Prevalence of medical adhesive-related skin injury at peripherally inserted central catheter insertion site in oncology patients

Central venous access device terminologies, complications, and reason for removal in oncology: a scoping review

BACKGROUND

Lack of agreed terminology and definitions in healthcare compromises communication, patient safety, optimal management of adverse events, and research progress. The purpose of this scoping review was to understand the terminologies used to describe central venous access devices (CVADs), associated complications and reasons for premature removal in people undergoing cancer treatment. It also sought to identify the definitional sources for complications and premature removal reasons. The objective was to map language and descriptions used and to explore opportunities for standardisation.

METHODS

A systematic search of MedLine, PubMed, Cochrane, CINAHL Complete and Embase databases was performed. Eligibility criteria included, but were not limited to, adult patients with cancer, and studies published between 2017 and 2022. Articles were screened and data extracted in Covidence. Data charting included study characteristics and detailed information on CVADs including terminologies and definitional sources for complications and premature removal reasons. Descriptive statistics, tables and bar graphs were used to summarise charted data.

RESULTS

From a total of 2363 potentially eligible studies, 292 were included in the review. Most were observational studies (n = 174/60%). A total of 213 unique descriptors were used to refer to CVADs, with all reasons for premature CVAD removal defined in 84 (44%) of the 193 studies only, and complications defined in 56 (57%) of the 292 studies. Where available, definitions were author-derived and/or from national resources and/or other published studies.

CONCLUSION

Substantial variation in CVAD terminology and a lack of standard definitions for associated complications and premature removal reasons was identified. This scoping review demonstrates the need to standardise CVAD nomenclature to enhance communication between healthcare professionals as patients undergoing cancer treatment transition between acute and long-term care, to enhance patient safety and rigor of research protocols, and improve the capacity for data sharing.

Central Venous Access Device-Associated Skin Complications in Adults with Cancer: A Prospective Observational Study

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.

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

BACKGROUND

The skin in contact with the adhesives used to secure catheters is vulnerable to medical adhesive-related skin injury (MARSI). The incidence of these injuries and the risks associated with their development have not been accurately estimated previously in critically ill patients.

AIM

The aim of this study was to investigate the incidence and risk factors for MARSI in catheters of critically ill patients.

METHODS

A prospective cohort study was conducted in adult intensive care units of two Brazilian university hospitals. A total of 150 patients (439 catheters) were included. The skin exposed to the catheter fixation adhesives (central venous, nasogastric, nasoenteral, and indwelling urinary) was examined daily by four trained researchers. The patients' sociodemographic and clinical data were collected from their electronic medical records. The association between independent variables and MARSI was investigated by bivariate statistics, followed by a multiple logistic regression.

RESULTS

The MARSI incidence was 42% (86.5 MARSIs per 1000 patient-days). Advanced age, prolonged hospital stay, dry skin, repetitive adhesive removal, low Braden Scale score, and hypoalbuminemia were associated with MARSI (p < .05). According to the multivariate logistic regression, dry skin increased the chance of MARSI by 5.2 times (odds ratio: 5.2; 95% confidence interval: 2.4-11.1), while the Braden Scale score was a protective factor, showing 30% less chance of MARSI for each added score (odds ratio: 0.7; 95% confidence interval: 0.6-0.9). A higher incidence of MARSI was observed in nasoenteral catheters and in those fixed with adhesive using natural rubber. The MARSI types were predominantly mechanical (70.3%): skin stripping (41.3%), skin tear (26.1%), and tension injury or blister (2.9%).

CONCLUSIONS

MARSI is a common event in adult intensive care units, and most risk factors are modifiable. Preventive actions are potentially capable of reducing incidence, optimising financial resources, and improving clinical results.

Peripherally Inserted Central Catheter-Related Skin Injury in Patients with a Chest Tumor: Characteristics and Risk Factors

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.

