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Gavin NC, Northfield S, Mihala G, Somerville M, Kleidon T, Marsh N, Larsen E, Campbell J, Rickard CM, Ullman AJ. Central Venous Access Device-Associated Skin Complications in Adults with Cancer: A Prospective Observational Study. Semin Oncol Nurs 2024; 40:151618. [PMID: 38622044 DOI: 10.1016/j.soncn.2024.151618] [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: 10/08/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES To identify the prevalence and type of central venous access device-associated skin complications for adult cancer patients, describe central venous access device management practices, and identify clinical and demographic characteristics associated with risk of central venous access device-associated skin complications. METHODS A prospective cohort study of 369 patients (626 central venous access devices; 7,682 catheter days) was undertaken between March 2017 and March 2018 across two cancer care in-patient units in a large teaching hospital. RESULTS Twenty-seven percent (n = 168) of participants had a central venous access device-associated skin complication. In the final multivariable analysis, significant (P < .05) risk factors for skin complications were cutaneous graft versus host disease (2.1 times greater risk) and female sex (1.4 times greater risk), whereas totally implanted vascular access device reduced risk for skin complications by two-thirds (incidence risk ratio 0.37). CONCLUSION Central venous access device-associated skin complications are a significant, potentially avoidable injury, requiring cancer nurses to be aware of high-risk groups and use evidence-based preventative and treatment strategies. IMPLICATIONS FOR PRACTICE This study has confirmed how common these potentially preventable injuries are. Therefore, the prevalence of these complications could be reduced by focusing on improvements in skin assessment, reductions in central venous access device dressing variation and improving clinician knowledge of this injury.
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Affiliation(s)
- Nicole C Gavin
- Nurse Researcher, Cancer Care Services, Royal Brisbane and Women's Hospital, Herston; Researcher, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Adjunct Associate Professor, School of Nursing, Queensland, Australia University of Technology, Kelvin Grove; Senior Research Fellow, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Senior Research Fellow, School of Medicine, University of Queensland, Herston; School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.
| | - Sarah Northfield
- Clinical Nurse Consultant, Specialist Palliative Care Service, Toowoomba Hospital, Queensland, Australia
| | - Gabor Mihala
- Biostatistician, School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Margarette Somerville
- Clinical Nurse Research, Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Tricia Kleidon
- Paediatrics and Neonatal Researcher, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Research Fellow, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Research Fellow, School of Nursing and Midwifery, Griffith University, Nathan; Nurse Practitioner, Vascular Access Management Service, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Nicole Marsh
- Acute/Critical Care Professor, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Professor, School of Nursing, Queensland, Australia University of Technology, Kelvin Grove; Professor, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Professor, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Emily Larsen
- Researcher, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; School of Nursing and Midwifery, Griffith University, Nathan; Research Fellow, Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jill Campbell
- Adjunct Senior Research Fellow, National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Claire M Rickard
- Infection Prevention Professor, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Professor, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Professor, School of Nursing and Midwifery, Griffith University, Nathan; Professor, Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston; Professor, National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast Campus; and Herston Infectious Diseases Institute, Metro North Health, Herston, Queensland, Australia
| | - Amanda J Ullman
- Professor, Alliance for Vascular Access Teaching and Research Group, School of Nursing and Midwifery, Nathan, and School of Pharmacy and Medical Services, Southport; Professor, School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia; Professor, Vascular Access Management Service, Queensland Children's Hospital, South Brisbane; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston; Professor, National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia
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Vo NH, Richman P, Torres R, Xu KT, Miller M. The incidence of dermatitis following application of foam tape in healthy volunteers-A prospective trial. Am J Emerg Med 2024; 79:212-213. [PMID: 38462426 DOI: 10.1016/j.ajem.2024.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Foam tape is commonly used in the emergency department as a dressing over chest tubes owing to its occlusive and compressible properties. There is a paucity of data regarding the incidence of significant cutaneous reactions to this material. We conducted a prospective trial to evaluate the incidence of dermatitis following application of foam tape to the upper arm of a cohort of healthy volunteers. METHODS This was a prospective, interventional trial. We enrolled a cohort of consenting, healthy physicians, nurses, and ancillary staff at a teaching facility who did not have known hypersensitivity to foam tape. Study investigators applied a 2 × 2 inch piece of 3 M microfoam adhesive to the medial aspect of each subject's upper arm. The contralateral arm served as a reference for comparison. The adhesive remained in place for 48 h and the study authors assessed patients utilizing the previously validated Cutaneous Irritancy Scoring System (CISS). Categorical variables analyzed by chi-square, continuous variables with t-tests. RESULTS There were 40 subjects in the study group; 52% female, mean age 40±7 years, 55% non-White race. 10/40 (25%; 95%CI[14%, 41%]) of subjects had erythema; 9/40 (22%) had an erythema score of 1 and 1/40 (2.5%) had a score of 2. With respect to edema, 2/40 (5%; 95% CI[1%,18%]); 1/40(2.5%) had an edema score of 1, and 1/40(2.5%) had a score of 2. There were 9/40 subjects with an irritancy score > 0; (22%; 95%CI[12%,38%]); 7/40(18%) had an irritancy score of 1, and 2/4(5.0%) had a score of 2. In terms of the severity score, 10/40 (25%; 95%CI[14%, 41%]) had a score > 0; 9/40(22%) had a score of 1, and 1/40(2.5%) had a score of 2. Overall, 10/40 (25%; 95%CI[14%, 41%]) of subjects had at least one positive measure of a reaction of any kind. Subjects' age, gender and race were not found to be statistically significantly associated with the incidence of erythema, edema, or irritancy. In addition, these characteristics were not statistically significantly associated with severity score > 0. The p values for all the above bivariate analyses were > 0.05. CONCLUSIONS Cutaneous reactions occurred in 25% of healthy volunteers after the application of foam tape to the arm. Patient characteristics were not associated with risk of a skin reaction. CLINICAL TRIALS REGISTRATION #NCT06059417.
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Affiliation(s)
- Nam H Vo
- Department of Emergency Medicine, CHRISTUS Health/Texas A&M Health Science Center, Corpus Christi, TX, United States of America
| | - Peter Richman
- Department of Emergency Medicine, CHRISTUS Health/Texas A&M Health Science Center, Corpus Christi, TX, United States of America.
| | - Roman Torres
- Department of Emergency Medicine, CHRISTUS Health/Texas A&M Health Science Center, Corpus Christi, TX, United States of America
| | - K Tom Xu
- Department of Emergency Medicine, CHRISTUS Health/Texas A&M Health Science Center, Corpus Christi, TX, United States of America
| | - Michael Miller
- Department of Emergency Medicine, CHRISTUS Health/Texas A&M Health Science Center, Corpus Christi, TX, United States of America
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Nazarko L. Stoma care: an update. Br J Community Nurs 2024; 29:184-188. [PMID: 38564443 DOI: 10.12968/bjcn.2024.29.4.184] [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: 04/04/2024]
Abstract
Each year an estimated 13 500 stoma surgeries are carried out in the UK (Kettle, 2019). Stoma surgery may involve the formation of a colostomy or an ileostomy. The person with a stoma may require help and support from the community nurse. This article aims to update readers on the indications for colostomy and ileostomy surgery and to enable them to support ostomates to reduce the risks of complications.
