PhD, Solventum, Maplewood, MN
- Kimberly Schommer, RN, BSN, PHN, VA-BC, Solventum, Maplewood, MN
- Jan Kottner, RN, PhD, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kimberly Schommer
- David Holm, PhD, Solventum, Maplewood, MN
- Kimberly Schommer, RN, BSN, PHN, VA-BC, Solventum, Maplewood, MN
- Jan Kottner, RN, PhD, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Kottner
- David Holm, PhD, Solventum, Maplewood, MN
- Kimberly Schommer, RN, BSN, PHN, VA-BC, Solventum, Maplewood, MN
- Jan Kottner, RN, PhD, Charité - Universitätsmedizin Berlin, Berlin, Germany
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15
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Ratliff C, Barton A, Hitchcock J, Gray M. Assessing and Managing Medical Adhesive-Related Skin Injury in Patients with a Peripherally Inserted Central Catheter: A Case Series. J Wound Ostomy Continence Nurs 2024; 51:S18-S23. [PMID: 39313963 DOI: 10.1097/won.0000000000001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
BACKGROUND Medical adhesive-related skin injuries (MARSIs) are prevalent adverse effects associated with use of medical devices and increasingly recognized as potentially avoidable. Despite advances in preventive measures, MARSI events still occur, and individualized care must be designed to meet patient needs. CASES This article describes three cases where skin injuries occurred because of application, removal, and ongoing use of a medical adhesive device; all three cases occurred underneath dressings used to secure and protect the skin adjacent to a peripherally inserted central catheter (PICC). The first case describes evaluation and management of a skin tear in an elderly female with multiple comorbid conditions, and Case 2 describes assessment and care of contact irritant dermatitis occurring under a PICC dressing. In both cases, specialist nurses with knowledge of MARSI assessed and managed the skin underneath the medical adhesive device in a manner that allowed maintenance of the PICC and continuation of therapy. In contrast, Case 3 describes a female with irritant contact dermatitis underneath a PICC dressing that was responding to care by the nurse specialists of a vascular access team. In this case, the patient presented to their facility's emergency department with severe itching. The vascular access team initially was not consulted, and the PICC line was removed, although inspection revealed dry skin without signs of infection. CONCLUSIONS Medical adhesive-related skin injury is a clinically relevant and useful construct that identifies a variety of prevalent conditions associated with the use of medical adhesive device such as tapes and PICC dressings. These cases, in particular Cases 1 and 2, illustrate that the MARSI construct provides a framework for assessing and managing medical skin injuries with the possibility of preserving the PICC and the ongoing therapy these patients were receiving.
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Affiliation(s)
- Catherine Ratliff
- Catherine Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, University of Virginia Health System, Charlottesville, Virginia
- Andrew Barton, RN, Frimley Health NHS Foundation Trust, Frimley, UK
- Jan Hitchcock, RN, MSc, Imperial College Healthcare NHS Trust, London, UK
- Mikel Gray, PhD, FNP, PNP, CUNP, CCCN-AP, WOCNF, FAANP, FAAN, University of Virginia Health System, Charlottesville, Virginia
| | - Andrew Barton
- Catherine Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, University of Virginia Health System, Charlottesville, Virginia
- Andrew Barton, RN, Frimley Health NHS Foundation Trust, Frimley, UK
- Jan Hitchcock, RN, MSc, Imperial College Healthcare NHS Trust, London, UK
- Mikel Gray, PhD, FNP, PNP, CUNP, CCCN-AP, WOCNF, FAANP, FAAN, University of Virginia Health System, Charlottesville, Virginia
| | - Jan Hitchcock
- Catherine Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, University of Virginia Health System, Charlottesville, Virginia
- Andrew Barton, RN, Frimley Health NHS Foundation Trust, Frimley, UK
- Jan Hitchcock, RN, MSc, Imperial College Healthcare NHS Trust, London, UK
- Mikel Gray, PhD, FNP, PNP, CUNP, CCCN-AP, WOCNF, FAANP, FAAN, University of Virginia Health System, Charlottesville, Virginia
| | - Mikel Gray
- Catherine Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, University of Virginia Health System, Charlottesville, Virginia
- Andrew Barton, RN, Frimley Health NHS Foundation Trust, Frimley, UK
- Jan Hitchcock, RN, MSc, Imperial College Healthcare NHS Trust, London, UK
- Mikel Gray, PhD, FNP, PNP, CUNP, CCCN-AP, WOCNF, FAANP, FAAN, University of Virginia Health System, Charlottesville, Virginia
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16
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Gray M. Context for Practice: Peripheral Arterial Disease and Lower Extremity Wounds, Skin Tears, and Defunctioning Tube Ileostomy. J Wound Ostomy Continence Nurs 2024; 51:349-350. [PMID: 39313966 DOI: 10.1097/won.0000000000001118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
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17
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Gray M. Medical Adhesive-Related Skin Injury (MARSI) at 10 Years, Progress, and Challenges: Editorial Context for a Supplement to JWOCN. J Wound Ostomy Continence Nurs 2024; 51:S1. [PMID: 39313960 DOI: 10.1097/won.0000000000001109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
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18
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Wang R, Li Y, Xiang L, Chen KJ, Wang X, Mao LL, Wei WS, Wang XF, Chen YM, Wang ML, Liu MH, Yang YQ. Risk factors for skin injuries in cancer patients with peripherally inserted central catheter: A prospective multicenter cohort study. J Vasc Access 2024; 25:1261-1270. [PMID: 36895143 DOI: 10.1177/11297298231158670] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND The risk factors for skin injuries remain poorly understood in cancer patients with peripherally inserted central catheters (PICC). We herein aimed at exploring the effect of clinical factors on the risk of PICC-related skin injuries. METHODS We included 1245 cancer patients with PICC from 16 hospitals in Suzhou, China. The study outcome was in-hospital skin injuries, including contact dermatitis, skin (epidermal) stripping, tension injury, allergic dermatitis, skin tear, maceration, folliculitis, and pressure injury. RESULTS During hospitalization, 274 patients (22.0%) developed skin injuries after prolonged use of an indwelling catheter. Univariable logistic regression analysis identified several risk factors for PICC-related skin injuries; multivariable logistic regression analysis showed that the following factors independently and significantly (p < 0.05) associated with the risk of PICC-related skin injuries: body mass index (BMI, >25 kg/m2 versus <18.5 kg/m2: odds ratio (OR), 1.79; 95% confidence interval (CI), 1.03-3.11), skin condition (humid vs normal: OR, 2.96; 95% CI, 1.62-5.43), skin indentation (OR, 4.67; 95% CI, 3.31-6.58), allergic history (OR, 2.11; 95% CI, 1.21-3.66), history of dermatitis (OR, 3.05; 95% CI, 1.00-9.28), history of eczema (OR, 3.36; 95% CI, 1.20-9.43), catheter insertion site (under elbow vs. upper arm: OR, 3.32; 95% CI, 1.12-9.90), and PICC maintenance interval (4-5 days vs ⩽3 days: OR, 0.06; 95% CI, 0.01-0.50; 5-7 days vs ⩽3 days: OR, 0.07; 95% CI, 0.02-0.31; 7-9 days vs ⩽3 days: OR, 0.10; 95% CI, 0.02-0.57). CONCLUSIONS BMI, skin condition, skin indentation, allergic history, history of dermatitis, history of eczema, catheter insertion site, and PICC maintenance interval were independent risk factors for PICC-related skin injuries in cancer patients. This knowledge will guide future studies with formulating optimal treatment strategies for improving the skin health of cancer patients with PICC.
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Affiliation(s)
- Rong Wang
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuan Li
- Stomatology Hospital of Shandong University, Shandong, China
- School of Nursing, Suzhou Medical College, Soochow University, Suzhou, China
| | - Ling Xiang
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ke-Jian Chen
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xu Wang
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ling-Ling Mao
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wen-Shi Wei
- School of Nursing, Suzhou Medical College, Soochow University, Suzhou, China
| | - Xi-Feng Wang
- School of Nursing, Suzhou Medical College, Soochow University, Suzhou, China
| | - Ya-Mei Chen
- The First Affiliated Hospital of Soochow University, Suzhou, China
- School of Nursing, Suzhou Medical College, Soochow University, Suzhou, China
| | - Mei-Ling Wang
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ming-Hong Liu
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi-Qun Yang
- The First Affiliated Hospital of Soochow University, Suzhou, China
- Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
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Van Houten CT, Mann CL, Misiti N, Qualls BW. Skin integrity preservation using a nurse-constructed silicone adhesive Foley catheter. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S20-S28. [PMID: 38900658 DOI: 10.12968/bjon.2024.0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
AIMS Skin breakdown is common in the intensive care unit (ICU). This pilot evaluation aimed to determine whether a nurse-constructed urinary catheter securement device using a silicone adhesive could reduce the complications of blistering and other skin breakdowns in a high-risk ICU population with Foley catheters. DESIGN A prospective, non-randomised performance improvement study using a convenience sample was carried out. SUBJECTS AND SETTING The study sample consisted of 29 patients with urethral Foley catheters and any degree of thigh oedema in a surgical ICU at an academic quarternary medical center. METHODS Patients were fitted with a standard acrylic-adhesive catheter securement device on one thigh and a nurse-constructed device on the contralateral thigh. At the beginning of each 12-hour shift, the nurse moved the Foley catheter from one securement device to the other; the nurse recorded the assessment findings at the end of the shift. RESULTS The average age of the 29 patients was 61±16 (range 20-87) years. Visible skin compromise occurred in 21% of the time with the standard acrylic securement device; an equal percentage of men and women developed skin breakdown. Oedema status was a significant factor related to skin breakdown. There was no visible damage to the skin associated with the nurse-constructed silicone-adhesive device. CONCLUSIONS A silicone adhesive urinary catheter securement device causes less skin damage than one with acrylic adhesive. One-step application, pain-free and atraumatic removal, and reliable securement are essential considerations in product development.