Silk Bioprotein as a Novel Surgical-Site Wound Dressing: A Prospective, Randomized, Single-Blinded, Superiority Clinical Trial

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

Clinical characteristics of peripherally inserted central catheter-related complications in cancer patients undergoing chemotherapy: a prospective and observational study

PURPOSE

The incidence of peripherally inserted central catheter (PICC)-related complications is higher in cancer patients than in noncancer patients. However, the pattern of specific complication occurrence over time remains unclear. The purpose of this study was to investigate the clinical characteristics of PICC-related complications in cancer patients undergoing chemotherapy.

METHODS

This prospective, observational study was conducted at a university-affiliated hospital in Western China. Cancer patients undergoing PICC insertion for anticancer treatment were recruited and followed up until the first week after catheter removal. Any complications, including occurrence time and outcomes, were recorded. The trajectory of specific PICC-related complications over time were identify based on the Kaplan‒Meier curve analysis.

RESULTS

Of the 233 patients analyzed, nearly half (n = 112/233, 48.1%) developed 150 PICC-related complication events. The most common were symptomatic catheter-related thrombosis (CRT) (n = 37/233, 15.9%), medical adhesive-related skin injury (MARSI) (n = 27/233, 11.6%), and catheter dislodgement (n = 17/233, 7.3%), accounting for 54.0% (n = 81/150, 54.0%) of total complications events. According to Kaplan‒Meier curve analysis, symptomatic CRT, pain, phlebitis, and insertion site bleeding were classified as the "early onset" group mainly occurring within the first month post-insertion. Catheter fracture and catheter-related bloodstream infection were classified as the "late onset" group occurring after the second month post-insertion. MARSI, catheter dislodgement, occlusion, and insertion site infection were classified as the "persistent onset" group persistently occurring during the whole catheter-dwelling period. Among the 112 patients with PICC-related complications, 50 (44.6%) patients had their catheters removed due to complications, and 62 (55.4%) patients successfully retained their catheters until treatment completion through conventional interventions. The major reasons for unplanned catheter removal were catheter dislodgement (n = 12/233, 5.2%), symptomatic CRT (n = 10/233, 4.3%), and MARSI (n = 7/233, 3.0%), accounting for 58.0% (n = 29/50, 58.0%) of the total unplanned catheter removal cases. Catheter dwelling times between patients with complications under successful interventions (130.5 ± 32.1 days) and patients with no complications (138.2 ± 46.4 days) were not significantly different (t = 1.306, p = 0.194; log-rank test = 2.610, p = 0.106).

CONCLUSIONS

PICC-related complications were pretty common in cancer patients undergoing chemotherapy. The time distribution of PICC-related complications varied, and medical staff should develop time-specific protocols for prevention. Because more than half of the patients with PICC-related complications could be managed with conventional interventions, PICCs remain a priority for cancer patients undergoing short-term chemotherapy. The study was registered in 02/08/2019 at Chinese Clinical Trial Registry (registration number: ChiCTR1900024890).

Identifying the impact of the Zone Insertion MethodTM (ZIMTM): A randomized controlled trial

BACKGROUND

In 2011, Dawson proposed the Zone Insertion MethodTM (ZIMTM) to identify the optimal peripherally inserted central catheters (PICCs) insertion site in the upper arm. However, data on the effectiveness and safety of the ZIMTM in guiding PICC placement in Chinese population is limited.

METHODS

In this randomized controlled trial, 120 cancer patients were randomly assigned to the upper portion of the red zone (RZ), the green zone (GZ) and the lower portion of the yellow zone (YZ) groups (at a 1:1:1 ratio). The aim was to compare the degree of patient comfort and the incidence of major PICC complications among the three insertion zones based on the ZIMTM in a Chinese Cancer Center. (Clinical Trials. Gov number, ChiCTR1900024111).

RESULTS

A total of 118 catheters were inserted in 118 patients (2 patients were lost to follow-up). After the 1-month follow-up, patients randomly assigned to the YZ group had a higher degree of comfort with a lower score than those assigned to the other two zone groups: 30.21±3.16 in the YZ group versus 31.65±2.51 in the RZ group and 31.59±2.92 in the GZ group (P=.046). The incidence of thrombosis (10/40, 25%) and occlusion (4/40, 10%) in the RZ, which were significantly higher than those in the other two zone groups (χ2 =7.368, P=.02; χ2 =5.778, P =.03), whereas the risk in the GZ group was similar to that in the YZ group. The incidence of contact dermatitis in the GZ group was significantly higher than that of the other two zone groups (χ2=12.873, P=.001).

