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Zinzoni V, Planche L, Le Potier S, Robin L, Le Parco C, Terrat P, Leroyer MH, Atger R, Dauvergne JE, Muller L, Fontaine L, Morand C, Dennemont P, Paillard O, Vastral S, Dardaine B, Le Guillou S, Maquigneau N, Martin S, Lachérade JC. Impact of two endotracheal tube fixation on the incidence of peri-oral lesions: Elastic adhesive strips versus cord in a protective sheath. Study protocol for a cluster cross-over randomized trial. PLoS One 2024; 19:e0297349. [PMID: 38330026 PMCID: PMC10852271 DOI: 10.1371/journal.pone.0297349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/20/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Endotracheal tube fixation in ventilated patients must be appropriate to ensure security during mechanical ventilation and prevent skin lesions. The incidence of endotracheal tube-caused pressure ulcers ranges from 7% to 45%. Various endotracheal tube fixations are used in intensive care units (ICUs) worldwide. By pressure exercised on the skin, these systems could lead to mucosal and skin peri-oral lesions. The main objective of this study is to evaluate the impact of the two fixation systems most commonly used in French ICUs (adhesive elastic band versus fixation cord with PolyVinyl Chloride (PVC) sheath) on the incidence of these peri-oral skin lesions. METHODS This studyis a multicenter, open-label, controlled, superiority, cluster cross-over randomized trial. 768 patients will be recruited in the 16 ICUs involved. The inclusion of patients will be carried out over two 12-month periods. Each site begins with one of the evaluated fixation systems: elastic adhesive tape or cord associated with a protective sheath. After a 4-month break, each site switches to the other fixation system. The primary outcome is the development of at least one peri-oral lesion during the first ten days of maintaining an orally inserted endotracheal tube. The presence of lesions is assessed by a blinded adjudication committee using photographs taken daily. DISCUSSION This study is the first multicenter, randomized trial designed to evaluate the impact of elastic adhesive tape versus fixation cord with PVC sheath on the incidence of peri-oral lesions. The results will provide data which could change and standardize care practices. TRIAL REGISTRATION https://www.clinicaltrials.gov. Reference number: NCT04819425.
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Affiliation(s)
- Vanessa Zinzoni
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
| | - Lucie Planche
- Unité de Recherche Clinique, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
| | - Sophie Le Potier
- Service de Réanimation Polyvalente, Centre Hospitalier Bretagne Sud, Lorient, France
| | - Laurence Robin
- Service de Réanimation Polyvalente, Centre Hospitalier d’Angoulême, Angoulême, France
| | - Cécile Le Parco
- Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Philippe Terrat
- Service de Réanimation, Centre Hospitalier de La Rochelle, La Rochelle, France
| | - Marie-Hélène Leroyer
- Service de Réanimation Médico-Chirurgicale, Centre Hospitalier du Mans, Le Mans, France
| | - Romain Atger
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jérôme E. Dauvergne
- Service d’anesthésie-réanimation, INSERM, CIC 1413, Hôpital Laënnec, Nantes Université, CHU Nantes, Nantes, France
- Institut du Thorax, CNRS, INSERM, Nantes Université, CHU Nantes, Nantes, France
| | - Lucie Muller
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d’Orléans, Orléans, France
| | - Laetitia Fontaine
- Service de Réanimation Médico-Chirurgicale, Centre Hospitalier Intercommunal de Poissy/Saint Germain-en-Laye, Poissy, France
| | - Célina Morand
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Pascaline Dennemont
- Service de Réanimation Polyvalente, Centre Hospitalier Universitaire de la Réunion, Saint-Pierre, La Réunion, France
| | - Ophélie Paillard
- Service de Neuro-réanimation, Centre Hospitalier Universitaire de la Réunion, Saint-Pierre, La Réunion, France
| | - Servane Vastral
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Saint-Nazaire, Saint-Nazaire, France
| | - Baptiste Dardaine
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Sylvie Le Guillou
- Service Anesthésie-Réanimation Chirurgicale, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Natacha Maquigneau
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
| | - Stéphanie Martin
- Unité de Recherche Clinique, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
| | - Jean-Claude Lachérade
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
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Chen G, Li X, Li X, Liu S, Xie J. Mucosal membrane pressure injury in intensive care units: A scoping review. Intensive Crit Care Nurs 2024; 80:103560. [PMID: 37918080 DOI: 10.1016/j.iccn.2023.103560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/11/2023] [Accepted: 09/29/2023] [Indexed: 11/04/2023]
Abstract