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Schachl J, Stoiber M, Socha M, Zimpfer D, Wiedemann D, Schima H, Schlöglhofer T. Mechanical Characterization of Anchoring Devices for the Prevention of Driveline Infection in Left Ventricular Assist Device Patients. ASAIO J 2024; 70:249-256. [PMID: 38081043 DOI: 10.1097/mat.0000000000002111] [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: 04/04/2024] Open
Abstract
Driveline infection (DLI) is associated with increased mortality and morbidity in left ventricular assist device (LVAD) patients. Because trauma to the driveline exit-site (DLES) is a risk factor for DLI, adhesive anchoring devices are used to immobilize the DL. In this study, commonly used products (identified through literature review and contact with nine international VAD implantation centers) were mechanically characterized to evaluate their effectiveness in preventing DLES trauma. Eight devices were tested in an in vitro abdominal model of the DLES, where a tensile force (10 N) was applied to a HeartMate 3 DL, whereas the resulting force ( FTotal ) on the DLES was recorded using a three-axis load cell. Four devices (CathGrip: FTotal = 2.1 ± 0.4 N, Secutape: FTotal = 2.6 ± 0.3 N, Hollister: FTotal = 2.7 ± 0.5 N, Tubimed: FTotal = 2.9 ± 0.2 N) were significantly ( p < 0.05) better at preventing tensile forces at the DLES compared to the other four devices (Main-Lock: FTotal = 3.7 [0.7] N, Secutape sensitive: FTotal = 3.9 ± 0.4 N, Foley Anchor: FTotal = 4.3 ± 0.5 N, Grip-Lok: FTotal = 5.4 ± 0.8 N). Immobilization of the DL with each anchoring device resulted in lower tensile force on the DLES than without an anchor ( FTotal = 8.2 ± 0.3 N). In conclusion, the appropriate selection of anchoring devices plays a critical role in reducing the risk of DLI, whereas the CathGrip, Secutape, Hollister, or Tubimed were superior in preventing trauma to the DLES in this study.
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Affiliation(s)
- Johanna Schachl
- From the Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Stoiber
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - Martina Socha
- From the Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel Zimpfer
- From the Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Dominik Wiedemann
- From the Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Heinrich Schima
- From the Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - Thomas Schlöglhofer
- From the Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
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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: 0] [Impact Index Per Article: 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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Zhang Y, Han X, Zhao J, Gan M, Chen Y, Zhang J, He Y, Wu M, Liu H. Process optimization and character evaluation of Bletilla striata polysaccharide (BSP) and chitosan (CS) composite hemostatic sponge (BSP-CS). Biointerphases 2024; 19:021002. [PMID: 38526056 DOI: 10.1116/6.0003369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
Bletilla striata polysaccharide (BSP) and chitosan (CS) were chemically cross-linked using oxalyl chloride to prepare a composite hemostatic sponge (BSP-CS), and the process parameters were optimized using the Box-Behnken design (BBD) with response surface methodology. To optimize the performance of the hemostatic sponge, we adjusted the ratio of independent variables, the amount of oxalyl chloride added, and the freeze-dried volume. A series of evaluations were conducted on the hemostatic applicability of BSP-CS. The characterization results revealed that BSP-CS had a stable bacteriostatic effect on Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa within 72 h, and the bacteriostatic rate was above 30%. The CCK-8 cytotoxicity test demonstrated that BSP-CS had a certain effect on promoting cell proliferation of L929 cells. In the mouse tail-cutting experiment, the hemostasis time of BSP-CS was 463.0±38.16 s, shortened by 91.3 s on average compared with 554.3±34.67 s of the gauze group. The blood loss of the BSP-CS group was 28.47±3.74 mg, which was 34.7% lower than that of the control gauze group (43.6±3.83 mg). In the in vitro coagulation experiment, the in vitro coagulation index of the BSP-CS group was 97.29%±1.8%, which was reduced to 8.6% of the control group. The CT value of the BSP-CS group was 240±15 s, which was 155 s lower than that of the gauze group (355±31.22 s). All characterization results indicate that BSP-CS is an excellent hemostatic material.
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Affiliation(s)
- Yeshan Zhang
- Key laboratory of Plant Resource Conservation and Germplasm Innovation in Mountainous Region (Ministry of Education), College of Life Sciences/Institute of Agro-bioengineering, Guizhou University, Guiyang 550025, Guizhou Province, China
| | - Xue Han
- Institute of Modern Chinese Herbal Medicine/Guizhou Institute of Crop Variety Resources, Guizhou Engineering Research Center for the Cultivation and Planting of Chinese Medicine Bletilla striata, Guizhou Academy of Agricultural Sciences, Guiyang 550006, China
| | - Jun Zhao
- Guizhou Tongde Pharmaceutical Co., Ltd., Tongren 554300, Guizhou Province, China
| | - Menglan Gan
- Guizhou Vocational College of Agriculture, Guiyang 551400, Guizhou Province, China
| | - Yaya Chen
- Institute of Modern Chinese Herbal Medicine/Guizhou Institute of Crop Variety Resources, Guizhou Engineering Research Center for the Cultivation and Planting of Chinese Medicine Bletilla striata, Guizhou Academy of Agricultural Sciences, Guiyang 550006, China
| | - Jinxia Zhang
- Institute of Modern Chinese Herbal Medicine/Guizhou Institute of Crop Variety Resources, Guizhou Engineering Research Center for the Cultivation and Planting of Chinese Medicine Bletilla striata, Guizhou Academy of Agricultural Sciences, Guiyang 550006, China
| | - Yu He
- Key laboratory of Plant Resource Conservation and Germplasm Innovation in Mountainous Region (Ministry of Education), College of Life Sciences/Institute of Agro-bioengineering, Guizhou University, Guiyang 550025, Guizhou Province, China
| | - Mingkai Wu
- Institute of Modern Chinese Herbal Medicine/Guizhou Institute of Crop Variety Resources, Guizhou Engineering Research Center for the Cultivation and Planting of Chinese Medicine Bletilla striata, Guizhou Academy of Agricultural Sciences, Guiyang 550006, China
| | - Hai Liu
- Institute of Modern Chinese Herbal Medicine/Guizhou Institute of Crop Variety Resources, Guizhou Engineering Research Center for the Cultivation and Planting of Chinese Medicine Bletilla striata, Guizhou Academy of Agricultural Sciences, Guiyang 550006, China
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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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Gefen A, Alves P, Beeckman D, Cullen B, Lázaro-Martínez JL, Lev-Tov H, Najafi B, Santamaria N, Sharpe A, Swanson T, Woo K. How Should Clinical Wound Care and Management Translate to Effective Engineering Standard Testing Requirements from Foam Dressings? Mapping the Existing Gaps and Needs. Adv Wound Care (New Rochelle) 2024; 13:34-52. [PMID: 35216532 PMCID: PMC10654650 DOI: 10.1089/wound.2021.0173] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/20/2022] [Indexed: 02/07/2023] Open
Abstract
Significance: Wounds of all types remain one of the most important, expensive, and common medical problems, for example, up to approximately two-thirds of the work time of community nurses is spent on wound management. Many wounds are treated by means of dressings. The materials used in a dressing, their microarchitecture, and how they are composed and constructed form the basis for the laboratory and clinical performances of any advanced dressing. Recent Advances: The established structure/function principle in material science is reviewed and analyzed in this article in the context of wound dressings. This principle states that the microstructure determines the physical, mechanical, and fluid transport and handling properties, all of which are critically important for, and relevant to the, adequate performances of wound dressings. Critical Issues: According to the above principle, once the clinical requirements for wound care and management are defined for a given wound type and etiology, it should be theoretically possible to translate clinically relevant characteristics of dressings into physical test designs resulting specific metrics of materials, mechanical, and fluid transport and handling properties, all of which should be determined to meet the clinical objectives and be measurable through standardized bench testing. Future Directions: This multidisciplinary review article, written by an International Wound Dressing Technology Expert Panel, discusses the translation of clinical wound care and management into effective, basic engineering standard testing requirements from wound dressings with respect to material types, microarchitecture, and properties, to achieve the desirable performance in supporting healing and improving the quality of life of patients.