CONCLUSIONS

This study found that the lower portion of YZ seems to be another suitable PICC insertion site for a higher degree of comfort and a lower risk of occlusion and thrombosis, which broadens the choice of PICC insertion sites in the upper arm for clinical practice.

Incidence and Predictive Model of Medical Adhesive-Related Skin Injury in Cancer Patients Managed With Central Venous Access Devices: A Retrospective Study

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.

The Science of Skin: Measuring Damage and Assessing Risk

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.

The prevalence of medical adhesive-related skin injury caused by protective dressings among medical staff members during the 2019 coronavirus pandemic in China

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.

Outcomes of 2-octyl cyanoacrylate skin adhesives following musculoskeletal oncology surgery: A STROBE-compliant observational study

ABSTRACT

2-octyl cyanoacrylate (2OCA) is a high-viscosity medical-grade tissue adhesive that is routinely used. However, no studies have evaluated its use in musculoskeletal surgery.We enrolled 99 patients who underwent musculoskeletal surgery. 2OCA was chosen for wound closure and was performed by a specific surgeon for all patients. The drying times for the adhesive were recorded, and photographs were obtained intra-operatively. Posttreatment follow-up consisted of queries regarding pain level and recording incisional dehiscence, wound infection, hematoma, and incisional bleeding. Data collection was performed postoperatively at 48 hours, 5 to 10 days, 14 days, and 30 days. Other adverse events were documented.2OCA was applied to 110 incisions in 99 patients, comprising 62 female and 37 male patients. The mean age of patients was 50.41 (±16.83) years; mean incision length was 10.24 (±5.7) cm, and the mean pain score using a visual analogue scale was 2.37 on a postoperative day 7. The mean drying time was 1.81 (±0.59) minutes; 91 (91%) patients reported excellent and superior satisfaction, and the remaining patients reported "good" (6%) and "fair" (2%) satisfaction. The percentages of dehiscence, hematoma and keloid formation were considerably low.In this study, 2OCA was safe for musculoskeletal oncology surgical incisions. The incidence of postoperative adverse events was low. However, some patients develop hematomas. Postoperative pain was low, and patient satisfaction was high. 2OCA can be a practical alternative to traditional suture closure for skin incisions after musculoskeletal surgery.

Medical adhesive-related skin injury in cancer patients: A prospective cohort study

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.

Safe central venous catheters for esophageal cancer treatment

 Introduction : Central venous catheter (CVC) use is essential for treating esophageal cancer. Peripherally inserted central catheters (PICC) are commonly used recently for improved patient comfort and safety. We compared centrally inserted central catheters (CICC) and PICC insertions and examined their safety. Methods : We retrospectively investigated complications at the catheter insertion and post-insertion for 199 patients' esophageal cancer treatment (CICC : 45, PICC : 154) from 2013 to 2018. In addition, we summarized the results of catheter tip culture. Results : No serious complications occurred at the catheter insertion in either group. The rate of complications at catheter insertion was 5.8% for PICC and 6.7% for CICC patients. Post-insertion complications were observed in 6.5% and 11.1% of patients with PICC and CICC, respectively, and this difference was not significant. The incidence of catheter-related blood stream infection (CRBSI) was significantly lower in PICC than CICC patients (0.3 vs. 1.8 / 1,000 catheter-days ; p = 0.029). Catheter-related thrombosis was observed in PICC : 0.5 and CICC : 0.6, and occlusion due to blood flow reversal was observed in PICC : 0.5 and CICC : 0.6. Conclusion : PICCs are safer and more effective than CICCs for the treatment of esophageal cancer, and reduce the incidence of CRBSI. We hope to standardize the insertion procedures, conventionalize techniques, and establish training systems. J. Med. Invest. 67 : 298-303, August, 2020.

Medical Adhesive-Related Skin Injury Associated with Surgical Wound Dressing among Spinal Surgery Patients: A Cross-Sectional Study

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.