AIM To describe published work on the current situation of mucosal membrane pressure injury of patients in the intensive care unit. BACKGROUND Device-related pressure injuries in critically ill patients are mostly focused on skin surface injuries, and less attention is paid to mucosal membrane pressure injury. METHODS We searched PubMed, Embase, Web of Science, CINAHL, and Cochrane Library from database construction until March 1, 2023. Two researchers independently screened and extracted data. RESULTS Eighteen articles met our criteria and were published in 2014-2023. The included studies showed that the incidence of mucosal membrane pressure injury in critically ill patients ranged from 0.83% to 88.2%, and the prevalence ranged from 0.16% to 55.6%. The most frequently reported site of mucosal injury is the oral mucosa, followed by the nasal mucosa. Ten studies used Braden to assess the risk of mucosal membrane pressure injury, and only six studies reported specific stages of mucosal membrane pressure injury. Thirteen studies described 30 risk factors for mucosal membrane pressure injury, with albumin being the most frequently reported risk factor, followed by the vasoconstrictive drugs use. Thirty risk factors were summarized in six aspects: medical device-related factors, disease-related factors, treatment- related factors, physiological and biochemical parameters, demographic-related factors, and microbial colonisation. CONCLUSIONS The incidence or prevalence of mucosal membrane pressure injury varies widely, and specific risk assessment tools and standardized staging criteria need to be further determined. The risk factors of mucosal membrane pressure injury involve multiple aspects, and some risk factors have only been explored in few studies and need to be further verified, in order to detect the risk group of mucosal membrane pressure injury early and take targeted preventive measures. IMPLICATIONS FOR CLINICAL PRACTICE We synthesized the current research status of mucosal membrane pressure injury in critically ill patients, which can provide a valuable reference for the clinical staff to develop preventive and management measures for such patients.
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Affiliation(s)
- Guanjie Chen
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China
| | - Xiaoqing Li
- Department of Nursing, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China.
| | - Xuezhu Li
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China
| | - Songqiao Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China
| | - Jianfeng Xie
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China
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Morata L, Vollman K, Rechter J, Cox J. Manual Prone Positioning in Adults: Reducing the Risk of Harm Through Evidence-Based Practices. Crit Care Nurse 2024; 44:e1-e9. [PMID: 38295861 DOI: 10.4037/ccn2023201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
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Aydım Kudu A, Taşdemir N, Sönmez M. Incidence of medical device-related pressure injuries in the intensive care unit and related risk factors. J Tissue Viability 2023; 32:564-571. [PMID: 37407387 DOI: 10.1016/j.jtv.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/18/2023] [Accepted: 06/16/2023] [Indexed: 07/07/2023]
Abstract
AIM At present, physicians employ medical devices extensively in the treatment of numerous diseases and in the care and follow-up of patients. However, these medical devices are a potential cause of pressure injuries.The study aimed to investigate the incidence and affecting risk factors of medical device-related pressure injuries (MDRPIs) in an adult intensive care unit. MATERIALS AND METHODS This is a longitudinal descriptive/analytical and cross-sectional study. The researchers conducted this study with 213 intensive care patients between 15.06.2021 and 15.12.2021. The skin and mucosa under and around each medical device were observed once a day for MDRPIs during the stay of patients who had been hospitalized in the intensive care unit for at least 24 h. The data were collected using Patient Information Form developed by the researchers based on the literature, Medical Device-Related Pressure Injury Monitoring Form, the Jackson/Cubbin Pressure Area Risk Calculator (Jackson/Cubbin BARHATr)-Turkish Version, the National Pressure Injury Advisory Panel (NPIAP) Pressure Injury Staging System and the Glasgow Coma Scale. RESULTS The incidence of MDRPIs was 28.6% (61/213). The study revealed that 48.4% (46/95) of these injuries were caused by medical devices for respiratory system, 26.3% (25/95) by devices for gastrointestinal and genitourinary system. The study also revealed that 70.5% of MDRPIs occurred on the skin and 29.5% on the mucosal membrane, and that 82.1% of the MDRPIs occurring on the skin were at Stage 1. In terms of anatomical location, 21.1% of these injuries developed on the fingers and 13.7% on the mouth/lip. In multivariate analysis, parenteral + enteral (p = 0.006, OR = 0.083, 95%CI = [0.014-0.497]) and oral nutrition (p = 0.037, OR = 0.210, 95%CI = [0.049-0.908]), a higher number of devices (nine or more) (p = 0.002, OR = 5.387, 95%CI = [1.840-15.772]) and the duration of device wear (p < 0.05) were identified as independent risk factors for the occurrence of MDRPIs. CONCLUSIONS The study showed that the incidence of MDRPIs was relatively high and was associated with various factors. It is critical for intensive care nurses, who encounter MDRPIs more frequently, to consider these factors while caring for their patients and to take appropriate preventive measures to reduce the incidence of these injuries.