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Affiliation(s)
- Cathleen T Van Houten
- Program Manager, Inpatient Wound, Ostomy, and Continence Nursing, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY
| | - Carrie L Mann
- Nurse, Surgical Intensive Care Unit, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY
| | - Natalya Misiti
- Nurse, Surgical Intensive Care Unit, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY
| | - Brandon W Qualls
- Research Scientist, Clinical Nursing Research Center, Strong Memorial Hospital, University of Rochester Medical Center; Research Associate, University of Rochester School of Nursing, Rochester, NY
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20
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Qi M, Qin Y, Meng S, Feng N, Meng Y. Risk factors for medical adhesive-related skin injury at the site of peripherally inserted central venous catheter placement in patients with cancer: a single-centre prospective study from China. BMJ Open 2024; 14:e080816. [PMID: 38443083 PMCID: PMC11146366 DOI: 10.1136/bmjopen-2023-080816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/22/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVES This study aims to explore the incidence of, and risk factors for medical adhesive-related skin injury (MARSI) at peripherally inserted central venous catheter (PICC) sites in patients with cancer. DESIGN A prospective observational cohort study was conducted at a tertiary hospital in Shenzhen, China. SETTING This was a single-centre study conducted in a tertiary hospital in Shenzhen, China. PARTICIPANTS A total of 340 patients with cancer and PICC placement from January 2022 to June 2023 were selected using a convenience sampling method. METHODS Factors potentially associated with PICC-related MARSI (PICC-MARSI) were recorded, including patient demographics, and catheter placement and maintenance. Patients were divided into MARSI and non-MARSI groups. Univariate analysis was performed to screen for associated variables, and logistic regression analysis was used to identify independent risk factors for PICC-MARSI. RESULTS Of all 340 patients enrolled, 33 (9.7%) developed PICC-MARSI, including skin tear (8, 24.2%), tension injury (5, 15.2%), irritant contact dermatitis (10, 30.3%), allergic dermatitis (7, 21.2%) and maceration (3, 9.1%). Multivariable analysis showed that age (OR=1.058, p=0.001, 95% CI 1.023-1.094), wet skin (OR=4.873, p=0.003, 95% CI 1.728-13.742), dry skin (OR=6.247, p<0.0001, 95% CI 2.239-17.431), oedema (OR=3.302, p=0.008, 95% CI 1.365-7.985), allergy history (OR=6.044, p=0.001, 95% CI 2.040-17.906), dressing type (OR=3.827, p=0.003, 95% CI 1.595-9.185), body mass index (BMI) <18.5 (OR=4.271, p=0.015, 95% CI 1.327-13.742) and BMI 25-30 (OR=2.946, p=0.027, 95% CI 1.131-7.678) were independent risk factors for PICC-MARSI. CONCLUSIONS Proper catheter maintenance and appropriate dressing selection are crucial for the prevention of this condition.
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Affiliation(s)
- Mengying Qi
- Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Yuju Qin
- Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Siya Meng
- Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Nan Feng
- Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Yan Meng
- Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, Guangdong, China
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de Paula FM, Frota OP, Ruiz JS, Braulio IC, do Nascimento Gonçalves FC, Ferreira-Júnior MA, Sonobe HM, Ferreira DN, Pompeo CM, de Sousa AFL. Safety and efficacy of silicone tape for indwelling urinary catheter fixation in intensive care patients-A randomized clinical trial. Nurs Crit Care 2024; 29:347-356. [PMID: 37264262 DOI: 10.1111/nicc.12937] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/19/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023]
Abstract
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.
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Affiliation(s)
| | - Oleci Pereira Frota
- School of Nursing, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Juliana Silva Ruiz
- School of Nursing, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | | | | | | | - Helena Megumi Sonobe
- Ribeirao Preto College of Nursing, University of Sao Paulo, Ribeirão Preto, Brazil
| | | | - Carolina Mariano Pompeo
- School of Nursing, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
- Maria Aparecida Pedrossian University Hospital, Campo Grande, Brazil
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Turnbull MJ, Grigsby I, Unertl K, Sokol K, Nordby T, Liu C, Bailey A, Spiewak B, Smith G, McNulty AK. Comparison of Medical Tape Performance Using Skin Response Quantitative Measurements on Healthy Volunteers. Cureus 2024; 16:e56548. [PMID: 38646282 PMCID: PMC11027027 DOI: 10.7759/cureus.56548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Medical tapes can lead to skin damage upon removal in susceptible patients with fragile skin and at higher risk of developing tissue injury. PURPOSE We compared the effect of medical tapes with silicone-based versus acrylate-based adhesives on the back or volar forearm stratum corneum using analytical techniques to assess skin condition and potential damage post product removal on 88 healthy volunteers. METHODS Two studies were conducted in separate facilities (Study 1: 3M In-house Clinical Facility, St. Paul, Minnesota; Study 2: DermiCo, LLC, Broomall, Pennsylvania). Four commercially available tapes were the same in both studies, two for each type of adhesive. We evaluated adhesion to the skin, total proteins and corneocytes removed by the tapes, changes in transepidermal water loss (TEWL), and induction of the inflammatory cytokine interleukin-1 alpha (IL-1a). RESULTS One of the silicone tapes displayed the strongest adhesion at 24 hours, and one of the acrylate tapes had the lowest adhesion, showing differences in performance within adhesive categories. The adhesion forces did not correlate with the amount of total protein or corneocytes removed. Silicone adhesives removed less total protein and corneocytes than acrylate adhesives. Silicone adhesives did not alter TEWL, whereas acrylate adhesives significantly raised TEWL. There were no differences in interleukin-1alpha induction. CONCLUSION The silicone adhesive tapes were less disruptive to the skin barrier than the acrylate adhesive tapes, even in healthy volunteers whose skin is not as fragile as what is observed in typical patients. This type of data could guide clinical product usage decisions.
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Affiliation(s)
| | - Iwen Grigsby
- Medical Solutions Division, 3M Health Care, St. Paul, USA
| | - Karl Unertl
- Medical Solutions Division, 3M Health Care, St. Paul, USA
| | - Kerry Sokol
- Medical Solutions Division, 3M Health Care, St. Paul, USA
| | - Tera Nordby
- Global Medical and Clinical Affairs, 3M Health Care, St. Paul, USA
| | - Cedric Liu
- Medical Solutions Division, 3M Health Care, St. Paul, USA
| | - Anna Bailey
- Medical Solutions Division, 3M Health Care, St. Paul, USA
| | - Brian Spiewak
- Medical Solutions Division, 3M Health Care, St. Paul, USA
| | - Graham Smith
- Global Medical and Clinical Affairs, 3M Health Care, St. Paul, USA
| | - Amy K McNulty
- Medical Solutions Division, 3M Health Care, St. Paul, USA
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Lorente Flores CM, Zhan Z, Scholten AWJ, Hutten GJ, Vervoorn M, Niemarkt HJ. The Effects of a New Wireless Non-Adhesive Cardiorespiratory Monitoring Device on the Skin Conditions of Preterm Infants. SENSORS (BASEL, SWITZERLAND) 2024; 24:1258. [PMID: 38400415 PMCID: PMC10892062 DOI: 10.3390/s24041258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Abstract
AIM The aim of our study was to investigate skin conditions when wearing and removing a novel wireless non-adhesive cardiorespiratory monitoring device for neonates (Bambi-Belt) compared to standard adhesive electrodes. STUDY DESIGN This was a prospective study including preterm neonates requiring cardiorespiratory monitoring. Besides standard electrodes, the infants wore a Bambi Belt for 10 consecutive days. Their skin conditions were assessed using Trans Epidermal Water Loss (TEWL) and the Neonatal Skin Condition Score (NSCS) after daily belt and standard electrode removal. The ∆TEWL was calculated as the difference between the TEWL at the device's location (Bambi-Belt/standard electrode) and the adjacent control skin location, with a higher ∆TEWL indicating skin damage. RESULTS A total of 15 infants (gestational age (GA): 24.1-35.6 wk) were analyzed. The ΔTEWL significantly increased directly after electrode removal (10.95 ± 9.98 g/m2/h) compared to belt removal (5.18 ± 6.71 g/m2/h; F: 8.73, p = 0.004) and after the washout period (3.72 ± 5.46 g/m2/h vs. 1.86 ± 3.35 g/m2/h; F: 2.84, p = 0.09), although the latter did not reach statistical significance. The TEWL was not influenced by prolonged belt wearing. No significant differences in the NSCS score were found between the belt and electrode (OR: 0.69, 95% CI [0.17, 2.88], p = 0.6). CONCLUSION A new wireless non-adhesive device for neonatal cardiorespiratory monitoring was well tolerated in preterm infants and may be less damaging during prolonged wearing.