Multidisciplinary cooperative mode led by infusion nurse specialists used to ensure the nursing quality of peripherally inserted central catheters in China: A 5-year retrospective study

OBJECTIVE

To analyze the effect of multidisciplinary cooperation mode (MCM) led by infusion nurse specialists (INSs) on peripherally inserted central catheters (PICC) catheterization and indwelling nursing quality.

METHODS

Participants' demographic information, catheter types, catheterization approaches, puncture site, tip position, professional title of nurses, success rate of catheterization, consultation rate, detection rate of complications and outcome improvement rate of 6576 outpatients and hospitalized patients with PICC were analyzed retrospectively by a software named "questionnaire stars," in a large tertiary general hospital in Shanghai, from January 2015 to December 2019. SPSS 26.0 for Windows was used for data collection and description, Chi-square test were used for statistical analysis of enumeration data, and p < 0.05 was statistically significant.

RESULTS

According to the catheter types' data, the use rate of three-way valve catheters decreased from 79.9% to 14.5%, while the use rate of three-way valve solo catheters increased from 12.7% to 51.6%, and the use rate of power injectable and open-ended catheters increased from 7.4% to 33.9%. According to the data of PICC catheterization method, conventional technology decreased significantly from 16.8% to 1.1%, modified Seldinger technique (MST) increased gradually from 26.1% to 51.3%, while ultrasound guided modified Seldinger technique (US and MST) decreased slightly from 57.2% to 47.6%. 7.5% catheter tip ends were malpositioned while nine indwelled PICCs were traced to have tip end malposition. The consultation rate was significantly higher than that before applying MCM led by INSs (x² = 151.713, p < 0.05). After applying MCM led by INSs, the detection rate of complications was significantly higher than before (x² = 5.499, p < 0.05), the rate of successful insertion at one time was significantly higher than before (x² = 187.589, p < 0.05).

CONCLUSION

After the application of INSs-led MCM, progresses have been achieved. The nursing quality of patients' PICC was significantly improved than before.

Medical adhesive-related skin injuries in the neonatology department of a teaching hospital

BACKGROUND

Medical adhesives are used to affix components to the skin. They are part of procedures performed by medical specialties because of their participation as constituents of different products, such as tapes, dressings, and electrodes.

AIM

This study aims to assess the prevalence of, and factors associated with, the development of medical adhesive-related skin injuries (MARSIs) in patients treated with medical tapes in the neonatology department of a large teaching hospital in Brazil.

STUDY DESIGN

Cohort study.

METHODS

All premature newborns (gestational age from 28 to <37 weeks) admitted in the neonatal intensive care unit of a teaching hospital, from March to August 2019, were followed up. Neonate skin condition was assessed based on the Neonatal Skin Condition Scale (NSCS). Data analyses were conducted in R software.

RESULTS

In total, 46 premature newborns were included in the study; 552 evaluations were performed-mean of 11.7 per patient. Most neonates (n = 41; 89.1%) used adhesive tapes, either paper tape (n = 37; 80.4%) or transparent film dressing (n = 34; 73.9%). Newborns' face and head were the most affected body regions (n = 125; 50.2%). Eight patients had MARSIs (19.5% of patients who used tape). NSCS scores (P value <.001) and the adopted warming system (P value = .01302) were associated with the occurrence of MARSIs. Incubators seem to be a protective factor for MARSI (OR = 0.048; IC95% = 0.0008-0.75; P value = .013).

CONCLUSION

Adhesive tapes in premature newborns should be considered a risk factor for injuries. Although NSCS showed mild-to-moderate impairment and lesion severity was low, this event is relatively frequent in neonatal units.

RELEVANCE TO CLINICAL PRACTICE

Awareness of the risk associated with adhesive tape application and removal in newborns allow health services to better address the problem by enforcing good practices, elaborating better protocols, qualifying the health care professionals, and potentially selecting softer tapes for neonates.

Analysis of Factors Causing Skin Damage in the Application of Peripherally Inserted Central Catheter in Cancer Patients

Objective

To investigate the related factors of skin damage caused by peripherally inserted central catheter (PICC) in cancer patients.