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Affiliation(s)
- Aslıhan Aydım Kudu
- Department of Nursing, Zonguldak Bülent Ecevit University Health Sciences Institute, Zonguldak, Turkey.
| | - Nurten Taşdemir
- Zonguldak Bülent Ecevit University, Health Sciences Faculty, Nursing Department, 67000, Zonguldak, Turkey.
| | - Münevver Sönmez
- Faculty of Health Science, Department of Fundamentals of Nursing, Atılım University, 06830, Ankara, Turkey.
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Lyu Y, Huang YL, Li ZY, Lin F. Interventions and strategies to prevent medical device-related pressure injury in adult patients: A systematic review. J Clin Nurs 2023; 32:6863-6878. [PMID: 37300246 DOI: 10.1111/jocn.16790] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/27/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Current evidence shows that medical device-related pressure injury (MDRPI) has a high prevalence (10%) and incidence (12%), and much research has been done to prevent MDRPI in recent years. However, to our knowledge, there is limited systematic review available on interventions and strategies to prevent MDRPI. AIM To synthesise research evidence on interventions and strategies used to prevent MDRPI. METHODS This systematic review adhered to the PRISMA Guidelines. We searched six databases including Medline, CINAHL, EMBASE, Cochrane library, Web of Science and ProQuest with no restriction to year of publication. Data were extracted and checked by two authors independently. A narrative summary technique was used to describe the findings. Implementation strategies were grouped into six classifications: dissemination/implementation process/integration/capacity building/sustainability/scale-up strategies. RESULTS Twenty-four peer-reviewed papers met the inclusion criteria, which comprised of 11 quality improvement projects and 13 original research. Types of devices included respiratory devices (non-invasive ventilation mask, CPAP/BiPAP mask, endotracheal tube), gastrointestinal/urinary devices and other devices. Interventions used included the use of dressing, hyperoxygenated fatty acids, full-face mask, training, and/or multidisciplinary education, use of special securement devices or tube holder, repositioning, application of stockinette, early removal and foam ring use. Common implementation strategies included ongoing staff education, audit and standardising documentation or guideline development. CONCLUSION Much work on MDRPI prevention strategies has been undertaken. There were a variety of devices reported, however, it is evident that higher quality research is needed. RELEVANCE TO CLINICAL PRACTICE Current evidence shows that interventions including use of dressing or special securement device, repositioning, and training/multidisciplinary education can be beneficial for MDRPI prevention. High-quality research, such as randomised controlled trials are needed to test the effectiveness of the interventions and their implementation strategies. No patient or public contribution.
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Affiliation(s)
- Yang Lyu
- Department of Thoracic Surgery, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ya-Ling Huang
- Faculty of Health (Nursing), Southern Cross University, Gold Coast, Queensland, Australia
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Zhao-Yu Li
- School of Nursing, Capital Medical University, Beijing, China
| | - Frances Lin
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
- School of Health, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
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Anis A, Patel R, Tanios MA. Analytical Review of Unplanned Extubation in Intensive Care Units and Recommendation on Multidisciplinary Preventive Approaches. J Intensive Care Med 2023:8850666231199055. [PMID: 37670719 DOI: 10.1177/08850666231199055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Unplanned extubations (UE) frequently occur in critical care units. These events are precipitated by many risk factors and are associated with adverse outcomes for patients. We reviewed the current literature to examine factors related to UE and presented the analysis of 41 articles critical to the topic. Our review has identified specific risk factors that we discuss in this review, such as sedation strategies, physical restraints, endotracheal tube position, and specific nursing care aspects associated with an increased incidence of UE. We recommend interventions to reduce the risk of UE. However, we recommend that bundled rather than a single intervention is likely to yield higher success, given the heterogeneity of factors contributing to increasing the risk of UE.