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Affiliation(s)
- Carmen M. Lorente Flores
- Máxima Medical Center, Department of Neonatology, De Run 4600, 5504 DB Veldhoven, The Netherlands; (C.M.L.F.); (M.V.)
| | - Zhuozhao Zhan
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands;
| | - Anouk W. J. Scholten
- Department of Neonatology, UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands (G.J.H.)
- Amsterdam Reproduction & Development Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Gerard J. Hutten
- Department of Neonatology, UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands (G.J.H.)
- Amsterdam Reproduction & Development Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Marieke Vervoorn
- Máxima Medical Center, Department of Neonatology, De Run 4600, 5504 DB Veldhoven, The Netherlands; (C.M.L.F.); (M.V.)
| | - Hendrik J. Niemarkt
- Máxima Medical Center, Department of Neonatology, De Run 4600, 5504 DB Veldhoven, The Netherlands; (C.M.L.F.); (M.V.)
- Department of Electrical Engineering, Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands
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24
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Van Wicklin SA. Intraoperative Management of Older Adult Patients Undergoing Plastic Surgical Procedures. PLASTIC AND AESTHETIC NURSING 2024; 44:20-27. [PMID: 38166304 DOI: 10.1097/psn.0000000000000540] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Affiliation(s)
- Sharon Ann Van Wicklin
- Sharon Ann Van Wicklin, PhD, RN, CNOR, CRNFA(E), CPSN-R, PLNC, ISPAN-F, FAORN, FAAN, is the Editor-in-Chief, Plastic and Aesthetic Nursing , and a Perioperative and Legal Nurse Consultant, Aurora, CO
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25
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Frota OP, Pinho JN, Ferreira-Júnior MA, Sarti ECFB, Paula FM, Ferreira DN. Incidence and risk factors for medical adhesive-related skin injury in catheters of critically ill patients: A prospective cohort study. Aust Crit Care 2023; 36:997-1003. [PMID: 37002019 DOI: 10.1016/j.aucc.2023.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND The skin in contact with the adhesives used to secure catheters is vulnerable to medical adhesive-related skin injury (MARSI). The incidence of these injuries and the risks associated with their development have not been accurately estimated previously in critically ill patients. AIM The aim of this study was to investigate the incidence and risk factors for MARSI in catheters of critically ill patients. METHODS A prospective cohort study was conducted in adult intensive care units of two Brazilian university hospitals. A total of 150 patients (439 catheters) were included. The skin exposed to the catheter fixation adhesives (central venous, nasogastric, nasoenteral, and indwelling urinary) was examined daily by four trained researchers. The patients' sociodemographic and clinical data were collected from their electronic medical records. The association between independent variables and MARSI was investigated by bivariate statistics, followed by a multiple logistic regression. RESULTS The MARSI incidence was 42% (86.5 MARSIs per 1000 patient-days). Advanced age, prolonged hospital stay, dry skin, repetitive adhesive removal, low Braden Scale score, and hypoalbuminemia were associated with MARSI (p < .05). According to the multivariate logistic regression, dry skin increased the chance of MARSI by 5.2 times (odds ratio: 5.2; 95% confidence interval: 2.4-11.1), while the Braden Scale score was a protective factor, showing 30% less chance of MARSI for each added score (odds ratio: 0.7; 95% confidence interval: 0.6-0.9). A higher incidence of MARSI was observed in nasoenteral catheters and in those fixed with adhesive using natural rubber. The MARSI types were predominantly mechanical (70.3%): skin stripping (41.3%), skin tear (26.1%), and tension injury or blister (2.9%). CONCLUSIONS MARSI is a common event in adult intensive care units, and most risk factors are modifiable. Preventive actions are potentially capable of reducing incidence, optimising financial resources, and improving clinical results.
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Affiliation(s)
- Oleci P Frota
- School of Nursing, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil.
| | - Jéssica N Pinho
- School of Nursing, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Marcos A Ferreira-Júnior
- School of Nursing, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Elaine C F B Sarti
- School of Nursing, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Fabiana M Paula
- School of Nursing, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Danielle N Ferreira
- Hospital Universitário Maria Aparecida Pedrossian, Campo Grande, Mato Grosso do Sul, Brazil
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26
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Santamaria N, Woo K, Beeckman D, Alves P, Cullen B, Gefen A, Lázaro‐Martínez JL, Lev‐Tov H, Najafi B, Sharpe A, Swanson T. Clinical performance characteristics for bordered foam dressings in the treatment of complex wounds: An international wound dressing technology expert panel review. Int Wound J 2023; 20:3467-3473. [PMID: 37139846 PMCID: PMC10588323 DOI: 10.1111/iwj.14217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/05/2023] Open
Abstract
The aim of this article is to identify and describe clinical practice performance characteristics for bordered foam dressings in the treatment of complex wounds. Our recently published systematic review of outcomes and applied measurement instruments for the use of bordered foam dressings in complex wounds has led to us identifying a range of important clinical and patient-centred issues related to this dressing class. Specifically, here, we focus on an overview of performance criteria in the areas of application, adhesion, exudate management and debridement functions of bordered foam dressings. Our hope is that by highlighting the clinical performance criteria, future testing standards for wound dressings will more closely match our clinical expectations and, thereby, assist clinicians to make better wound treatment choices based on meaningful and clinically relevant dressing product performance standards. complex wounds, complex wound care, treatment, bordered foam dressings, dressing performance.
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Affiliation(s)
- Nick Santamaria
- School of Health SciencesUniversity of MelbourneMelbourneVictoriaAustralia
| | - Kevin Woo
- School of NursingQueen's UniversityKingstonOntarioCanada
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT)University Centre for Nursing and MidwiferyGhentBelgium
- Department of Public Health and Primary CareGhent UniversityGhentBelgium
- Swedish Centre for Skin and Wound Research, Faculty of Health and Medicine, School of Health SciencesÖrebro UniversityÖrebroSweden
- Research Unit of Plastic Surgery, Department of Clinical ResearchFaculty of Health SciencesOdenseDenmark
- School of Nursing & MidwiferyRoyal College of Surgeons in Ireland (RCSI)DublinIreland
| | - Paulo Alves
- Wounds Research Lab ‐ Centre for Interdisciplinary Research in HealthUniversidade Catolica PortuguesaPortugal
| | | | - Amit Gefen
- Department of Biomedical EngineeringFaculty of Engineering, Tel Aviv UniversityTel AvivIsrael
| | | | - Hadar Lev‐Tov
- Dr. Phillip Frost Department of Dermatology and Cutaneous SurgeryUniversity of Miami Hospital Miller School of MedicineMiamiFloridaUSA
| | - Bijan Najafi
- Michael E. DeBakey Department of Surgery, Baylor College of MedicineInterdisciplinary Consortium on Advanced Motion Performance (iCAMP)HoustonTexasUSA
| | - Andrew Sharpe
- Podiatry DepartmentSalford Royal NHS Foundation Trust, Salford Care OrganisationSalfordUK
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27
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Wang Y, Miao M, Xu MS, Wan GM. Peripherally Inserted Central Catheter-Related Skin Injury in Patients with a Chest Tumor: Characteristics and Risk Factors. Adv Skin Wound Care 2023; 36:1-6. [PMID: 37861672 DOI: 10.1097/asw.0000000000000052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To investigate the characteristics and risk factors of skin injury in patients with chest tumors who have peripherally inserted central catheters (PICCs). METHODS This study included a total of 252 patients with chest tumors with PICC placement who were treated from March 2018 to December 2021 in a tertiary hospital in Shanghai, China. Investigators used univariate analysis and multivariate logistic regression to identify the risk factors. RESULTS Among the included patients, 40.8% had skin injuries (n = 103). Skin injury occurred between 2 and 361 days after PICC placement, with a median time of 56.0 days (interquartile range, 20.75-99.25 days). Skin injury may occur during catheter retention and be concentrated in the first 3 months after PICC placement; the occurrence trajectory of skin injury exhibits a downward trend. Logistic regression analysis shows that skin injury is more likely to occur if the patient has a history of smoking, allergy history, use of recombinant human endostatin, or an excessive duration of catheter retention. CONCLUSIONS The incidence of PICC-related skin injury in patients with chest tumors remains high. Medical practitioners should be aware of its characteristics and risk factors and adopt effective solutions early to mitigate the occurrence of skin injury and improve patients' safety.