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Affiliation(s)
- Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Centre for Interdisciplinary Research in Health, Catholic University of Portugal, Porto, Portugal
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Ghent University and Swedish Centre for Skin and Wound Research, School of Health Sciences, Örebro University, Örebro, Sweden
| | | | | | - Hadar Lev-Tov
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Hospital Miller School of Medicine, Miami, Florida, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Nick Santamaria
- School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Sharpe
- Podiatry Department, Salford Royal NHS Foundation Trust, Salford Care Organisation, Salford, United Kingdom
| | - Terry Swanson
- Nurse Practitioner, Warrnambool, Victoria, Australia
| | - Kevin Woo
- School of Nursing, Queen's University, Kingston, Ontario, Canada
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Zanatta DA, Carvalho VO, da Silva RPGVC. What the skin of 341 premature newborns says - a transversal study. J Pediatr (Rio J) 2023; 99:582-587. [PMID: 37172615 PMCID: PMC10594010 DOI: 10.1016/j.jped.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES Determine the frequency of dermatological diagnoses in preterm newborns up to 28 days of life and associated perinatal factors. METHOD a cross-sectional analytical study with a convenience sample and prospective data collection, was conducted between November 2017 and August 2019. Overall, 341 preterm newborns who had been admitted to a University hospital - including those admitted to the Neonatal Intensive Care Unit - were evaluated. RESULTS 61 (17.9%) had less than 32 weeks gestational age (GA), with a mean GA and birth weight of 33.9 ± 2.8 weeks and 2107.8 ± 679.8g (465 to 4230g), respectively. The median age at the time of evaluation was 2.9 days (4 h to 27 days). The frequency of dermatological diagnoses was 100% and 98.5% of the sample had two or more, with an average of 4.67+1.53 dermatoses for each newborn. The 10 most frequent diagnoses were lanugo (85.9%), salmon patch (72.4%), sebaceous hyperplasia (68.6%), physiological desquamation (54.8%), dermal melanocytosis (38.7%), Epstein pearls (37.2%), milia (32.2%), traumatic skin lesions (24%), toxic erythema (16.7%), and contact dermatitis (5%). Those with GA< 28 weeks showed more traumatic injuries and abrasions, whereas those with ≥ 28 weeks had physiological changes more frequently, and those with GA between 34-366/7 weeks, had transient changes. CONCLUSION Dermatological diagnoses were frequent in our sample and those with higher GA showed a higher frequency of physiological (lanugo and salmon patch) and transient changes (toxic erythema and miliaria). Traumatic lesions and contact dermatitis were among the 10 most frequent injuries, reinforcing the need to effectively implement neonatal skin care protocols, especially in preterm.
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Affiliation(s)
- Danielle Arake Zanatta
- Hospital de Clínicas da Universidade Federal do Paraná (UFPR), Departamento de Pediatria, Unidade de Dermatologia Pediátrica, Curitiba, PR, Brasil.
| | - Vânia Oliveira Carvalho
- Hospital de Clínicas da Universidade Federal do Paraná (UFPR), Departamento de Pediatria, Unidade de Dermatologia Pediátrica, Curitiba, PR, Brasil
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11
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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: 0] [Impact Index Per Article: 0] [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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12
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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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13
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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: 0] [Impact Index Per Article: 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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14
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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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Hugill K, van Rens MFPT, Alderman A, Kaczmarek L, Lund C, Paradis A. Safe and effective removal of cyanoacrylate vascular access catheter securement adhesive in neonates. Front Pediatr 2023; 11:1237648. [PMID: 37691778 PMCID: PMC10492643 DOI: 10.3389/fped.2023.1237648] [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: 06/09/2023] [Accepted: 07/26/2023] [Indexed: 09/12/2023] Open
Abstract
Neonatal vascular access continues to pose challenges. Recent times have seen considerable innovations in practice and the design and manufacture of materials used to provide infusion-based therapies with the intent of reducing the incidence and severity of vascular access-related complications. However, despite these efforts, vascular access-related complication rates remain high in this patient group and research evidence remains incomplete. In neonates, a medical-grade formulation of cyanoacrylate adhesive is widely used to secure percutaneously inserted central venous catheters and is beginning to establish a role in supporting the effective securement of other devices, such as umbilical and peripheral intravenous catheters. This Perspective article considers issues specific to the removal of cyanoacrylate used to secure vascular access devices from neonatal skin before its bonding releases due to natural skin exfoliation processes. The aim of this information is to ensure the safe and effective removal of octyl-cyanoacrylate adhesive-secured vascular access catheters from neonatal skin and stimulate professional discussion.
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Affiliation(s)
- Kevin Hugill
- Nursing and Midwifery Education, Hamad Medical Corporation, Doha, Qatar
| | | | - Angela Alderman
- NICU, Carilion Children’s Hospital, Roanoke, VA, United State
| | | | - Carolyn Lund
- NICU, UCSF Benioff Children's Hospital, Oakland, CA, United State
- School of Nursing, University of California, San Francisco, CA, United State
| | - Amy Paradis
- NICU, CNS Doctors Medical Center, Modesto, CA, United State
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16
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Ehtiati K, Eiler J, Bochynska A, Nissen LL, Strøbech E, Nielsen LF, Thormann E. Skin and Artificial Skin Models in Electrical Sensing Applications. ACS APPLIED BIO MATERIALS 2023; 6:3033-3051. [PMID: 37552576 DOI: 10.1021/acsabm.3c00356] [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: 08/10/2023]
Abstract
Skin electrical properties play a significant role in recording biopotentials by using electrophysiological sensors. To test and evaluate sensor systems, it is commonly accepted to employ artificial skin models due to complications associated with testing on living tissues. The first goal of this Review is to provide a systematic understanding of the relation between skin structure and skin electrochemical behavior at an appropriate depth for electrophysiological sensing applications through a focus on skin structure, electrochemical properties of skin, and theoretical models (equivalent circuits) representing skin electrochemical behavior. The second goal is to review artificial skin models mimicking the electrochemical properties of skin and to give suggestions for future studies on relevant skin models based on a comparison between the behavior of skin and that of artificial skin models. The Review aims to help the reader to analyze the relation between the structure, elements of the equivalent circuits, and the resulting impedance data for both skin and artificial skin models.
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Affiliation(s)
- Koosha Ehtiati
- Department of Chemistry, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | - Johannes Eiler
- Department of Chemistry, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | | | | | | | | | - Esben Thormann
- Department of Chemistry, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
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17
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Iliev IE, Koutny-Adensamer AM, Herbst F, Dauser B. A Novel No Foil-to-Skin Contact Technique for Vacuum-assisted Wound Closure in Patients with Sensitive Skin. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5160. [PMID: 37547350 PMCID: PMC10400055 DOI: 10.1097/gox.0000000000005160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/20/2023] [Indexed: 08/08/2023]
Abstract
In some patients with chronic wounds, the surrounding skin is so injured due to various underlying conditions that negative pressure dressing cannot be applied or cannot function properly. Having faced this problem in our everyday practice, we developed a new skin-sparing technique for vacuum-assisted wound closure, which ensures that the peri-wound skin does not come into contact with the transparent adhesive films. Methods For 9 months (April-December 2022), we performed 32 vacuum wound dressings with the newly developed technique using the 3M ActiV.A.C. Therapy Unit and accessories, and Convatec's VARIHESIVE, avoiding skin contact with the adhesive films. Results Seven patients with 11 wounds who had sensitive skin or allergy to the conventionally used adhesive films were successfully treated with the new technique. The negative pressure wound dressings remained intact and functioned properly for up to 168 hours without compromising patients' daily activities and therapy. Conclusion The novel "no foil-to-skin contact" technique for vacuum-assisted wound closure can successfully be incorporated in the treatment of patients in whom conventional negative pressure dressings are otherwise not applicable.