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Affiliation(s)
- Antonious Anis
- Internal Medicine Residency Program, St. Mary Medical Center, Long Beach, CA, USA
- Critical Care Medicine Fellowship, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Ravi Patel
- Division of Pulmonary Diseases and Critical Care Medicine, University of California, Irvine, CA, USA
| | - Maged A Tanios
- Division of Pulmonary Diseases and Critical Care Medicine, University of California, Irvine, CA, USA
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Lin F, Dawson D. Pressure injury: Reflecting on previous publications in Intensive and Critical Care Nursing and a call for papers. Intensive Crit Care Nurs 2023; 75:103379. [PMID: 36566142 DOI: 10.1016/j.iccn.2022.103379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Frances Lin
- University of the Sunshine Coast, Queensland, Sippy Downs 4556, Queensland, Australia.
| | - Deborah Dawson
- Ventilator Unit, Royal Hospital for Neuro-disability West Hill, London SW15 3SW, United Kingdom.
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Morata L, Vollman K, Rechter J, Cox J. Manual Prone Positioning in Adults: Reducing the Risk of Harm Through Evidence-Based Practices. Crit Care Nurse 2023; 43:59-66. [PMID: 36720277 DOI: 10.4037/ccn2023174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Moser CH, Peeler A, Long R, Schoneboom B, Budhathoki C, Pelosi PP, Brenner MJ, Pandian V. Prevention of Endotracheal Tube-Related Pressure Injury: A Systematic Review and Meta-analysis. Am J Crit Care 2022; 31:416-424. [PMID: 36045034 DOI: 10.4037/ajcc2022644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Hospital-acquired pressure injuries, including those related to airway devices, are a significant source of morbidity in critically ill patients. OBJECTIVE To determine the incidence of endotracheal tube-related pressure injuries in critically ill patients and to evaluate the effectiveness of interventions designed to prevent injury. METHODS MEDLINE, Embase, CINAHL, and the Cochrane Library were searched for studies of pediatric or adult patients in intensive care units that evaluated interventions to reduce endotracheal tube-related pressure injury. Reviewers extracted data on study and patient characteristics, incidence of pressure injury, type and duration of intervention, and outcomes. Risk of bias assessment followed the Cochrane Collaboration's criteria. RESULTS Twelve studies (5 randomized clinical trials, 3 quasi-experimental, 4 observational) representing 9611 adult and 152 pediatric patients met eligibility criteria. The incidence of pressure injury was 4.2% for orotracheal tubes and 21.1% for nasotracheal tubes. Interventions included anchor devices, serial endotracheal tube assessment or repositioning, and barrier dressings for nasotracheal tubes. Meta-analysis revealed that endotracheal tube stabilization was the most effective individual intervention for preventing pressure injury. Nasal alar barrier dressings decreased the incidence of skin or mucosal injury in patients undergoing nasotracheal intubation, and data on effectiveness of serial assessment and repositioning were inconclusive. CONCLUSIONS Airway device-related pressure injuries are common in critically ill patients, and patients with nasotracheal tubes are particularly susceptible to iatrogenic harm. Fastening devices and barrier dressings decrease the incidence of injury. Evidence regarding interventions is limited by lack of standardized assessments.
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Affiliation(s)
- Chandler H Moser
- Chandler H. Moser is a PhD candidate, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Anna Peeler
- Anna Peeler is a PhD candidate, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Robert Long
- Robert Long is chief of anesthesia nursing, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Bruce Schoneboom
- Bruce Schoneboom (retired) was associate dean for Practice, Innovation, and Leadership, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Chakra Budhathoki
- Chakra Budhathoki is a biostatistician, School of Nursing and Biostatistics Core, Johns Hopkins University
| | - Paolo P Pelosi
- Paolo P. Pelosi is a chief professor, Anaesthesia and Intensive Care, and director, Specialty School in Anaesthesiology, University of Genoa, and head of the Anaesthesia and Intensive Care Unit at IRCCS San Martino-IST Hospital, Genoa, Italy
| | - Michael J Brenner
- Michael J. Brenner is an associate professor, Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, and President, Global Tracheostomy Collaborative, Raleigh, North Carolina
| | - Vinciya Pandian
- Vinciya Pandian is an associate professor, School of Nursing and Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University
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Coyer F, Cook JL, Doubrovsky A, Vann A, McNamara G. Exploring medical device-related pressure injuries in a single intensive care setting: A longitudinal point prevalence study. Intensive Crit Care Nurs 2021;:103155. [PMID: 34736833 DOI: 10.1016/j.iccn.2021.103155] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/30/2021] [Accepted: 09/13/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To report longitudinal prevalence rates of device-related pressure injuries in critically ill adult patients in the intensive care unit and to explore the patient characteristics associated with the development of device related pressure injuries. RESEARCH DESIGN A prospective observational design where observations of patients' skin integrity were conducted on one day each week for 52 weeks. SETTING The study was conducted in the 36-bed ICU of a major metropolitan tertiary referral hospital in Queensland, Australia. The sample included all patients aged 18 years or older admitted to the intensive care unit before midnight on the day preceding the observation, with a medical device in situ. MAIN OUTCOME MEASURES The primary outcome measure was device related pressure injuries identified at the weekly observations and defined as a pressure injury found on the skin or mucous membrane with a history of medical device in use at the location of the injury. Patient demographic and clinical characteristics were recorded. RESULTS Over the study period, 11.3% (71/631) of patients developed at least one hospital-acquired DRPI. The most common devices associated with injury were nasogastric/nasojejunal tubes (41%) and endotracheal tubes (27%). Significant predictors of device related pressure injuries were the total number of devices (OR 1.230, 95% CI 1.09-1.38, p < 0.001), the length of time in the ICU (OR 1.05, 95% CI 1.02-1.09, p = 0.003), male sex, (OR 2.099, 95% CI 1.18-3.7, p = 0.012), and increased severity of illness score on admission (OR 1.044, 95% CI 1.01-1.09, p = 0.013). CONCLUSION Device related pressure injuries are an all-too-common iatrogenic problem for this vulnerable patient cohort.