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Affiliation(s)
- Yan Wang
- Yan Wang, BS; Miao Miao, BS; and Min-Shan Xu, BS, are Graduate Students, Shanghai JiaoTong University School of Medicine, School of Nursing, Shanghai, China. Guang-Ming Wan, MN, is Head Nurse, Shanghai Jiao Tong University Affiliated Chest Hospital, Shanghai, China. The authors have disclosed no financial relationships related to this article. Submitted December 17, 2022; accepted in revised form February 3, 2023
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Rouhani DS, Singh NK, Chao JJ, Almutairi A, Badowski-Platz R, Seradj MH, Mofid MM. Silk Bioprotein as a Novel Surgical-Site Wound Dressing: A Prospective, Randomized, Single-Blinded, Superiority Clinical Trial. Aesthet Surg J Open Forum 2023; 5:ojad071. [PMID: 37899912 PMCID: PMC10603584 DOI: 10.1093/asjof/ojad071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Background Medical adhesive-related skin injuries (MARSIs) affect about 1.5 million patients annually in the United States. Complications include allergic contact dermatitis, skin blistering, skin tears, and surgical-site infections (SSIs). The authors hypothesize that a natural hypoallergenic silk bioprotein wound dressing will decrease the incidence of MARSI in comparison to a synthetic alternative. Objectives This study aimed to assess the efficacy and safety of a silk bioprotein wound dressing compared to the Dermabond Prineo (Ethicon, Inc., Somerville, NJ) skin closure system. Methods This prospective, randomized, single-blinded trial studied 25 patients who were dressed with Dermabond Prineo on one side of their body and on the contralateral side with the silk bioprotein dressing after undergoing abdominoplasty or reduction mammaplasty procedures. Data were collected over 5 postoperative visits using photographs and an investigator administered questionnaire to track rash, itch, discomfort, erythema, edema, SSIs, need for pharmaceutical intervention, mechanical injury, removal time, and bathing routines. Results Sixty-four percent (16/25) of patients characterized the severity of discomfort as a score of 4 out of 10 or greater on the Dermabond Prineo control side and only 4% (1/25) for the silk-dressing side (P < .001). Fifty-two percent (13/25) had a visible rash of 4 or higher on the Dermabond Prineo side of their incision and 0% (0/25) had a rash on the silk side (P < .001). Fifty-two percent (13/25) required steroids or antibiotics to treat MARSI to Dermabond Prineo and 0% (0/25) required pharmaceutical intervention on the silk side (P < .001). Conclusions The use of a silk bioprotein wound dressing significantly reduces the incidence of MARSI throughout the postoperative period. Level of Evidence 2
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Affiliation(s)
| | | | | | | | | | | | - Mehrdad Mark Mofid
- Corresponding Author: Dr Mehrdad Mark Mofid, 4150 Regents Park Row STE 300, La Jolla, CA 92037, USA. E-mail:
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Swanson S, Luu V, Smith R, Gross A, Tudor J, MacKenzie D, Taroc AM, Gow KW, Nelson LY, Seibel EJ. A temperature-sensitive, high-adhesion medical tape: a comparative, single-blind clinical trial. J Wound Care 2023; 32:665-675. [PMID: 37830828 PMCID: PMC10798267 DOI: 10.12968/jowc.2023.32.10.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
OBJECTIVE Medical adhesives are used to secure wound care dressings and other critical devices to the skin. While high peel-strength adhesives provide more secure skin attachment, they are difficult to remove from the skin and are correlated with medical adhesive-related skin injuries (MARSI), including skin tears, and an increased risk of infection. Lower-adhesion medical tapes may be applied to avoid MARSI, leading to dressing or device dislodgement and further medical complications. METHOD This paper reports on the clinical testing of a new, high-adhesion medical tape, ThermoTape (University of Washington, US), designed for low skin trauma upon release. ThermoTape was benchmarked with Tegaderm (3M, US) and Kind Removal Tape (KRT) (3M, US). All three tapes were applied to both the left and right forearm of healthy volunteers and were removed 24 hours later-the right arm without applying heat and the left arm by applying a heat pack for 30 seconds before removal. Tape wear, self-reported pain (0-10 scale) and skin redness 15 minutes after removal were recorded. RESULTS This was a 53-subject comparative, single-blind clinical trial. There were clinically and statistically significant results supporting reduced pain during removal of ThermoTape with warming, with an average 58% decrease in pain, paired with a statistically significant 45% reduction in skin redness (p<0.01 for both values). In contrast, there were statistically insignificant differences in pain and redness for removal of Tegaderm and KRT with warming. ThermoTape after warming, in comparison with Tegaderm without warming, produced a reduced pain score of >1 on the 0-10 Wong-Baker/Face pain scale, which was statistically significant (p<0.01). CONCLUSION These results provide compelling evidence that warming ThermoTape prior to removal can reduce pain and injury when compared with standard medical tapes. This could allow for stronger attachment of wound care dressings and critical medical devices while reducing cases of MARSI.
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Affiliation(s)
- Shawn Swanson
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA, US
| | - Vivian Luu
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA, US
| | - Ryan Smith
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA, US
| | - Allayna Gross
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA, US
| | - Joelle Tudor
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA, US
| | - Devin MacKenzie
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA, US
- Washington Clean Energy Testbeds, University of Washington, Seattle, WA, US
- Department of Materials Science and Engineering, University of Washington, Seattle, WA, US
| | | | - Kenneth W Gow
- Seattle Children’s Hospital, Seattle, WA, US
- Department of Surgery, University of Washington, Seattle, WA, US
| | - Leonard Y Nelson
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA, US
| | - Eric J Seibel
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA, US
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Berg AK, Grauslund AC, Sørensen F, Thorsen SU, Thyssen JP, Zachariae C, Svensson J. A Skin Care Program to Prevent Skin Problems due to Diabetes Devices in Children and Adolescents: A Cluster-Controlled Intervention Study. Diabetes Care 2023; 46:1770-1777. [PMID: 37478335 DOI: 10.2337/dc23-0462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/04/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE Diabetes devices that deliver insulin and measure blood glucose levels are cornerstones in modern treatment of type 1 diabetes. However, their use is frequently associated with the development of skin problems, particularly eczema and wounds. Proper skin care may prevent skin problems, yet evidence-based information from interventional studies is missing. Providing this information is the aim of this study. RESEARCH DESIGN AND METHODS This cluster-controlled intervention study tested the efficacy of a basic skin care program (including use of lipid cream, removal, and avoidance of disinfection). A total of 170 children and adolescents with type 1 diabetes were included and assigned either to the intervention group (n = 112) or the control group (n = 58). Participants were seen quarterly the first year after device initiation, with clinical assessment and interview in an unblinded setting. RESULTS Eczema or wounds were observed in 33.6% of the intervention group compared with 46.6% of control participants (absolute difference, 12.9% [95% CI -28.7%, 2.9%]; P = 0.10). The adjusted odds of wound development were decreased by 71% in the intervention compared with control group (for wounds, odds ratio 0.29 [95% CI 0.12, 0.68]; P = 0.005). In total, only eight infections were seen, without a higher frequency in the intervention group, despite advice to omit disinfection. CONCLUSIONS These data indicate our basic skin care program partially prevented diabetes device-induced skin reactions. However, more preventive strategies with other adhesives, patches, and/or types of lotions are needed for optimized prevention.
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Affiliation(s)
- Anna Korsgaard Berg
- Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Pediatrics, Herlev and Gentofte Hospital, Herlev, Denmark
| | | | - Fiona Sørensen
- Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Pediatrics, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Steffen Ullitz Thorsen
- Department of Pediatrics, Herlev and Gentofte Hospital, Herlev, Denmark
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jacob P Thyssen
- Department of Dermatology and Venerology, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Claus Zachariae
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Gentofte, Denmark
| | - Jannet Svensson
- Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Pediatrics, Herlev and Gentofte Hospital, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Allen A, Zana-Taïeb E. Recommendations for use of adhesives on hospitalized newborns: A systematic review of the literature. Arch Pediatr 2023; 30:486-492. [PMID: 37604760 DOI: 10.1016/j.arcped.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/04/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The skin is the largest organ in the human body. It provides multiple barrier functions, tactile or defensive, and acts as a mediator allowing for the attachment of vital monitoring devices with medical adhesives. Adhesives consist of several layers with varying compositions and properties. We aimed to provide recommendations for their use in the care of hospitalized neonates on the basis of a systematic literature review. METHODS We searched PubMed for English or French articles published before May 29, 2020, using the keywords "adhesive," "tape,", "skin," and "neonat*." Recommendations were developed after review by a multidisciplinary group including 15 professionals and parent representatives. RESULTS We identified 295 studies, and from 30 eligible studies we developed six recommendations according to four perspectives: assessment of the skin condition to improve the methods of application of the different adhesives and their removal; use of adhesives as a platform; and discouraging the regular use of semi-permeable dressings to compensate for the immaturity of the skin barrier. CONCLUSION Skin lesions are common for hospitalized neonates. Use of adhesives may increase the occurrence of such lesions. Adhesives should be subject to good clinical practice guidelines. Health professionals caring for newborns should know the tools for screening and preventing skin lesions.