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Affiliation(s)
- Iliyan Emilov Iliev
- From the Department of Surgery, St. John of God’s Hospital Vienna, Vienna, Austria
| | | | - Friedrich Herbst
- From the Department of Surgery, St. John of God’s Hospital Vienna, Vienna, Austria
| | - Bernhard Dauser
- From the Department of Surgery, St. John of God’s Hospital Vienna, Vienna, Austria
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18
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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 DOI: 10.1136/bmjopen-2023-073546] [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] [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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Jiang Y, Trotsyuk AA, Niu S, Henn D, Chen K, Shih CC, Larson MR, Mermin-Bunnell AM, Mittal S, Lai JC, Saberi A, Beard E, Jing S, Zhong D, Steele SR, Sun K, Jain T, Zhao E, Neimeth CR, Viana WG, Tang J, Sivaraj D, Padmanabhan J, Rodrigues M, Perrault DP, Chattopadhyay A, Maan ZN, Leeolou MC, Bonham CA, Kwon SH, Kussie HC, Fischer KS, Gurusankar G, Liang K, Zhang K, Nag R, Snyder MP, Januszyk M, Gurtner GC, Bao Z. Wireless, closed-loop, smart bandage with integrated sensors and stimulators for advanced wound care and accelerated healing. Nat Biotechnol 2023; 41:652-662. [PMID: 36424488 DOI: 10.1038/s41587-022-01528-3] [Citation(s) in RCA: 75] [Impact Index Per Article: 75.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 09/23/2022] [Indexed: 11/26/2022]
Abstract
'Smart' bandages based on multimodal wearable devices could enable real-time physiological monitoring and active intervention to promote healing of chronic wounds. However, there has been limited development in incorporation of both sensors and stimulators for the current smart bandage technologies. Additionally, while adhesive electrodes are essential for robust signal transduction, detachment of existing adhesive dressings can lead to secondary damage to delicate wound tissues without switchable adhesion. Here we overcome these issues by developing a flexible bioelectronic system consisting of wirelessly powered, closed-loop sensing and stimulation circuits with skin-interfacing hydrogel electrodes capable of on-demand adhesion and detachment. In mice, we demonstrate that our wound care system can continuously monitor skin impedance and temperature and deliver electrical stimulation in response to the wound environment. Across preclinical wound models, the treatment group healed ~25% more rapidly and with ~50% enhancement in dermal remodeling compared with control. Further, we observed activation of proregenerative genes in monocyte and macrophage cell populations, which may enhance tissue regeneration, neovascularization and dermal recovery.
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Affiliation(s)
- Yuanwen Jiang
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA
| | - Artem A Trotsyuk
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Simiao Niu
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA
| | - Dominic Henn
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Kellen Chen
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Chien-Chung Shih
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA
| | - Madelyn R Larson
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Alana M Mermin-Bunnell
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Smiti Mittal
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Jian-Cheng Lai
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA
| | - Aref Saberi
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA
| | - Ethan Beard
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Serena Jing
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Donglai Zhong
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA
| | - Sydney R Steele
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Kefan Sun
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA
| | - Tanish Jain
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Eric Zhao
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA
| | - Christopher R Neimeth
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Willian G Viana
- Department of Biology, Stanford University, Stanford, CA, USA
| | - Jing Tang
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA
| | - Dharshan Sivaraj
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Jagannath Padmanabhan
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Melanie Rodrigues
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - David P Perrault
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Arhana Chattopadhyay
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Zeshaan N Maan
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Melissa C Leeolou
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Clark A Bonham
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Sun Hyung Kwon
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Hudson C Kussie
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Katharina S Fischer
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | | | - Kui Liang
- BOE Technology Center, BOE Technology Group Co., Ltd, Beijing, China
| | - Kailiang Zhang
- BOE Technology Center, BOE Technology Group Co., Ltd, Beijing, China
| | - Ronjon Nag
- Stanford Distinguished Careers Institute, Stanford University, Stanford, CA, USA
| | - Michael P Snyder
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Januszyk
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Geoffrey C Gurtner
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA.
| | - Zhenan Bao
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA.
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20
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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: 0] [Impact Index Per Article: 0] [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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21
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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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22
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Wei M, Yang D, Chen L, Wu L, Lu M, Wang J, Qiu T. The prevalence of medical adhesive-related skin injury caused by protective dressings among medical staff members during the 2019 coronavirus pandemic in China. J Tissue Viability 2023; 32:69-73. [PMID: 36639257 PMCID: PMC9827744 DOI: 10.1016/j.jtv.2023.01.003] [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: 07/03/2020] [Revised: 11/11/2020] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
AIM To explore the prevalence and risk factors for medical adhesive-related skin injury (MARSI) caused by protective dressings among medical staff members during the 2019 coronavirus disease pandemic (COVID-19) in China. MATERIALS AND METHODS A cross-sectional survey was conducted using a questionnaire. The questionnaire was released through the Questionnaire Star website and was completed online. The prevalence of MARSI was calculated and risk factors were analyzed using a multiple regression model. RESULTS A total of 414 front-line medical staff members treating COVID-19 patients were enrolled from 46 hospitals across four provinces and two municipalities. Overall, 83.1% used protective medical adhesive dressings applied to the head and face to prevent skin damage from personal protective equipment. The prevalence of MARSI caused by adhesive dressings was 41.9%. By multiple regression analysis, the type of dressing, duration of dressing usage, and pain score were risk factors for MARSI development. CONCLUSIONS The high prevalence indicates MARSI is common among front-line medical staff members, especially those using hydrocolloid dressings and longer durations of dressing usage. Pain upon dressing removal can be severe and increased the risk of MARSI. We call for paying more attention to MARSI and recommend multisite studies with larger sample sizes to enhance the generalizability of these findings.
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Affiliation(s)
- Min Wei
- Wound Care Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | | | - Lu Chen
- Nursing Department Office, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
| | - Ling Wu
- Wound Care Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
| | - Minyuan Lu
- Affiliated Hospital of YangZhou University, Nanjing, Jiangsu, China
| | - Jiandong Wang
- Department of Pathology, Jinglin Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Ting Qiu
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
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23
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Muacevic A, Adler JR, Bjork J, Turnbull M, Sieracki J. Finite Element Analysis Modelling of Negative Pressure Wound Therapy Drapes. Cureus 2023; 15:e33412. [PMID: 36751188 PMCID: PMC9897684 DOI: 10.7759/cureus.33412] [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: 12/16/2022] [Indexed: 01/07/2023] Open
Abstract
Negative pressure wound therapy (NPWT) drape removal from the skin may be painful for patients and inadvertently cause skin damage during the length of therapy. Most NPWT drapes utilize an acrylate adhesive to achieve the seal. To improve the experience associated with NPWT drape removal, a novel hybrid drape was developed. This drape is composed of areas of acrylate adhesive and areas of silicone adhesive. To more fully understand how the removal of the hybrid drape versus the acrylate drape affects the skin, drape removal models were developed to assess the differences in strain profiles for acrylate versus hybrid NPWT drapes using finite element analysis (FEA) to measure the strain and deformation that occurs at the tissue interface with the NPWT drape. The FEA modeling showed that the maximum principal strain associated with the removal of the acrylate drape was 47.3%, whereas the maximum principal strain associated with the removal of the hybrid drape was 21.5%. The average peel force associated with the acrylate drape was 66.1 gf/in, while the peel force for the hybrid drape was 112.5 gf/in. NPWT drape removal may, in certain instances, be related to pain and periwound skin injury. The hybrid drape tested may provide clinicians with an option for NPWT that is gentler for the skin.