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Margi R, Gefen A. Evaluation of facial tissue stresses under medical devices post application of a cyanoacrylate liquid skin protectant: An integrated experimental-computational study. Int Wound J 2021; 19:615-632. [PMID: 34402167 PMCID: PMC8874053 DOI: 10.1111/iwj.13660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/26/2021] [Accepted: 06/29/2021] [Indexed: 12/21/2022] Open
Abstract
Medical device‐related pressure ulcers (PUs) (injuries) are a subclass of PUs, associated with pressure and/or shear applied by a medical device onto the skin. Clinical application of a cyanoacrylate liquid skin protectant (CLSP) under the contours of skin‐contacting medical devices to shield an intact skin from the sustained mechanical loads that are applied by medical devices is a preventative option, but no computer modelling work has been reported to assess the biomechanical efficacy of such interventions. Here, we investigated the biomechanical protective effect of a polymerised cyanoacrylate coating using three‐dimensional, anatomically realistic finite element models of the ear with oxygen cannula and the mouth with endotracheal attachment device, informed by experimental studies. We have compared tissue stress exposures under the devices at these facial sites between conditions where the cyanoacrylate skin protectant has been applied or where the device was contacting the skin directly, without the shielding of the cyanoacrylate coating. The CLSP considerably reduced the skin stress concentration levels and overall tissue stress exposures under the aforementioned medical devices. This demonstrates strong biomechanical effectiveness of the studied cyanoacrylate‐based skin protectant in prevention of facial medical device‐related injuries at small, curved and thereby difficult to protect facial sites.
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Affiliation(s)
- Raz Margi
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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Çam Yanık T, Altun Uğraş G. Effects of endotracheal tube fixation methods on haemodynamic parameters during endotracheal suction: A single-blind non-randomized clinical trial study. Int J Nurs Pract 2021; 28:e13007. [PMID: 34390084 DOI: 10.1111/ijn.13007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to determine the effect of the methods used in endotracheal tube fixation on haemodynamic parameters (systolic and diastolic blood pressure, heart rate and oxygen saturation) during endotracheal suction. METHODS The sample of this prospective, parallel two-armed, single-blind non-randomized clinical trial study included 86 intubated patients treated in the cardiovascular surgery intensive care unit between September 2016 and December 2017. The endotracheal tube was fixed with tube holders in the intervention group (n = 43), whereas the endotracheal tube was fixed with plasters in the control group (n = 43). The patients' haemodynamic parameters were measured before, during, at the end of suction, and 5 and 15 min after suction. RESULTS In comparison with the patients with plasters, patients with tube holders had significantly lower systolic blood pressure 15 min after endotracheal suction and significantly lower diastolic blood pressure during and at the end of endotracheal suction. Oxygen saturation of the patients with tube holder during, at the end, and following 5 min after endotracheal suction were higher than patients with plaster. Heart rate was not affected during endotracheal suction in both groups. CONCLUSION The study showed the tube holder affected the haemodynamic parameters during endotracheal suction less than the plaster.