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Affiliation(s)
- Aurore Allen
- Department of Neonatal Medicine, Cochin-Port Royal Hospital, FHU PREMA, AP-HP, Paris, 75014, France; Group of Reflection and Evaluation of the Environment of Newborns (GREEN) study group from the French Neonatal Society
| | - Elodie Zana-Taïeb
- Department of Neonatal Medicine, Cochin-Port Royal Hospital, FHU PREMA, AP-HP, Paris, 75014, France; Group of Reflection and Evaluation of the Environment of Newborns (GREEN) study group from the French Neonatal Society
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Gefen A, Alves P, Beeckman D, Lázaro‐Martínez JL, Lev‐Tov H, Najafi B, Swanson T, Woo K. Mechanical and contact characteristics of foam materials within wound dressings: Theoretical and practical considerations in treatment. Int Wound J 2023; 20:1960-1978. [PMID: 36564958 PMCID: PMC10333050 DOI: 10.1111/iwj.14056] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
In the treatment of acute and chronic wounds, the clinical performance of a given foam-based dressing, and, ultimately, the wound healing and cost of care outcomes are strongly influenced by the mechanical performance of the foam material/s within that dressing. Most aspects of the mechanical performance of foam materials, for example, their stiffness, frictional properties, conformability, swelling characteristics and durability, and the overall mechanical protection provided by a foam-based dressing to a wound strongly depend on the microstructure of the foam components, particularly on their microtopography, density and porosity. This article, therefore, provides, for the first time, a comprehensive, self-inclusive compilation of clinically relevant theoretical and practical considerations, based on published analytical and experimental research as well as clinical experience related to the mechanical performance of foams in foam-based wound dressings. The current bioengineering information is useful for establishing understanding of the importance of mechanical properties of foams in foam-based dressings among clinicians and researchers in industry and academia, and other potential stakeholders in the wound care field, for example, regulators and buyers. This information is also particularly important for the development of standardised test methods for the evaluation of foam-based wound dressings and resulting standard mechanical performance metrics for these dressings.
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Affiliation(s)
- Amit Gefen
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv UniversityTel AvivIsrael
| | - Paulo Alves
- Wounds Research Lab ‐ Centre for Interdisciplinary Research in HealthCatholic University of PortugalPortoPortugal
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary CareGhent UniversityGhentBelgium
- Swedish Centre for Skin and Wound Research, Faculty of Medicine and Health, School of Health SciencesÖrebro UniversityÖrebroSweden
| | | | - Hadar Lev‐Tov
- Dr. Phillip Frost Department of Dermatology and Cutaneous SurgeryUniversity of Miami Hospital Miller School of MedicineMiamiFloridaUSA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Terry Swanson
- Wound Education Research Consultancy (WERC)WarrnamboolVictoriaAustralia
| | - Kevin Woo
- School of NursingQueen's UniversityKingstonOntarioCanada
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Hofman H, Beeckman D, Duljic T, Al Gilani S, Johansson S, Kottner J, Kinnaer LM, Eriksson M. Patients' experiences with the application of medical adhesives to the skin: a qualitative systematic review protocol. BMJ Open 2023; 13:e073546. [PMID: 37344112 PMCID: PMC10314666 DOI: 10.1136/bmjopen-2023-073546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023] Open
Abstract
INTRODUCTION Medical adhesives are adhesives used in medical devices to establish and maintain contact with the body over a period of time (usually by application to the skin) and are widely used in most care settings. Application of medical adhesives to the skin can lead to skin stripping, mild or severe allergic reactions and skin irritation that may manifest as redness, itching or rash. Adhesive-related skin injury can lead to infection, delayed wound healing and an increased risk of scarring. These injuries can cause severe discomfort and pain, and can affect the patient's quality of life. A systematic review summarising patient's experiences on this topic will contribute to informing adhesive producers and policy makers, and guiding further development and improvement of available technologies. METHODS AND ANALYSIS This systematic review protocol is based on the principles of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guideline. A systematic search will be conducted in CINAHL, EMBASE, MEDLINE and PsycINFO. In addition, manual searches will be performed, reviewing the reference lists of relevant reviews and articles included for quality assessment. Qualitative studies using various methods will be considered for inclusion. Screening of title, abstract and full text will be done by two reviewers. The methodological quality of studies under consideration will be critically assessed by two reviewers using the Joanna Briggs Institute Critical Appraisal Tool for Qualitative Research. Data extraction will be performed independently by two reviewers using a predefined data extraction form. Meta-aggregation will be used to summarise the evidence. ETHICS AND DISSEMINATION No ethical approval or consent is required because no participants will be recruited. This systematic review protocol is published in an open access journal to increase transparency of the research methods used. Results will be disseminated at national and international conferences.
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Affiliation(s)
- Hannelore Hofman
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Dimitri Beeckman
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Swedish Centre for Skin and Wound Research (SCENTR), Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Tanja Duljic
- Swedish Centre for Skin and Wound Research (SCENTR), Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
- Department of Care Science, Malmö University, Malmö, Sweden
| | - Samal Al Gilani
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | | | - Jan Kottner
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Institute of Clinical Nursing Science, Charité Center for Health and Human Sciences, Charité Universitätsmedizin, Berlin, Germany
| | - Lise-Marie Kinnaer
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Ousey K, Rippon MG, Rogers AA, Totty JP. Considerations for an ideal post-surgical wound dressing aligned with antimicrobial stewardship objectives: a scoping review. J Wound Care 2023; 32:334-347. [PMID: 37300859 DOI: 10.12968/jowc.2023.32.6.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Most surgical wounds heal by primary or secondary intention. Surgical wounds can present specific and unique challenges including wound dehiscence and surgical site infection (SSI), either of which can increase risk of morbidity and mortality. The use of antimicrobials to treat infection in these wounds is prevalent, but there is now an imperative to align treatment with reducing antimicrobial resistance and antimicrobial stewardship (AMS). The aim of this review was to explore the published evidence identifying general considerations/criteria for an ideal post-surgical wound dressing in terms of overcoming potential wound healing challenges (including infection) while supporting AMS objectives. METHOD A scoping review examining evidence published from 1954-2021, conducted by two authors acting independently. Results were synthesised narratively and have been reported in line with PRISMA Extension for Scoping Reviews. RESULTS A total of 819 articles were initially identified and subsequently filtered to 178 for inclusion in the assessment. The search highlighted six key outcomes of interest associated with post-surgical wound dressings: wound infection; wound healing; physical attributes related to comfort, conformability and flexibility; fluid handling (e.g., blood and exudate); pain; and skin damage. CONCLUSION There are several challenges that can be overcome when treating a post-surgical wound with a dressing, not least the prevention and treatment of SSIs. However, it is imperative that the use of antimicrobial wound dressings is aligned with AMS programmes and alternatives to active antimicrobials investigated.