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24
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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 2022. [PMID: 36564958 DOI: 10.1111/iwj.14056] [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: 10/23/2022] [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 Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Wounds Research Lab - Centre for Interdisciplinary Research in Health, Catholic University of Portugal, Porto, Portugal
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Swedish Centre for Skin and Wound Research, Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | | | - Hadar Lev-Tov
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Hospital Miller School of Medicine, Miami, Florida, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Terry Swanson
- Wound Education Research Consultancy (WERC), Warrnambool, Victoria, Australia
| | - Kevin Woo
- School of Nursing, Queen's University, Kingston, Ontario, Canada
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25
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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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26
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Barton A, Bitmead J, Clare S, Daniels R, Gregory B, Lee P, Leitch A, McDonald C. How to improve aseptic technique to reduce bloodstream infection during vascular access procedures. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:880-885. [PMID: 36149420 DOI: 10.12968/bjon.2022.31.17.880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Bloodstream infections associated with vascular access procedures pose a serious risk to patients that can be reduced by better standards of aseptic technique. The objectives of this roundtable of experts were to achieve a consensus on how to improve skin antisepsis in hospital, improve training, competency, compliance and consistency in skin antisepsis, review the role of devices in improving skin antisepsis, identify methods to improve skin antisepsis integrated with the Aseptic Non Touch Technique (ANTT®) approach, and identify challenges to the implementation of the panel's recommendations. Recommendations include using MHRA-licensed 2% chlorhexidine gluconate in 70% isopropyl alcohol solution with bidirectional strokes for up to 30 seconds, then leaving the skin to air dry for 30 seconds; using the ANTT Clinical Practice Framework and terminology as the standard for skin antisepsis training and practice; standardised ANTT and skin antisepsis education with 3-yearly competency assessments for all UK health professionals; and more research to address the evidence gap on transmission of infection after skin antisepsis.
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Affiliation(s)
- Andrew Barton
- Nurse Consultant, Intravenous Therapy and Vascular Access, Frimley Health NHS Foundation Trust
| | - James Bitmead
- Senior Infection Prevention Control Nurse, University College London Hospitals NHS Foundation Trust
| | - Simon Clare
- Research and Practice Development Director, The Association for Safe Aseptic Practice
| | - Ron Daniels
- Consultant in Intensive Care Medicine, University Hospitals Birmingham NHS Foundation Trust, and Founder and Joint CEO, UK Sepsis Trust
| | - Beverley Gregory
- Consultant Nurse HCAI Healthcare-Acquired Infections, HARP Healthcare Associated Infection and Antimicrobial Resistance and Prescribing Programme, Public Health Wales
| | - Paul Lee
- Medical Devices Training Manager and Deputy Head of MEMS (Medical Equipment Management Services), Swansea Bay University Health Board
| | - Anne Leitch
- Value Based Heath and Care Lead, Scottish Government (secondment)
| | - Carl McDonald
- Former Bacteriology Consultant Clinical Scientist for NHS Blood and Transplant
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27
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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] [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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28
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Xu NY, Nguyen KT, DuBord AY, Pickup J, Sherr JL, Teymourian H, Cengiz E, Ginsberg BH, Cobelli C, Ahn D, Bellazzi R, Bequette BW, Gandrud Pickett L, Parks L, Spanakis EK, Masharani U, Akturk HK, Melish JS, Kim S, Kang GE, Klonoff DC. Diabetes Technology Meeting 2021. J Diabetes Sci Technol 2022; 16:1016-1056. [PMID: 35499170 PMCID: PMC9264449 DOI: 10.1177/19322968221090279] [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] [Indexed: 11/16/2022]
Abstract
Diabetes Technology Society hosted its annual Diabetes Technology Meeting on November 4 to November 6, 2021. This meeting brought together speakers to discuss various developments within the field of diabetes technology. Meeting topics included blood glucose monitoring, continuous glucose monitoring, novel sensors, direct-to-consumer telehealth, metrics for glycemia, software for diabetes, regulation of diabetes technology, diabetes data science, artificial pancreas, novel insulins, insulin delivery, skin trauma, metabesity, precision diabetes, diversity in diabetes technology, use of diabetes technology in pregnancy, and green diabetes. A live demonstration on a mobile app to monitor diabetic foot wounds was presented.
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Affiliation(s)
- Nicole Y. Xu
- Diabetes Technology Society,
Burlingame, CA, USA
| | | | | | | | | | | | - Eda Cengiz
- University of California, San
Francisco, San Francisco, CA, USA
| | | | | | - David Ahn
- Mary & Dick Allen Diabetes Center
at Hoag, Newport Beach, CA, USA
| | | | | | | | - Linda Parks
- University of California, San
Francisco, San Francisco, CA, USA
| | - Elias K. Spanakis
- Baltimore VA Medical Center,
Baltimore, MD, USA
- University of Maryland, Baltimore,
MD, USA
| | - Umesh Masharani
- University of California, San
Francisco, San Francisco, CA, USA
| | - Halis K. Akturk
- Barbara Davis Center for Diabetes,
University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Sarah Kim
- University of California, San
Francisco, San Francisco, CA, USA
| | - Gu Eon Kang
- The University of Texas at Dallas,
Richardson, TX, USA
| | - David C. Klonoff
- Diabetes Research Institute,
Mills-Peninsula Medical Center, San Mateo, CA, USA
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29
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Fronzo C. Evaluación, prevención y tratamiento de MARSI en América latina: reporte del JWC Masterclass. J Wound Care 2022; 31:41-43. [PMID: 36787949 DOI: 10.12968/jowc.2022.31.latam_sup_6a.41] [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: 02/16/2023]
Abstract
Resumen: El 13 de julio de 2022, el Journal of Wound Care LATAM (JWC LATAM) presentó su primer Masterclass. Esta clase magistral fue transmitida en vivo, en formato de webinar. Contó con la participación de tres ponentes que abarcaron definición, causas, factores de riesgo y clasificación de MARSI. Describieron, también, cómo determinar quiénes están en riesgo de desarrollar MARSI, qué cuidados tener en cuenta para reducir el riesgo de este tipo de heridas, cuán desarrollado está el concepto de MARSI en América latina, y qué dice la literatura acerca de las mejores prácticas. El siguiente reporte resume los puntos más relevantes. Conflicto de interés: Ninguno.
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30
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Fronzo C. Evaluación, prevención y tratamiento de MARSI en América latina: reporte del JWC Masterclass. J Wound Care 2022; 31:41-43. [PMID: 36789901 DOI: 10.12968/jowc.2022.31.latam_sup_6.41] [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: 02/16/2023]
Abstract
Resumen: El 13 de julio de 2022, el Journal of Wound Care LATAM (JWC LATAM) presentó su primer Masterclass. Esta clase magistral fue transmitida en vivo, en formato de webinar. Contó con la participación de tres ponentes que abarcaron definición, causas, factores de riesgo y clasificación de MARSI. Describieron, también, cómo determinar quiénes están en riesgo de desarrollar MARSI, qué cuidados tener en cuenta para reducir el riesgo de este tipo de heridas, cuán desarrollado está el concepto de MARSI en América latina, y qué dice la literatura acerca de las mejores prácticas. El siguiente reporte resume los puntos más relevantes. Conflicto de interés: Ninguno.
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31
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Swanson S, Bashmail R, Fellin CR, Luu V, Shires N, Cox PA, Nelson A, MacKenzie D, Taroc AM, Nelson LY, Seibel EJ. Prototype Development of a Temperature-Sensitive High-Adhesion Medical Tape to Reduce Medical-Adhesive-Related Skin Injury and Improve Quality of Care. Int J Mol Sci 2022; 23:7164. [PMID: 35806167 PMCID: PMC9266747 DOI: 10.3390/ijms23137164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 02/01/2023] Open
Abstract
Medical adhesives are used to secure wound care dressings and other critical devices to the skin. Without means of safe removal, these stronger adhesives are difficult to painlessly remove from the skin and may cause 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 device dislodgement and further medical complications. This paper outlines the development of a high-adhesion medical tape designed for low skin trauma upon release. By warming the skin-attached tape for 10-30 s, a significant loss in adhesion was achieved. A C14/C18 copolymer was developed and combined with a selected pressure-sensitive adhesive (PSA) material. The addition of 1% C14/C18 copolymer yielded the largest temperature-responsive drop in surface adhesion. The adhesive film was characterized using AFM, and distinct nanodomains were identified on the exterior surface of the PSA. Our optimized formulation yielded 67% drop in adhesion when warmed to 45 °C, perhaps due to melting nanodomains weakening the adhesive-substrate boundary layer. Pilot clinical testing resulted in a significant decrease in pain when a heat pack was used for removal, giving an average pain reduction of 66%.