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Affiliation(s)
- Tuğba Çam Yanık
- Faculty of Nursing, Department of Surgical Nursing, Mersin University, Mersin, Turkey
| | - Gülay Altun Uğraş
- Faculty of Nursing, Department of Surgical Nursing, Mersin University, Mersin, Turkey
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Fulbrook P, Lovegrove J, Miles S, Isaqi B. Systematic review: Incidence and prevalence of mucous membrane pressure injury in adults admitted to acute hospital settings. Int Wound J 2021; 19:278-293. [PMID: 34128339 PMCID: PMC8762539 DOI: 10.1111/iwj.13629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 12/27/2022] Open
Abstract
Mucous membrane pressure injury (MMPI) is associated with a history of medical device use at the site of injury. The current international guideline recommends they should be reported in incidence and prevalence studies. The aim of this systematic review was to analyse the incidence and prevalence of hospital-acquired MMPI in adults admitted to acute hospital settings. Database searches (EBSCO CINAHL Complete, EBSCO Medline Complete, Embase, Scopus and Web of Science) were undertaken between October 2019 and February 2021, using search terms related to hospital-acquired, mucosal and device-related pressure injury/ulcer incidence and prevalence. Searches were limited to the English language. Articles published between 2008 and 2020, reporting incidence or prevalence of mucous membrane or medical device-related pressure injury in non-interventional samples were selected. Two authors assessed study bias and extracted data, with a third reviewer as arbitrator. Twenty-one studies met inclusion criteria; most provided incidence data. No studies were found that specifically reported MMPI incidence or prevalence. It was possible to calculate incidence or prevalence from four studies; all were in intensive care settings. MMPI incidence of 0.8% and 30.4%, and prevalence of 1.7% and 3.7% were found. One study provided data that enabled calculation of prevalence of 0.1% in a non-intensive care sample. Only one other study provided specific data about MMPI. It is concluded that there is insufficient evidence available to enable estimation of MMPI incidence or prevalence in either acute hospital or intensive care settings.
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Affiliation(s)
- Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Josephine Lovegrove
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Sandra Miles
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia
| | - Ban Isaqi
- College of Dentistry, Hawler Medical University, Erbil, Iraq
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Choi MA, Kim MS, Kim C. Incidence and risk factors of medical device-related pressure injuries among patients undergoing prone position spine surgery in the operating room. J Tissue Viability 2021; 30:331-338. [PMID: 34154878 DOI: 10.1016/j.jtv.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 02/07/2023]
Abstract
AIM We aimed to investigate the incidence rate and risk factors of medical device-related pressure injuries (MDRPIs) among patients undergoing prone position spine surgery. MATERIALS AND METHODS This was a prospective observational study of 147 patients who underwent spine surgery in an orthopaedic hospital in Korea. The incidence of MDRPI according to intrinsic and extrinsic factors was assessed using the independent t-, χ2 -, or Fisher's exact tests. A logistic regression analysis was performed exclusively for MDRPI areas with an incidence rate >5%. RESULTS The mean incidence rate of overall MDRPI was 27.4%, while that of MDRPI by Wilson frame, bi-spectral index, and endotracheal tube (ETT) was 56.5%, 52.4%, and 9.5%, respectively. The risk factors under Wilson frame were operation time and body mass index classification. Compared to their normal weight counterparts, those who were underweight, overweight, and obese had a 46.57(95% CI: 6.37-340.26), 3.96 (95% CI: 1.13-13.86), and 5.60 times (95% CI: 1.62-19.28) higher risk of developing MDRPI, respectively. The risk factors by bi-spectral index were sex, operation time, and the American Society of Anaesthesiologists classification. Compared to ETT intubation of <2 h, the risk of MDRPI increased by 7.16 times (95% CI: 1.35-38.00) and 7.93 times (95% CI: 1.45-43.27) for<3 and ≥3 h' duration, respectively. CONCLUSION The difficulty of device repositioning can increase the incidence of MDRPI, and prolonged surgery was a significant risk factor. Thus, appropriate planning and correct equipment utilization is needed during prone position spine surgeries.