Methods

It was a retrospective analysis of 202 cancer patients admitted to our hospital from February 2014 to July 2019. 50 cases of PICC-related skin damage and 152 cases of non-skin damage were studied. In addition, multivariate logistic regression analysis was used to determine independent risk factors for PICC-related skin damage, including cancer patients with catheter-related skin damage and patients without skin damage.

Results

50 patients with PICC skin damage (19 males and 31 females) and 152 patients without skin damage (62 males and 90 females) were retrospectively analyzed. The skin damage rate was 24.8%. The analysis of variance results showed that many factors are related to PICC catheter-related skin damage, including hormones (χ²/Z = 4.468, P < 0.05), body mass index (BMI) (χ²/Z = −2.443, P < 0.05), days with tube (χ² = 26.230, P < 0.05), chemotherapy cycle (χ²/Z = 25.638, P < 0.05), and self-care ability (χ²/Z = −1.968, P < 0.05). Logistic regression analysis showed that hormones (odds ratio (OR) = 3.896, P=0.045), BMI (OR = 1.129, P=0.017), days with tube (OR = 0.419, P=0.013), and chemotherapy cycle (OR = 3.302, P=0.028) are independent factors affecting PICC-related skin damage.

Conclusion

The independent influencing factors of skin damage during PICC catheterization are hormones, BMI, number of days with tube, and chemotherapy cycle.

Incidence and Influencing Factors of Medical Adhesive-Related Skin Injury in Critically Ill Patients

OBJECTIVE

To determine the incidence and influencing factors of medical adhesive-related skin injury (MARSI) among ICU patients.

METHODS

Study authors enrolled patients admitted to two ICUs at a class 3, grade A hospital in Beijing between January and June 2018 in this prospective cohort study. A data collection sheet was designed, and the data were collected by querying the electronic medical record and via direct assessment. Univariate and multivariate logistic regression analyses were performed to identify factors that independently influenced MARSI incidence. The STROBE checklist was used.

RESULTS

In total, 39 of 356 patients (27 men and 12 women with an average age of 61.51 ± 17.49 years) developed MARSI, an incidence of 10.96%. The median time from admission to MARSI occurrence was 26 days. Multivariate logistic regression analysis revealed that the ICU length of stay, Braden Scale score, and mechanical ventilation all independently influenced incidence. The Braden Scale score (odds ratio [OR], 0.758; 95% confidence interval [CI], 0.636-0.904; P < .05) was a protective factor against MARSI, with higher scores indicating lower risk. The ICU length of stay (OR, 1.098; 95% CI, 1.061-1.136; P < .05) and mechanical ventilation (OR, 3.373; 95% CI, 0.889-12.795; P < .05) were independent risk factors for MARSI.

CONCLUSIONS

The incidence of MARSI in ICU patients was relatively high. Awareness of MARSI should be increased among medical staff, and proper skin care should be provided to prevent and treat MARSI effectively.

Incidence of and Risk Factors for Medical Adhesive-Related Skin Injuries Among Patients: A Cross-sectional Study

PURPOSE

We explored the incidence of medical adhesive-related skin injuries (MARSIs) that developed in an intensive care unit (ICU) and identified the relevant risk factors associated with these skin injuries.

DESIGN

Cross-sectional.

SUBJECTS AND SETTING

A 29-bed adult general ICU of a tertiary teaching hospital affiliated with Zhejiang University in southeast China.

METHODS

Data regarding MARSIs, skin assessments, and related nursing procedures were collected between January 2018 and May 2018. The incidence of MARSIs was calculated, and the associated risk factors were analyzed using a logistic regression model.

RESULTS

During the study period, 430 patients were evaluated, of which 55 experienced MARSIs (4 prior to hospitalization in our ICU). The overall MARSI incidence rate was 11.86% (51/430); mechanical damage including epidermal stripping (72.7%; 40/55) and skin tears (14.5%; 8/55) was the most common MARSI. Moderate-to-severe edema, hyperthermia, and the use of certain medicines such as immunosuppressants and anticoagulants were independent risk factors for MARSIs.