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Affiliation(s)
- Karen Ousey
- Professor Skin Integrity, Director for the Institute of Skin Integrity, and Infection Prevention, University of Huddersfield, UK
- Department of Nursing and Midwifery, Adjunct Professor, School of Nursing, Faculty of Health at the Queensland University of Technology, Australia
- Visiting Professor, Royal College of Surgeons of Ireland, Ireland
- Chair, International Wound Infection Institute UK
- President Elect, International Skin Tear Advisory Panel, US
| | - Mark G Rippon
- Visiting Clinical Research Associate, Huddersfield University, Huddersfield, UK
- Consultant, Dane River Consultancy Ltd, Cheshire, UK
| | - Alan A Rogers
- Independent Wound Care Consultant, Flintshire, North Wales, UK
| | - Joshua P Totty
- NIHR Clinical Lecturer in Plastic Surgery, Hull York Medical School, UK
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Protz K. [Medical adhesive-related skin injuries (MARSI)]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:525-528. [PMID: 37017693 DOI: 10.1007/s00120-023-02075-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 04/06/2023]
Affiliation(s)
- Kerstin Protz
- Institut für Versorgungsforschung in der Dermatologie und bei Pfegeberufen (IVDP), Uniklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
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Li J, Hao N, Han J, Zhang M, Li X. Incidence and Predictive Model of Medical Adhesive-Related Skin Injury in Cancer Patients Managed With Central Venous Access Devices: A Retrospective Study. J Wound Ostomy Continence Nurs 2023; 50:209-213. [PMID: 37146111 DOI: 10.1097/won.0000000000000971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE The purpose of this study was to determine the prevalence of medical adhesive-related skin injury (MARSI) at the site of central venous access device (CVAD) implantation in patients with cancer, identify risk factors associated with MARSI in patients with cancer, and create a nomogram for predicting risk of MARSI. DESIGN Retrospective, single-center study. SUBJECTS AND SETTING The sample comprised 1172 consecutive patients who underwent CVAD implantation between February 2018 and February 2019; their mean age was 55.7 years (SD: 13.9). Data were collected at the First Affiliated Hospital of Xi'an Jiaotong University, located in Xi'an, China. METHODS Demographic and pertinent clinical data were collected from patient records. Routine dressing changes were performed every 7 days for peripherally inserted central venous catheters (PICCs) or 28 days for ports except in patients with existing skin injuries. Skin injuries related to use of medical adhesives and persisting for more than for 30 minutes were classified MARSI. Data were used to develop a nomogram for predicting MARSI. The accuracy of the nomogram was verified by calculating the concordance index (C-index) and drawing a calibration curve. RESULTS Among the 1172 patients, 330 (28.2%) had undergone PICC implantation, and 282 (24.1%) experienced 1 or more MARSIs representing an incidence rate of 1.7 events per 1000 CVAD days. Statistical analysis identified previous MARSI history, the need for total parenteral nutrition support, other catheter-related complications, a history of allergy, and PICC implantation as associated with a higher likelihood of developing for MARSI. Based on these factors, we established a nomogram for predicting the risk of developing MARSI in patients with cancer who underwent CVAD implantation. The C-index of the nomogram was 0.96, and the calibration curve of the nomogram showed that the predictive ability of the nomogram was strong. CONCLUSIONS We evaluated patients with cancer who were undergoing CVAD and identified that previous MARSI history, patients needing total parenteral nutrition support, other catheter-related complications, allergic history, and PICC implantation (compared with ports) were associated with a higher likelihood for developing MARSI. The nomogram we developed showed a good ability for predicting the risk of developing MARSI and may assist nurses to predict MARSI in this population.
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Affiliation(s)
- Jieqiong Li
- Jieqiong Li, MPH, Department of Nursing, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Nan Hao, MPH, Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Juan Han, BM, Department of Intensive Care Unit, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Mi Zhang, MSN, Department of Nursing, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
- Xiaomei Li, DNP, School of Nursing, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Nan Hao
- Jieqiong Li, MPH, Department of Nursing, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Nan Hao, MPH, Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Juan Han, BM, Department of Intensive Care Unit, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Mi Zhang, MSN, Department of Nursing, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
- Xiaomei Li, DNP, School of Nursing, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Juan Han
- Jieqiong Li, MPH, Department of Nursing, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Nan Hao, MPH, Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Juan Han, BM, Department of Intensive Care Unit, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Mi Zhang, MSN, Department of Nursing, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
- Xiaomei Li, DNP, School of Nursing, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Mi Zhang
- Jieqiong Li, MPH, Department of Nursing, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Nan Hao, MPH, Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Juan Han, BM, Department of Intensive Care Unit, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Mi Zhang, MSN, Department of Nursing, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
- Xiaomei Li, DNP, School of Nursing, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaomei Li
- Jieqiong Li, MPH, Department of Nursing, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Nan Hao, MPH, Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Juan Han, BM, Department of Intensive Care Unit, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Mi Zhang, MSN, Department of Nursing, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
- Xiaomei Li, DNP, School of Nursing, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Scientific and Clinical Abstracts From WOCNext® 2023: Las Vegas, Nevada ♦ June 4-7, 2023. J Wound Ostomy Continence Nurs 2023; 50:S1-S78. [PMID: 37632270 DOI: 10.1097/won.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Salhi N, El Guourrami O, Rouas L, Moussaid S, Moutawalli A, Benkhouili FZ, Ameggouz M, Alshahrani MM, Al Awadh AA, Bouyahya A, Faouzi MEA, Cherrah Y. Evaluation of the Wound Healing Potential of Cynara humilis Extracts in the Treatment of Skin Burns. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2023; 2023:5855948. [PMID: 37114146 PMCID: PMC10129424 DOI: 10.1155/2023/5855948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/03/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023]
Abstract
Cynara humilis is traditionally used to treat skin burns and microbial infections. However, experimental studies on this plant are rare. Furthermore, the aim of this study was to investigate the effects of Cynara humilis, a Moroccan herbal remedy, on the healing of deep second-degree burns in rats with a silver sulfadiazine group. This research was also carried out to confirm if C. humilis had antibacterial capabilities. Under typical burn procedures, each rat received a deep second-degree burn on the upper back. The burns were treated regularly with control groups (control and control VH), silver sulfadiazine (SDD) in group 3, C. humilis ethanolic extract (CHEE) in group 4, and C. humilis aqueous extract (CHAE) in group 5. Throughout the treatment, digital photography was used to measure rat responses to the treatment until day 18. After the scar biopsy at the end of the study, histological parameters (inflammatory cells, collagen, epithelialization, fibrosis, and granulation tissue) were assessed. Using the well technique, the antibacterial activity of the extracts was tested against Staphylococcus aureus CIP 483, Bacillus subtilis CIP 5262, Escherichia coli CIP 53126, Pseudomonas aeruginosa CIP 82118, and Salmonella enterica CIP 8039, and the results showed important activities of the ethanolic and aqueous extracts against the five species tested with MICs of 2 and 4 mg/mL, respectively. In the aqueous extract group, the wound healed faster. In addition, the healing rate in the C. humilis extracts (CHEA and CHEE) group was faster than in the silver sulfadiazine and control groups. In the C. humilis group, maximum wound surface recovery was observed at the same time, as it was not noted in the silver sulfadiazine group. Pathologically, epithelialization was more marked in wounds treated with C. humilis extracts (CHE). Angiogenesis and inflammatory cells were considerably lower in the CHE group than in the silver and other control groups. However, elastic fibers were considerable in the CHE-treated group. In histological examination, the C. humilis group had a low incidence of angiogenesis and inflammation, indicating that this group had less wound scarring. Collagen and burn wound healing were both faster in the C. humilis group. The findings of this study suggest that C. humilis, as indicated by traditional medicine, is a promising natural source for the management of wound healing.
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Affiliation(s)
- Najoua Salhi
- Pharmacoepidemiology and Pharmacoeconomics Research Team, Laboratory of Pharmacology and Toxicology, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Otman El Guourrami
- Laboratory of Analytical Chemistry and Bromatology, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Lamiae Rouas
- Laboratory of Anatomy Cytology, Faculty of Medicine and Pharmacy, Children's Hospital, Mohammed V University in Rabat, Rabat, Morocco
| | - Siham Moussaid
- Laboratory of Plant, Animal and Agro Industry Productions, Faculty of Science, Ibn Tofail University, B.P 133, Kenitra 1400, Morocco
| | - Amina Moutawalli
- Department of Drug Sciences, Laboratory of Medicinal Chemistry, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Fatima Zahra Benkhouili
- Department of Drug Sciences, Laboratory of Medicinal Chemistry, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Mouna Ameggouz
- Laboratory of Analytical Chemistry and Bromatology, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Mohammed Merae Alshahrani
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia
| | - Ahmed Abdullah Al Awadh
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia
| | - Abdelhakim Bouyahya
- Laboratory of Human Pathologies Biology, Faculty of Sciences, Department of Biology, Mohammed V University in Rabat, Rabat, Morocco
| | - My El Abbes Faouzi
- Biopharmaceutical and Toxicological Analysis Research Team, Laboratory of Pharmacology and Toxicology, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Yahya Cherrah
- Pharmacoepidemiology and Pharmacoeconomics Research Team, Laboratory of Pharmacology and Toxicology, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
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Abstract
Significance: Healthy skin provides a barrier to contaminants. Breaches in skin integrity are often encountered in the patient health care journey, owing to intrinsic health issues or to various procedures and medical devices used. The time has come to move clinical practice beyond mere awareness of medical adhesive-related skin injury and toward improved care and outcomes. Recent Advances: Methods developed in research settings allow quantitative assessments of skin damage based on the measurement of baseline skin properties. These properties become altered by stress and over time. Assessment methods typically used by the cosmetic industry to compare product performance could offer new possibilities to improve clinical practice by providing better information on the status of patient skin. This review summarizes available skin assessment methods as well as specific patient risks for skin damage. Critical Issues: Patients in health care settings may be at risk for skin damage owing to predisposing medical conditions, health status, medications taken, and procedures or devices used in their treatment. Skin injuries come as an additional burden to these medical circumstances and could be prevented. Technology should be leveraged to improve care, help maintain patient skin health, and better characterize functional wound closure. Future Directions: Skin testing methods developed to evaluate cosmetic products or assess damage caused by occupational exposure can provide detailed, quantitative information on the integrity of skin. Such methods have the potential to guide prevention and treatment efforts to improve the care of patients suffering from skin integrity issues while in the health care system.