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Affiliation(s)
- Shawn Swanson
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA; (S.S.); (R.B.); (V.L.); (N.S.); (L.Y.N.)
| | - Rahaf Bashmail
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA; (S.S.); (R.B.); (V.L.); (N.S.); (L.Y.N.)
| | - Christopher R. Fellin
- Department of Chemistry, University of Washington, Seattle, WA 98195, USA; (C.R.F.); (A.N.)
| | - Vivian Luu
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA; (S.S.); (R.B.); (V.L.); (N.S.); (L.Y.N.)
| | - Nicholas Shires
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA; (S.S.); (R.B.); (V.L.); (N.S.); (L.Y.N.)
| | - Phillip A. Cox
- Washington Clean Energy Testbeds, University of Washington, Seattle, WA 98105, USA;
| | - Alshakim Nelson
- Department of Chemistry, University of Washington, Seattle, WA 98195, USA; (C.R.F.); (A.N.)
| | - Devin MacKenzie
- Department of Materials Science and Engineering, University of Washington, Seattle, WA 98195, USA;
| | | | - Leonard Y. Nelson
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA; (S.S.); (R.B.); (V.L.); (N.S.); (L.Y.N.)
| | - Eric J. Seibel
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA; (S.S.); (R.B.); (V.L.); (N.S.); (L.Y.N.)
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Howell M, Loera S, Kirkland-Kyhn H. Cutaneous Anomalies of the Critically Ill Patient. AACN Adv Crit Care 2022; 33:165-172. [PMID: 35657760 DOI: 10.4037/aacnacc2022402] [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: 11/01/2022]
Abstract
Critically ill patients are at high risk for organ failure, including that of the integumentary system. Nurses working in intensive care are adept at performing comprehensive assessments that include the skin. Although pressure injury is a well-known complication associated with critical illness, patients may also have debilitating and life-threatening dermatoses. Conditions such as skin failure and medical adhesive-related skin damage are commonly seen in the critically ill. Infectious processes, such as Fournier gangrene, invasive candidiasis, mucormycosis, and herpetic lesions, can result in severe or superimposed critical illness and elude detection. Similarly, cutaneous manifestations of COVID-19 may develop prior to commonly recognized symptoms of infection. Nurses and providers caring for critically ill patients should be aware of common, but less widely known, skin conditions to facilitate early detection and treatment.
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Affiliation(s)
- Melania Howell
- Melania Howell is Wound Ostomy Continence Specialist, Emanuel Medical Center, 825 Delbon Avenue, Turlock, CA 95382
| | - Salomé Loera
- Salomé Loera is Clinical Nurse Specialist, Adult Critical Care Services, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Holly Kirkland-Kyhn
- Holly Kirkland-Kyhn is Director of Wound Care, University of California, Davis Medical Center, Sacramento, California
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Abstract
BACKGROUND Within every neonatal clinical setting, vascular access devices are considered essential for administration of fluids, nutrition, and medications. However, use of vascular access devices is not without danger of failure. Catheter securement adhesives are being evaluated among adult populations, but to date, studies in neonatal settings are scant. PURPOSE This research describes the prevalence of peripherally inserted central catheter failure related to catheter securement before and after the introduction of tissue adhesive for catheter securement. The identified modifiable risks might be used to evaluate efficacy, to innovate neonatal practice and support future policy developments. METHOD AND SETTING This was a retrospective observational analysis of routinely collected anonymized intravenous therapy-related data. The study was carried out at the tertiary neonatal intensive care unit (112 beds) of the Women's Wellness and Research Center of Hamad Medical Corporation, Doha, Qatar. RESULTS The results showed that the use of an approved medical grade adhesive for catheter securement resulted in significantly less therapy failures, compared with the control group. This remains significant after adjusting for day of insertion, gestational age, birth weight, and catheter type. IMPLICATIONS FOR PRACTICE AND RESEARCH In parallel with currently published international literature, this study's findings support catheter securement with an octyl-based tissue adhesive in use with central venous catheters. When device stabilization is most pertinent, securement with tissue adhesive is a safe and effective method for long-term vascular access among the neonatal population.
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Pearse I, Corley A, Larsen EN, Rickard CM, Ware RS, Campbell J, Coyer F, Alexandrou E, O'Brien C, Marsh N. Securing jugular central venous access devices with dressings fixed to a liquid adhesive in an intensive care unit population: a randomised controlled trial. Trials 2022; 23:390. [PMID: 35549750 PMCID: PMC9097412 DOI: 10.1186/s13063-022-06322-9] [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: 11/18/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Central venous access devices (CVADs) can have high rates of failure due to dressing-related complications. CVADs placed in the internal jugular vein are at particular risk of dressing failure-related complications, including catheter-associated bloodstream infection and medical adhesive-related skin injury. Application of Mastisol liquid adhesive (MLA) may reduce CVAD dressing failure and associated complications, by reducing the frequency of dressing changes. The aim of this study is to investigate whether, in an intensive care unit (ICU) population, standard dressing care with or without the addition of MLA, improves internal jugular CVAD dressing adherence. METHODS This two-arm, parallel group randomised controlled trial will be conducted in three Australian ICUs. A total of 160 patients (80 per group) will be enrolled in accordance with study inclusion and exclusion criteria. Patients will be randomised to receive either (1) 'standard' (in accordance with local hospital policy) CVAD dressings (control) or (2) 'standard' dressings in addition to MLA (intervention). Patients will be followed from the time of CVAD insertion to 48 h after CVAD removal. The primary outcome is 'dressing failure' defined as requirement for initial CVAD dressing to be replaced prior to seven days (routine replacement). DISCUSSION This study will be the first randomised controlled trial to evaluate the clinical effectiveness of MLA in the adult intensive care unit population and will also provide crucial data for patient-important outcomes such as infection and skin injury. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12621001012864 . Registered on 2 August 2021.
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Affiliation(s)
- India Pearse
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia. .,Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Chermside, Australia. .,School of Nursing and Midwifery, Griffith University, Brisbane, Australia. .,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.
| | - Amanda Corley
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.,AVATAR Group, Griffith University, Brisbane, Australia
| | - Emily N Larsen
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.,AVATAR Group, Griffith University, Brisbane, Australia.,Patient-Centred Health Services, Menzies Health Institute Queensland, Southport, Australia
| | - Claire M Rickard
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.,AVATAR Group, Griffith University, Brisbane, Australia.,Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Herston, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Jill Campbell
- National Health and Medical Research Council Centre for Research Excellence, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Fiona Coyer
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Australia.,Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Evan Alexandrou
- AVATAR Group, Griffith University, Brisbane, Australia.,School of Nursing and Midwifery and Centre for Applied Nursing Research, Western Sydney University, Penrith, Australia.,Department of Intensive Care, Liverpool Hospital, Liverpool, Australia
| | - Catherine O'Brien
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Nicole Marsh
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.,AVATAR Group, Griffith University, Brisbane, Australia.,Patient-Centred Health Services, Menzies Health Institute Queensland, Southport, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Australia
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Scientific and Clinical Abstracts From WOCNext® 2022: Fort Worth, Texas ♦ June 5-8, 2022. J Wound Ostomy Continence Nurs 2022; 49:S1-S99. [PMID: 35639023 DOI: 10.1097/won.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Protecting peristomal skin: A two-pronged approach in stoma patients. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S1-S8. [PMID: 37733640 DOI: 10.12968/bjon.2022.31.sup6.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
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Abstract
The skin has often been described in fictional literature as the window to the soul. It is the largest organ in the body and integral to both physical and psychosocial health. A complete skin assessment is essential for holistic care and must be completed by nurses and other health professionals on a regular basis. Providing patients and relatives with information on good skin hygiene can improve skin integrity and reduce the risk of pressure damage and skin tears.