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Affiliation(s)
- Mi Ae Choi
- Master, Unit Manager, Operating Room, Department of Nursing, Busan Korea Hospital, Busan, South Korea
| | - Myoung Soo Kim
- Professor, Department of Nursing, Pukyong National University, Busan, South Korea.
| | - Cheol Kim
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Spine Center, Busan Korea Hospital, Busan, South Korea
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Galetto SGDS, Nascimento ERPD, Hermida PMV, Busanello J, Malfussi LBHD, Lazzari DD. Medical device-related pressure injury prevention in critically ill patients: nursing care. Rev Bras Enferm 2021; 74:e20200062. [PMID: 33950113 DOI: 10.1590/0034-7167-2020-0062] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 10/03/2020] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES to know the care implemented by the nursing team to prevent medical device-related pressure injuries in critically ill patients. METHODS this is a qualitative research conducted with 15 nursing professionals from Intensive Care Unit. Sampling was carried out by theoretical saturation. For data analysis, the Discourse of the Collective Subject technique was used. RESULTS six speeches emerged, whose central ideas were interventions for medical device-related pressure injury prevention: care in fixation; frequent repositioning; protection and padding of body areas in contact; preferences for flexible materials, when available; attention of professionals so that they do not comer under patients; early assessment and removal, when clinically possible. FINAL CONSIDERATIONS nursing care was directed mainly to respiratory devices, catheters in general and monitoring equipment, indicating that professionals have the knowledge to provide safe assistance consistent with the literature.
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Abstract
The incidence rate of pressure injury is a critical nursing quality indicator in clinic care; consequently, factors causing pressure injury are diverse and complex. The early prevention of pressure injury and monitoring of these complex high-risk factors are critical to reduce the patients' pain, prevent further surgical treatment, avoid prolonged hospital stay, decrease the risk of wound infection, and lower associated medical costs and expenses. Although a number of risk assessment scales of pressure injury have been adopted in various countries, their criteria are set for specific populations, which may not be suitable for the medical care systems of other countries. This study constructs three prediction models of inpatient pressure injury using machine learning techniques, including decision tree, logistic regression, and random forest. A total of 11 838 inpatient records were collected, and 30 sets of training samples were adopted for data analysis in the experiment. The experimental results and evaluations of the models suggest that the prediction model built using random forest had most favorable classification performance of 0.845. The critical risk factors for pressure injury identified in this study were skin integrity, systolic blood pressure, expression ability, capillary refill time, and level of consciousness.
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Choi BK, Kim MS, Kim SH. Risk prediction models for the development of oral-mucosal pressure injuries in intubated patients in intensive care units: A prospective observational study. J Tissue Viability 2020; 29:252-257. [PMID: 32800513 DOI: 10.1016/j.jtv.2020.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/04/2020] [Accepted: 06/10/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE Oral-mucosal pressure injury (PI) is the most commonly encountered medical device-related PIs. This study was performed to identify risk factors and construct a risk prediction model for oral-mucosal PI development in intubated patients in the intensive care unit. METHODS The study design was prospective, observational with medical record review. The inclusion criteria stipulated that 1) participants should be > 18 years of age, 2) there should be ETT use with holding methods including adhesive tape, gauze tying, and commercial devices. Data of 194 patient-days were analysed. The identification and validation of risk model development was performed using SPSS and the SciKit learn platform. RESULTS The risk prediction logistic models were composed of three factors (bite-block/airway, commercial ETT holder, and corticosteroid use) for lower oral-mucosal PI development and four factors (commercial ETT holder, vasopressor use, haematocrit, and serum albumin level) for upper oral-mucosal PI development among 10 significant input variables. The sensitivity and specificity for lower oral-mucosal PI development were 85.2% and 76.0%, respectively, and those for upper oral-mucosal PI development were 60.0% and 89.1%, respectively. Based on the results of the machine learning, the upper oral-mucosal PI development model had an accuracy of 79%, F1 score of 88%, precision of 86%, and recall of 91%. CONCLUSIONS The development of lower oral-mucosal PIs is affected by immobility-related factors and corticosteroid use, and that of upper oral-mucosal PIs by undernutrition-related factors and ETT holder use. The high sensitivities of the two logit models comprise important minimum data for positively predicting oral-mucosal PIs.
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Affiliation(s)
- Byung Kwan Choi
- Department of Neurosurgery, College of Medicine, Pusan National University, Busan, South Korea.
| | - Myoung Soo Kim
- Department of Nursing, Pukyong National University, Busan, South Korea.
| | - Soo Hyun Kim
- The Artificial Kidney Room, Busan Medical Center, Busan, South Korea.