CONCLUSIONS

Critically ill patients are at a high risk of MARSIs in China. Preventive measures and good clinical nursing practice are needed to ensure patient safety.

Proof of Concept of a Surrogate High-Adhesion Medical Tape Using Photo-Thermal Release for Rapid and Less Painful Removal

Medical tapes often hold critical devices to the skin so having high adhesion for the lifespan of this product is of great importance. However, the removal process is challenging for caregivers and patients alike, often a painful process that can cause medical adhesive-related skin injury (MARSI). By using an industrial thermally sensitive tape, a surrogate photosensitive tape was developed that switched from the equivalent of high-adhesion medical tape to low-adhesion medical tape. This resulted in an 86% reduction in the average peel strength when heated from 45 to 55 °C using a custom test apparatus. To photo-release the prototype tape (PT), a near-infrared (NIR) absorbing layer was painted on the visibly clear thermal-sensitive tape and an NIR optical wand using 15-LEDs (940 nm) with thermal feedback control was designed and tested. Preliminary performance of photo-to-thermal conversion was numerically modeled with transient results matching experimental measurements with 96.8% correspondence. Using the verified energy conversion model of the surrogate photosensitive tape, a new NIR optical wand was designed for rapid and noncontact release of a future medical tape at 10 deg lower than the release temperature (RTemp) of the custom adhesive, called UnTape. Numerical simulations compared to the thermal skin pain threshold of 45 °C predicts photo-release within 1.1 s of NIR exposure (85.5% absorption in PT at &lt; 1.3 W/cm2). The unique properties of the multifunctional UnTape system (tape and portable NIR wand) may allow even stronger skin adhesion for critical medical devices while concurrently reducing the risk of MARSI upon photo release and easy removal.

Central venous access device Securement and dressing effectiveness: The CASCADE pilot randomised controlled trial in the adult intensive care

INTRODUCTION

Central venous access devices (CVADs) are a vital medical device for intensive care (ICU) patients; however, complications and failure are common, yet potentially prevented through effective dressings and securement.

OBJECTIVES/AIMS

The objective of this study was to test the feasibility of a randomised controlled trial (RCT) comparing standard care with three dressing and securement products to prevent CVAD failure. Secondary aims included comparing dressing and securement products on CVAD failure, microbial colonisation, and intervention costs.

METHODS

A single-centre pilot RCT of ICU adult patients requiring CVADs for >24 h were randomised to four groups: (i) sutures plus chlorhexidine gluconate (CHG) dressing (standard care); (ii) standard care plus tissue adhesive (TA); (iii) two sutureless stabilisation devices (SSD) plus CHG dressing; (iv) sutures, CHG disc plus integrated securement dressing (ISD). Descriptive statistics assessed feasibility. Incidence rates (IRs) of CVAD failure were reported, with group differences compared using the Fisher exact and log-rank tests. Cox regression explored univariable risks for failure. A substudy examined bacterial colonisation of catheter tips, dressings, and skin. Cost estimates of the intervention were compared.

RESULTS

A total of 121 participants were randomised. Study feasibility was established with no withdrawal and moderate staff acceptability; however, recruitment was low at 12%. Overall CVAD failure was seen in 14 of 114 (12%) CVADs (19 per 1000 catheter-days); highest in the SSD group (IR: 27.3 per 1000 catheter-days [95% confidence interval {CI}: 11.4-65.6]), followed by the standard care group (IR: 22.3 per 1000 catheter-days [95% CI: 8.38-59.5]) and TA group (IR: 20.6 per 1000 catheter-days [95% CI: 6.66-64.0]), and lowest in the ISD group (IR: 8.8 per 1000 catheter-days [95% CI: 2.19-35.0]). The majority of complications (11/14, 79%) were suspected central line-associated bloodstream infection (CLABSI), of which only one was laboratory confirmed (standard care group). The cost per patient was lowest in the standard care group by an average difference of AUD $14.

CONCLUSION(S)

A large multisite RCT examining forms of securement and dressing is feasible. ISD is the highest priority to test further as it had the lowest failure rate.

TRIAL REGISTRATION

ACTRN12615000667516 PROTOCOL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id = 368765.