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Affiliation(s)
- Aby Mitchell
- Senior Lecturer, Adult Nursing, and Professional Lead for Simulation and Immersive Technologies, University of West London
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Incidence of Medical Adhesive-Related Skin Injuries and Associated Factors After Pediatric Congenital Heart Surgery: A Prospective Cohort Study. J Wound Ostomy Continence Nurs 2022; 49:137-142. [PMID: 35255064 DOI: 10.1097/won.0000000000000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to identify the incidence, characteristics, and factors associated with medical adhesive-related skin injuries (MARSI). DESIGN Prospective cohort study. SUBJECTS AND SETTINGS The sample comprised 136 children in the postoperative period after congenital heart surgery. The study setting was in a 31-bed pediatric surgical intensive care unit (ICU) of a university hospital in Sao Paulo, Brazil. METHODS Patients were followed from admission, with daily skin assessments, until the onset of MARSI or ICU discharge. Outcomes were compared by Fisher's exact test, Pearson's χ2 test, Mann-Whitney test, Brunner-Munzel test, and Welch 2-sample t test. RESULTS The incidence of MARSI was 60.3%, with 85 injuries in 82 patients. The highest occurrence was on postoperative day 2 (27 wounds; 31.8%). The most frequent medical adhesive associated with MARSI was transparent film dressing (n = 74; 86.6%). Factors associated with MARSI were age (P = .000), number of devices inserted (P = .000), Braden Q Scale score (P = .005), duration of surgery (P = .021), cardiopulmonary bypass duration (P = .000), duration of mechanical ventilation (P = .000), and length of ICU stay (P = .000). Children who developed MARSI received more blood components (P = .039), vasopressors (P = .000), and corticosteroids (P = 0.000); required longer sedation (P = .000); and had more edema (P = .001). CONCLUSION This high incidence indicates the need for greater awareness and prompt action in response to MARSI. Polyurethane transparent film without concurrent use of a skin barrier product should be avoided.
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Rabelo AL, Moraes JT. BUNDLE: MEDICAL ADHESIVE-RELATED SKIN INJURY PREVENTION IN ADULT INTENSIVE CARE. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2022-0221en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
ABSTRACT Objective to build and validate a bundle for medical adhesive-related skin injury prevention in adult intensive care. Method this is a methodological study, carried out in three stages: development of a Scoping Review, bundle construction and content validity. This scoping review followed the JBI recommendations, and the content validity process was performed using the Delphi technique. Six expert judges participated in this process. For content validity analysis, the Content Validity Coefficient and binomial test were calculated. Items that reached a coefficient ≥0.80 and an agreement proportion of 80% among judges were considered valid for the binomial test. Results the bundle structure had 21 recommendations, grouped into categories: skin assessment, identification of patients at risk, product selection, skin preparation, adhesive application technique, adhesive removal technique and health professionals’ education. The criteria established for assessment achieved satisfactory levels of assessment, being considered adequate by judges. In Delphi I, the assessed items obtained a Content Validity Coefficient ≥0.83 and in Delphi II, ≥0.97. Conclusion in this study, it was allowed to construct and validate a bundle for medical adhesive-related skin injury prevention in adult intensive care.
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Rabelo AL, Bordonal J, Almeida TLD, Oliveira PP, Moraes JT. Lesão de pele relacionada a adesivo médico em unidade de terapia intensiva adulto: scoping review. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0926pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivos: identificar e sintetizar evidências científicas sobre prevenção de lesões de pele relacionadas a adesivo médico nos pacientes adultos em terapia intensiva. Métodos: trata-se de uma scoping review desenvolvida com base nas recomendações do PRISMA-ScR e no método proposto por Joanna Briggs Institute. Realizaram-se buscas nas bases de dados PubMed, CINAHL, Web of Science, Scopus, LILACS e Embase, utilizando os descritores “Injuries AND Adhesives AND Skin AND Medical”. Resultados: identificaram-se 1.329 estudos; após análise, a amostra final foi composta por nove artigos. Quanto ao tipo de estudos, obtiveram-se dois consensos de especialistas, três estudos de caso, dois estudos transversais, um de coorte prospectivo e uma revisão de literatura. Considerações Finais: as evidências sintetizadas possibilitaram elencar cuidados para prevenção de lesões de pele relacionadas a adesivos médicos. É importante que o profissional saiba identificar tanto as lesões de pele relacionadas aos adesivos médicos quanto as principais estratégias para prevenção destas.
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Rabelo AL, Moraes JT. BUNDLE: PREVENÇÃO DE LESÕES DE PELE RELACIONADAS A ADESIVOS MÉDICOS EM TERAPIA INTENSIVA ADULTO. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2022-0221pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RESUMO Objetivo construir e validar um bundle para a prevenção de lesões de pele relacionadas a adesivos médicos em terapia intensiva adulto. Método trata-se de um estudo metodológico, realizado em três etapas: desenvolvimento de uma Scoping Review, construção do bundle e validação de conteúdo. A Scoping Review seguiu as recomendações do Joanna Briggs Institute, e o processo de validação de conteúdo foi realizado, por meio da técnica Delphi. Participaram desse processo seis juízes especialistas. Para a análise da validação de conteúdo, foram calculados o Coeficiente de Validade de Conteúdo e teste binomial. Foram considerados válidos os itens que atingiram coeficiente ≥0,80 e a proporção de concordância de 80% entre os juízes, para o teste binomial. Resultados a estrutura do bundle contou com 21 recomendações, agrupadas em categorias: avaliação da pele, identificação dos pacientes de risco, seleção do produto, preparo da pele, técnica de aplicação do adesivo, técnica de remoção do adesivo e educação permanente dos profissionais de saúde. Os critérios estabelecidos para a avalição alcançaram níveis de avalição satisfatórios, sendo considerados adequados pelos juízes. Em Delphi I, os itens avaliados obtiveram um Coeficiente de Validação de Conteúdo ≥0,83 e em Delphi II, ≥0,97. Conclusão neste estudo, permitiu-se construir e validar bundle, para a prevenção de leões de pele relacionadas a adesivos médicos em terapia intensiva adulto.
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Roca-Sarsanedas J, Galimany-Masclans J, Regidor-Braojos AM, Falcó-Pegueroles A. Topical treatment of tissue damage due to extravasation of iodinated contrast using thermal compresses. J Tissue Viability 2021; 31:135-141. [DOI: 10.1016/j.jtv.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 11/30/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
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Pires-Júnior JF, Chianca TCM, Borges EL, Azevedo C, Simino GPR. Medical adhesive-related skin injury in cancer patients: A prospective cohort study. Rev Lat Am Enfermagem 2021; 29:e3500. [PMID: 34755780 PMCID: PMC8584878 DOI: 10.1590/1518-8345.5227.3500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/06/2021] [Indexed: 11/22/2022] Open
Abstract
Objective: to estimate the incidence of medical adhesive-related skin injury in the
peripheral venous catheter fixation region in critical cancer patients, to
identify risk factors, and to establish a risk prediction model for its
development. Method: a prospective cohort study with a sample of 100 adult and aged patients
hospitalized in an intensive care unit. The data were analyzed using
descriptive, bivariate and multivariate statistics with Cox regression. Results: the incidence of medical adhesive-related skin injury was 31.0% and the
incidence density was 3.4 cases per 100 people-days. The
risk factors were as follows: alcoholism, smoking habit, hospitalization due
to deep vein thrombosis, acute respiratory failure, immediate postoperative
period, heart disease, dyslipidemia, use of antiarrhythmics, blood
transfusion, friction injury, pressure injury, turgor, edema, hematoma,
petechiae, low values in the Braden scale, clinical severity of the patient,
elasticity, moisture, texture and color. The predictive model consisted in
the following: decreased skin turgor, presence of hematoma and edema. Conclusion: medical adhesive-related skin injury at the peripheral venous catheter
insertion site has a high incidence in critical cancer patients and is
associated with decreased turgor, presence of hematoma and edema, evidence
that can support the clinical practice.