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Kuniavsky M, Vilenchik E, Lubanetz A. Under (less) pressure – Facial pressure ulcer development in ventilated ICU patients: A prospective comparative study comparing two types of endotracheal tube fixations. Intensive Crit Care Nurs 2020; 58:102804. [DOI: 10.1016/j.iccn.2020.102804] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/18/2019] [Accepted: 01/17/2020] [Indexed: 11/28/2022]
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Affiliation(s)
- Dominik Greda
- Department of Head and Neck Surgery and Communication Sciences, Duke University Health System, Durham, North Carolina, USA
| | - David Straka
- Department of Head and Neck Surgery and Communication Sciences, Duke University Health System, Durham, North Carolina, USA
| | - Matthew Cooper
- Department of Head and Neck Surgery and Communication Sciences, Duke University Health System, Durham, North Carolina, USA
| | - Russel Kahmke
- Department of Head and Neck Surgery and Communication Sciences, Duke University Health System, Durham, North Carolina, USA
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Amrani G, Gefen A. Which endotracheal tube location minimises the device-related pressure ulcer risk: The centre or a corner of the mouth? Int Wound J 2019; 17:268-276. [PMID: 31724822 DOI: 10.1111/iwj.13267] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 02/07/2023] Open
Abstract
The use of an endotracheal tube (ETT), which is required for any mechanical ventilation procedure, involves an inherent risk for facial skin, lip, and mucosal pressure ulcers. The ETT is one of the most common devices associated with medical device-related pressure ulcers (MDRPUs) among surgical and intensive care unit patients. In the present work, we investigated, for the first time in the literature, the biomechanical effects of the presence and positioning of an ETT in the mouth on lip, mucosal and surrounding facial skin loads. Using two anatomically realistic finite element model variants, two ETT locations were simulated and compared, at the centre versus the corner of the mouth. Our study shows that a central location of the ETT inflicted greater lip and mucosal stress values, but a corner location caused a more widespread and diffused lip, mucosal and facial skin stress exposure. Accordingly, we cannot recommend a "safer" location for ETTs in the mouth; additional preventative measures such as dedicated dressing materials or special cushioning pads applied prophylactically, should be developed to protect from MDRPUs associated with ETT usage. The present modelling framework can be used to study the biomechanical efficacy of such protective technologies, and can therefore aid in the prevention of ETT-caused MDRPUs.
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Affiliation(s)
- Golan Amrani
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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Kim CH, Kim MS, Kang MJ, Kim HH, Park NJ, Jung HK. Oral mucosa pressure ulcers in intensive care unit patients: A preliminary observational study of incidence and risk factors. J Tissue Viability 2018; 28:27-34. [PMID: 30551969 DOI: 10.1016/j.jtv.2018.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 11/03/2018] [Accepted: 11/28/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE This study examined the incidence of oral mucosa pressure ulcers (PUs) in intensive care unit (ICU) patients and the relationship between biomechanical and physiological variables in onset of PUs. METHODS A prospective observational descriptive study design was used. We recruited patients over 18 years of age with endotracheal tube (ETT) insertion in three ICUs in a tertiary hospital in Korea. We analysed 113 patient-days of data. Patient assessments and medical record reviews were conducted to gather biomechanical and physiological data. Fisher's exact tests and χ2 test and Spearman's rank correlations were used to compare data. RESULTS The highest incidence of oral mucosa PUs occurred in lower oral mucosa (36.3%). There was a significant relationship between lower oral mucosa PU stage and bite-block or airway use (r = .20, p = .036), commercial ETT holder use (r = 0.19, p = .048), sedative use (r = -0.22, p = .022), and plasma protein (r = 0.20, p = .033). Upper oral mucosa PU stage was related to commercial ETT holder use (r = 0.19, p = .044), haemoglobin(r = 0.24, p = .011), haematocrit (r = 0.27, p = .004), and serum albumin (r = -0.24, p = .012). Stage was related to commercial ETT holder use in both sites (r = 0.28, p = .003), haematocrit (r = 0.19, p = .039), and serum albumin (r = -0.23, p = .015). CONCLUSION Oral mucosa PUs developed more frequently and healed more quickly than general skin PUs. Taken together, these data indicate that biomechanical and haematological variables are risk factors associated with PU incidence should be considered in intensive care patients.
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Affiliation(s)
- Chul-Hoon Kim
- Department of Oral and Maxillofacial Surgery, College of Medicine, Dong-A University, Busan, South Korea
| | - Myoung Soo Kim
- Department of Nursing, Pukyong National University, Busan, South Korea.
| | - Myung Ja Kang
- Department of Nursing, Pukyong National University, Busan, South Korea
| | - Hyun Hee Kim
- Respiratory Intensive Care Unit, Pusan National University Hospital, Busan, South Korea
| | - Nam Jung Park
- Infection Control Team, Pusan National University Hospital, Busan, South Korea
| | - Hyun Kyeong Jung
- Urology Ward, Pusan National University Hospital, Busan, South Korea
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