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Affiliation(s)
- Stéphanie F. Bernatchez
- 3M Health Care, St. Paul, Minnesota, USA.,Correspondence: 3M Health Care, St. Paul, MN 55144-1000, USA
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Wagih A, Mahmoud HA, Tao R, Lubineau G. Towards Tough Thermoplastic Adhesive Tape by Microstructuring the Tape Using Tailored Defects. Polymers (Basel) 2023; 15:polym15020259. [PMID: 36679140 PMCID: PMC9865412 DOI: 10.3390/polym15020259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
Abstract
This paper presents a strategy towards achieving thermoplastic adhesive tapes with high toughness by microstructuring conventional tapes using tailored defects. Toughened tape was manufactured using two layers of a conventional tape where the bondline between the two adhesive layers was microstructured by embedding tailored defects with specific size and gap between them using PTFE film. Mode I toughness of the toughened tape was characterized experimentally. A high-fidelity finite element model was implemented to describe the toughening mechanisms using double cantilever beam simulations and end notch flexural tests. The model considers for the plasticity of the adhesive layer, the decohesion at the adherend-adhesive and adhesive-adhesive interfaces and progressive damage inside the adhesive layer. The adhesive-adhesive interface with the tailored defects inside the adhesive layer enables crack migration between adherend-adhesive interfaces, crack propagation at adhesive-adhesive interface, backward crack propagation under the defect, and plastic deformation of the adhesive ligament. The maximum toughness improvement of the tape with tailored defects of equal width and gap between two successive defects of 2 mm reached 278% and 147% for mode I and II, respectively, compared to conventional tape.
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Affiliation(s)
- Ahmed Wagih
- Mechanical Engineering Program, Physical Science and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
- Mechanics of Composites for Energy and Mobility Lab, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
- Correspondence: (A.W.); (G.L.); Tel.: +966-(12)-808-2983 (A.W.)
| | - Hassan A. Mahmoud
- Mechanical Engineering Program, Physical Science and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
- Mechanics of Composites for Energy and Mobility Lab, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
| | - Ran Tao
- Mechanical Engineering Program, Physical Science and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
- Mechanics of Composites for Energy and Mobility Lab, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
| | - Gilles Lubineau
- Mechanical Engineering Program, Physical Science and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
- Mechanics of Composites for Energy and Mobility Lab, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
- Correspondence: (A.W.); (G.L.); Tel.: +966-(12)-808-2983 (A.W.)
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Grove G, Houser T, Dove J, Moody D. An objective comparison of two pulse oximetry sensors with different adhesive systems on healthy human volunteers based on biophysical assessments. Skin Res Technol 2023; 29:e13212. [PMID: 36329598 PMCID: PMC9838778 DOI: 10.1111/srt.13212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Medical Adhesive Related Skin Injuries can arise from topically applied medical devices, especially in those with fragile skin, including the elderly and premature infants. The purpose of this study was to compare gentleness and reapplication of two pulse oximetry sensors (OxySoftN and MaxN, Medtronic, Boulder, CO). MATERIALS AND METHODS Eighteen healthy subjects aged 65 years and older were enrolled in the gentleness trial, and 20 healthy subjects (18-69 years) were enrolled in the reapplication trial. For the gentleness trial, trans-epidermal water loss (TEWL) measurements were made at five sites on each forearm at three time points (baseline [T0], 4-h postinitial wear [T1], 4-h postsecond wear [T2]). Total amount of protein adhered to each device was also determined. For the reapplication trial, a series of 180° peel tests were performed to observe the forces required to detach the sensor from the skin. RESULTS TEWL rates in the tail region were significantly greater with MaxN compared to OxySoftN at T1 (p < 0.05). Both were significantly greater than control (p < 0.05). Further, protein analysis revealed that the amount of protein removed was significantly less with OxySoftN compared to MaxN (p < < 0.0001). Differences in loss of adhesion of the tail region between the two sensors were demonstrated, with OxySoftN depreciating at a much slower rate compared with MaxN. CONCLUSION The OxySoftN sensor appears to be gentle, even on fragile skin, based on reduced strain on the skin during removal. Further, it demonstrated the ability to withstand several reapplications without functional loss in adhesion.
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Affiliation(s)
- Gary Grove
- cyberDERM, Inc., Broomall, Pennsylvania, USA
| | | | - Jacob Dove
- Research and Development, Patient Monitoring, Medtronic, Boulder, Colorado, USA
| | - Derek Moody
- Research and Development, Patient Monitoring, Medtronic, Boulder, Colorado, USA
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Corley A, Ullman AJ, Marsh N, Genzel J, Larsen EN, Young E, Booker C, Harris PNA, Rickard CM. A pilot randomized controlled trial of securement bundles to reduce peripheral intravenous catheter failure. Heart Lung 2023; 57:45-53. [PMID: 36041346 DOI: 10.1016/j.hrtlng.2022.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are ubiquitous in acute care settings however failure rates are unacceptably high, with around half failing before prescribed treatment is complete. The most effective dressing and securement option to prolong PIVC longevity is unclear. OBJECTIVES To determine feasibility of conducting a definitive randomized controlled trial (RCT) investigating evidence-based securement bundles (medical adhesive tapes and supplementary securement products) to reduce PIVC failure. METHODS In this pilot non-masked 3-group RCT, adults requiring a PIVC for >24 hrs were randomized to Standard care (bordered polyurethane dressing plus non-sterile tape over extension tubing), Securement Bundle 1 (two sterile tape strips over PIVC hub plus Standard care) or Securement Bundle 2 (Bundle 1 plus tubular bandage) with allocation concealed until study entry. EXCLUSIONS laboratory-confirmed positive blood culture, current/high-risk of skin tear, or study product allergy. PRIMARY OUTCOME feasibility (eligibility, recruitment, retention, protocol fidelity, participant/staff satisfaction). SECONDARY OUTCOMES PIVC failure, PIVC dwell time, adverse skin events, PIVC colonization and cost. RESULTS Of 109 randomized participants, 104 were included in final analyses. Feasibility outcomes were met, except eligibility criterion (79%). Absolute PIVC failure was 38.2% (13/34) for Bundle 2, 25% (9/36) for Bundle 1 and 23.5% (8/34) for Standard care. Incidence rate ratio for PIVC failure/1000 catheter days, compared to Standard care, was 1.1 (95% confidence interval [CI] 0.4-2.7) and 2.1 (95% CI 0.9-5.1) for Bundles 1 and 2, respectively. CONCLUSIONS A large RCT testing securement bundles is feasible, with adjustment to screening processes. Innovative dressing and securement solutions are needed to reduce unacceptable PIVC failure rates. Trial registration ACTRN12619000026123.
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Affiliation(s)
- Amanda Corley
- School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, 4067, Australia; Menzies Health Institute Queensland, Griffith University, Nathan, 4111, Australia.
| | - Amanda J Ullman
- School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, 4067, Australia; Queensland Children's Hospital, Children's Health Queensland, South Brisbane, 4101, Australia.
| | - Nicole Marsh
- School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, 4067, Australia.
| | - Jodie Genzel
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia.
| | - Emily N Larsen
- School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, 4067, Australia.
| | - Emily Young
- Centre for Applied Economics, School of Medicine, Griffith University, Nathan, 4111, Australia.
| | - Catriona Booker
- Workforce Development & Education Unit, Royal Brisbane and Women's Hospital, Herston, 4006, Australia.
| | - Patrick N A Harris
- Pathology Queensland, Health Support Queensland, Herston, 4006, Australia; Centre for Clinical Research, University of Queensland, Herston, 4006, Australia.
| | - Claire M Rickard
- School of Nursing and Midwifery, Griffith University, Nathan, 4111, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, 4006, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, 4067, Australia; Queensland Children's Hospital, Children's Health Queensland, South Brisbane, 4101, Australia; Centre for Clinical Research, University of Queensland, Herston, 4006, Australia.
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Brescia F, Pittiruti M, Roveredo L, Zanier C, Morabito A, Santarossa E, Da Ros V, Montico M, Fabiani F. Subcutaneously anchored securement for peripherally inserted central catheters: Immediate, early, and late complications. J Vasc Access 2023; 24:82-86. [PMID: 34137321 DOI: 10.1177/11297298211025430] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND An adequate stabilization of a vascular device is an important part of insertion bundles and is an effective strategy in reducing complications. Dislodgment has a relevant clinical impact and an increase in healthcare costs. METHOD We have retrospectively investigated the safety and efficacy of Subcutaneously Anchored Securement (SAS) for Peripherally Inserted Central Catheters (PICC) in cancer patients. RESULTS We analyzed 639 patients who had a PICC inserted and secured with SAS, over the past 3 years (2018-2020). No immediate complications during SAS placement were reported. In the first 24-48 h, a slight local ecchymosis was reported in 24 cases with rapid spontaneous resolution. No cases of bleeding or hematoma of the exit site were reported. The total number of catheter days was 93078. Dislodgment occurred only in seven cases (1.1%). In 16 patients, the PICC was removed because of catheter-related bloodstream infection (CRBSI): the overall incidence of CRBSI was 0.17 per 1000 catheter days. Symptomatic venous thrombosis was documented in 12 patients (1.9%) and treated with low molecular weight heparin without PICC removal. We had no cases of irreversible lumen occlusion. In 17 patients, local discomfort-including device-related pressure ulcers and painful inflammation-was reported: these cases were treated without SAS removal or PICC removal. CONCLUSION In this retrospective analysis, subcutaneously anchored securement of PICCs was a safe and effective strategy for reducing the risk of dislodgment.