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Affiliation(s)
| | | | - Eline Lima Borges
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brazil
| | - Cissa Azevedo
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brazil
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Has C, El Hachem M, Bučková H, Fischer P, Friedová M, Greco C, Nevoránková P, Salavastru C, Mellerio JE, Zambruno G, Bodemer C. Practical management of epidermolysis bullosa: consensus clinical position statement from the European Reference Network for Rare Skin Diseases. J Eur Acad Dermatol Venereol 2021; 35:2349-2360. [PMID: 34545960 DOI: 10.1111/jdv.17629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/13/2021] [Indexed: 01/13/2023]
Abstract
Inherited epidermolysis bullosa (EB) comprises rare disorders that manifest with fragility and blistering of the skin and mucous membranes, with variable clinical severity. Management of EB is challenging due to disease rarity and complexity, the wide range of extracutaneous manifestations and a profound impact on daily life for the patient and family members. Although reference centres providing multidisciplinary care for EB exist in each European country, it is common for healthcare professionals that are not specialized in this rare disorder to treat EB patients. Here, experts of the European Reference Network for Rare and Undiagnosed Skin Diseases (ERN-Skin, https://ern-skin.eu) propose practical recommendations for the diagnosis and management of the commonest clinical issues, skin blisters and wounds, oral manifestations, pain and itch.
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Affiliation(s)
- C Has
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M El Hachem
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - H Bučková
- Department of Dermatology, Children's Hospital, University Hospital Brno, Brno, Czech Republic
| | - P Fischer
- Department of Prosthetic Dentistry, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Friedová
- NevDent, Dental Private Clinic, Brno, Czech Republic
| | - C Greco
- Pain and Palliative Care Unit, Hôpital Necker Enfants Malades, Paris, France
| | - P Nevoránková
- NevDent, Dental Private Clinic, Brno, Czech Republic
| | - C Salavastru
- Paediatric Dermatology Department, "Carol Davila" University of Medicine and Pharmacy, Colentina Clinical Hospital, Bucharest, Romania
| | - J E Mellerio
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - G Zambruno
- Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - C Bodemer
- Service de Dermatologie, Hôpital Necker Enfants Malades, Paris, France
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Kim J, Shin Y. Medical Adhesive-Related Skin Injury Associated with Surgical Wound Dressing among Spinal Surgery Patients: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179150. [PMID: 34501740 PMCID: PMC8430563 DOI: 10.3390/ijerph18179150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/29/2021] [Accepted: 08/29/2021] [Indexed: 11/16/2022]
Abstract
The aim of this cross-sectional study was to determine the incidence, types, and factors associated with medical adhesive-related skin injuries (MARSIs) among spinal surgery patients. Adult patients who underwent planned spinal surgery under general anesthesia at a tertiary hospital in Seoul, Korea were enrolled. Data were collected from March through April 2019. Skins under surgical wound dressings were evaluated for MARSI once every morning until discharge. Skin injuries lasting for 30 min or more were considered as MARSIs. Logistic regression was performed to identify factors associated with MARSI. The incidence of MARSIs in surgical areas was 36.4% and the rate per 100 medical adhesives was 9.8%. All MARSIs occurred on postoperative day 1 or 2. A history of contact dermatitis (OR = 10.517, 95% CI = 3.540–31.241, p < 0.001) and late ambulation (OR = 1.053, 95% CI = 1.012–1.095, p = 0.010) were identified as risk factors for MARSI. Spinal surgery patients were at high risk of MARSIs associated with surgical wound dressings. Patients with a history of contact dermatitis or prolonged bed rest periods need more active skin assessment and more careful skin care to prevent MARSIs after spinal surgery.
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Affiliation(s)
- Jeounghee Kim
- Department of Nursing, Asan Medical Center, Seoul 05505, Korea;
| | - Yongsoon Shin
- College of Nursing, Hanyang University, Seoul 04763, Korea
- Correspondence: ; Tel.: +82-02-2220-0798
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Hitchcock J, Haigh DA, Martin N, Davies S. Preventing medical adhesive-related skin injury (MARSI). ACTA ACUST UNITED AC 2021; 30:S48-S56. [PMID: 34379472 DOI: 10.12968/bjon.2021.30.15.s48] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Medical adhesive-related skin injury (MARSI) is an overlooked and underestimated problem. While awareness of this issue is growing, it is not fully understood by health professionals in a variety of clinical settings. Medical adhesive products are often applied and removed incorrectly, which, albeit unintentionally, causes skin damage. In many cases, MARSI should be considered a preventable injury. Organisations should have processes in place to educate health professionals in acute and community facilities in preventing MARSI; these processes should include the use of products that help to prevent these injuries, including medical adhesive removers. This article will explore this topic and relate it to the most recent consensus document.
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Affiliation(s)
- Jan Hitchcock
- Vascular Access Lead Nurse, Infection Prevention & Control, Imperial College Healthcare NHS Trust
| | - David A Haigh
- Tissue Viability Nurse Specialist, Guy's and St Thomas' NHS Foundation Trust
| | - Nuria Martin
- Tissue Viability Clinical Nurse Specialist, London North West University Healthcare NHS Trust-St Mark's Hospital
| | - Siân Davies
- Junior District Sister, Hywel Dda UHB District nurses office
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Evidence-Based Medicine G, Neonatologist S, Chinese Medical Doctor A. [Guidelines for neonatal skin management in the neonatal intensive care unit (2021)]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:659-670. [PMID: 34266521 PMCID: PMC8292657 DOI: 10.7499/j.issn.1008-8830.2106004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/22/2021] [Indexed: 06/13/2023]
Abstract
Neonates are easily suffering from local or systematic infections due to their vulnerable skin barrier function, which leads to the increasing risk of death. Therefore, it is important to protect neonatal skin integrity and prevent neonatal skin injury in the neonatal intensive care unit (NICU). Based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and current evidence, the guidelines for neonatal skin management in the NICU were developed to provide recommendations on routine skin care and prevention and treatment of iatrogenic skin injury of neonates for health care providers.
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Burch J, Boyles A, Maltby E, Marsden J, Martin N, McDermott B, Voegeli D. Keep it simple: peristomal skin health, quality of life and wellbeing. ACTA ACUST UNITED AC 2021; 30:5-24. [PMID: 33949894 DOI: 10.12968/bjon.2021.30.sup6.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jennie Burch
- (chair), Head of Gastrointestinal Nurse Education, St Mark's Hospital, London North West University Healthcare NHS Foundation Trust
| | - Anna Boyles
- Stoma Care Nurse, King's College Hospital NHS Foundation Trust
| | - Emma Maltby
- Stoma Care Nurse, Hampshire Hospitals NHS Foundation Trust
| | - Jenny Marsden
- Stoma Care Nurse, York Teaching Hospital NHS Foundation Trust
| | - Nuria Martin
- Tissue Viability Nurse, St Mark's Hospital, London North West University Healthcare NHS Foundation Trust
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Barton A. Prevention of medical adhesive-related skin injury (MARSI) during vascular access. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:1-8. [PMID: 33977767 DOI: 10.12968/bjon.2021.30.sup2.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew Barton
- Nurse Consultant, Intravenous Therapy and Vascular Access, Frimley Health NHS Foundation Trust
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50
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Le Ber F. Using a novel breathable silicone adhesive (Sil2 technology) in stoma appliances to improve peristomal skin health: answering the key questions. ACTA ACUST UNITED AC 2021; 30:19-24. [PMID: 34106773 DOI: 10.12968/bjon.2021.30.sup8.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fiona Le Ber answers some of the questions that stoma care nurses may have regarding this novel silicone adhesive based technology, which helps to avoid medical adhesive related skin injury (MARSI) and moisture-associated skin damage (MASD). Whereas hydrocolloid stoma appliances absorb moisture, this has a non-absorptive method of moisture management that prevents peristomal skin becoming damp and excoriated.
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Affiliation(s)
- Fiona Le Ber
- Clinical Nurse Specialist in Community Continence and Stoma Care, Queen's Nurse and Committee Member of the Royal College of Nursing Bladder and Bowel Forum, Jersey
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