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Affiliation(s)
- Fabrizio Brescia
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | - Laura Roveredo
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Chiara Zanier
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Antonietta Morabito
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Elisabetta Santarossa
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Valentina Da Ros
- Clinical Oncology Department, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Marcella Montico
- Clinical Trial Office, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Fabio Fabiani
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
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de Faria MF, Ferreira MBG, dos Santos Felix MM, Bessa RMV, Barbosa MH. Prevention of medical adhesive-related skin injury during patient care: A scoping review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100078. [PMID: 38745606 PMCID: PMC11080338 DOI: 10.1016/j.ijnsa.2022.100078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background : Medical adhesive-related skin injury can occur during health care. Professionals must adopt preventive measures to maintain the integrity of the skin and patient comfort and safety. Objective : To map the existing scientific evidence on preventing medical adhesive-related skin injury in adults. Design : Scoping Review. Methods : Searches were conducted in PubMed/Medline, Cochrane Library, Embase®, Latin American and Caribbean Literature in Health Sciences, Cumulative Index for Nursing and Allied Health Literature, and Google Scholar, without period delimitation. Duplicate studies and those that didn´t answer the research question were excluded. Results : Of the 209 studies identified in the search process, 30 made up the final sample. The prevention of injury by adhesives mainly involves identifying risk factors, proper adhesive selection, and correct application and removal. Health education and medical records about injuries related to medical adhesives are essential. Conclusions : The prevention of medical adhesive-related skin injury should be done by adopting multifactorial measures, which range from identifying risk factors and correct handling of adhesives to the process of educating professionals, patients and communities about these injuries. Registration : The research was registered on the Open Science Framework DOI 10.17605/OSF.IO/NSWP8.
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Affiliation(s)
- Maíla Fidalgo de Faria
- Stricto Sensu Graduate Program in Health Care, Federal University of Triângulo Mineiro, Uberaba/MG, Brazil
| | | | | | | | - Maria Helena Barbosa
- Stricto Sensu Graduate Program in Health Care, Federal University of Triângulo Mineiro, Uberaba/MG, Brazil
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Fröhlich-Reiterer E, Elbarbary NS, Simmons K, Buckingham B, Humayun KN, Johannsen J, Holl RW, Betz S, Mahmud FH. ISPAD Clinical Practice Consensus Guidelines 2022: Other complications and associated conditions in children and adolescents with type 1 diabetes. Pediatr Diabetes 2022; 23:1451-1467. [PMID: 36537532 DOI: 10.1111/pedi.13445] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Elke Fröhlich-Reiterer
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | | | - Kimber Simmons
- Barbara Davis Center for Diabetes, University of Colorado, Denver, Colorado, USA
| | - Bruce Buckingham
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University Medical Center, Stanford, California, USA
| | - Khadija N Humayun
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jesper Johannsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Herlev and Steno Diabetes Center Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Shana Betz
- Parent/Advocate for people with diabetes, Markham, Canada
| | - Farid H Mahmud
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Effectiveness of Non-Pharmacological Methods, Such as Breastfeeding, to Mitigate Pain in NICU Infants. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101568. [PMID: 36291504 PMCID: PMC9600280 DOI: 10.3390/children9101568] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/09/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022]
Abstract
Neonates do experience pain and its management is necessary in order to prevent long-term, as well as, short-term effects. The most common source of pain in the neonatal intensive care unit (NICU) is caused by medically invasive procedures. NICU patients have to endure trauma, medical adhesive related skin injuries, heel lance, venipuncture and intramuscular injection as well as nasogastric catheterization besides surgery. A cornerstone in pain assessment is the use of scales such as COMFORT, PIPP-R, NIPS and N-PASS. This narrative review provides an up to date account of neonate pain management used in NICUs worldwide focusing on non-pharmacological methods. Non-steroidal anti-inflammatory drugs have well established adverse side effects and opioids are addictive thus pharmacological methods should be avoided if possible at least for mild pain management. Non-pharmacological interventions, particularly breastfeeding and non-nutritive sucking as primary strategies for pain management in neonates are useful strategies to consider. The best non-pharmacological methods are breastfeeding followed by non-nutritive sucking coupled with sucrose sucking. Regrettably most parents used only physical methods and should be trained and involved for best results. Further research in NICU is essential as the developmental knowledge changes and neonate physiology is further uncovered together with its connection to pain.
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47
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Rabelo AL, Bordonal J, de Almeida TL, Oliveira PP, Moraes JT. Medical adhesive-related skin injury in adult intensive care unit: scoping review. Rev Bras Enferm 2022; 75:e20210926. [PMID: 36102472 PMCID: PMC9728873 DOI: 10.1590/0034-7167-2021-0926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/22/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES to identify and synthesize scientific evidence on preventing medical adhesive-related skin injuries in adult intensive care patients. METHODS this is a scoping review based on PRISMA-ScR recommendations and the technique proposed by Joanna Briggs Institute. PubMed, CINAHL, Web of Science, Scopus, LILACS, and Embase databases were searched using "Injuries AND Adhesives AND Skin AND Medical" descriptors". RESULTS 1,329 studies were identified, and after analysis, the final sample consisted of nine articles. We obtained two experts' consensus, three case studies, two cross-sectional studies, one prospective cohort study, and one literature review regarding the type of studies. FINAL CONSIDERATIONS the synthesized evidence allowed us to list health care measures to prevent medical adhesive-related skin injuries. The professional must know how to identify the skin injuries associated with medical adhesives and the main strategies for their prevention.
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Affiliation(s)
| | - Jéssica Bordonal
- Universidade Federal de São João Del Rei. Divinópolis, Minas Gerais, Brazil
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48
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Negative Pressure Wound Therapy With Instillation-Dwell in Orthopaedic Trauma: How to Avoid Leaks and Frustration. J Orthop Trauma 2022; 36:S17-S21. [PMID: 35994304 DOI: 10.1097/bot.0000000000002432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 02/02/2023]
Abstract
Negative pressure wound therapy with instillation-dwell (NPWTi-d) is the natural evolution of NPWT. This therapy combines the benefits of instillation with negative pressure. Advancements in the drape and the foam dressing has further advanced the utility of this therapy for use in orthopaedic trauma wounds. The technique for drape application plays an important role in maximizing the benefits of NPWTi-d. This article provides tips and guidance to ensure a proper dressing seal and other helpful instructions to maximize the benefits of NPWTi-d.
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Rippon MG, Rogers AA, Ousey K, Atkin L, Williams K. The importance of periwound skin in wound healing: an overview of the evidence. J Wound Care 2022; 31:648-659. [PMID: 36001708 DOI: 10.12968/jowc.2022.31.8.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
DECLARATION OF INTEREST The authors have no conflicts of interest.
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Affiliation(s)
| | | | - Karen Ousey
- Institute of Skin Integrity and Infection Prevention, Department of Nursing and Midwifery, University of Huddersfield.,Adjunct Professor, School of Nursing, Faculty of Health at the Queensland University of Technology, Australia.,Visiting Professor, RCSI, Dublin, Ireland
| | | | - Kate Williams
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
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Abstract
OBJECTIVE To establish a consensus on terminology used to define stomal, parastomal, and peristomal complications in Australia. METHODS A list of stomal, parastomal, and peristomal complications was generated through group dialogue, which was informed by clinical and academic knowledge of the researchers. An extensive literature review was undertaken to identify any additional terms and to create a database of definitions/descriptions. A library of images related to the identified conditions was generated. An online Delphi process was conducted among a representative, purposive sample of Australia expert wound, ostomy, and continence nurses and colorectal surgeons. Ten terms were presented to the panel with descriptive photographs of each complication. Up to three Delphi rounds and, if necessary, a priority voting round were conducted. RESULTS Seven of the 10 terms reached agreement in the first round. One term ( allergic dermatitis ) was refined ( allergic contact dermatitis ) and reached agreement in the second round. Two terms ( mucocutaneous granuloma and mucosal granuloma ) were considered by the panel to be the same condition in different anatomical locations and were combined as one term ( granuloma ). Two terms ( skin stripping and tension blisters ) were combined as one term ( medical adhesive-related skin injury ) and reached agreement in round 2. CONCLUSIONS A consensus in terminology used to describe stomal or parastomal/peristomal complications will enhance communication among patients and health professionals and advance opportunities for education and benchmarking of stomal, parastomal, and peristomal complications nationally.
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