Device-related Pressure Research Articles

Medical Device-Related Pressure Injuries in Infants and Children.

The purpose of this study was to describe medical device-related pressure injuries (MDRPIs) in hospitalized pediatric patients. A prospective, descriptive study. The sample comprised 625 patients cared for in 8 US pediatric hospitals. Participants were aged preterm to 21 years, on bed rest for at least 24 hours, and had a medical device in place. Two nursing teams, blinded to the other's assessments, worked in tandem to assess pressure injury risk, type of medical devices in use, and preventive interventions for each medical device. They also identified the presence, location, and stage of MDRPI. Subjects were observed up to 8 times over 4 weeks, or until discharge, whichever occurred first. Of 625 enrolled patients, 42 (7%) developed 1 or more MDRPIs. Two-thirds of patients with MDRPIs were younger than 8 years. Patients experiencing MDRPIs had higher acuity scores on hospital admission, were more frequently cognitively and/or functionally impaired, or were extreme in body mass index. Respiratory devices caused the most injuries (6.19/1000 device-days), followed by immobilizers (2.40/1000 device-days), gastric tubes (2.24/1000 device-days), and external monitoring devices (1.77/1000 device-days). Of the 6336 devices in place, 36% did not have an MDRPI preventive intervention in place. Clinical variables contributing to MDRPI development included intensive care unit care (odds ratio [OR] 8.9, 95% confidence interval [CI] 1.9-43.6), use of neuromuscular blockade (OR 3.7, 95% CI 1.7-7.8), and inotropic/vasopressor medications (OR 2.7, 95% CI 1.7-4.3). Multivariable analysis indicated that Braden QD scores alone predicted MDRPI development. Medical devices are common in hospitalized infants and children and these medical devices place patients at risk for MDRPI.

Medical Device-Related Pressure Injuries During the COVID-19 Pandemic.

BACKGROUND:Medical device–related pressure injuries (MDRPIs) account for more than 30% of all hospital-acquired pressure injuries. The COVID-19 pandemic introduced a large population of patients at risk for MDRPIs due to prolonged intubation and prone positioning. We reviewed our experience with MDRPIs during the 2020 COVID-19 pandemic at an Academic Medical Center.CASES:We evaluated 30 cases of MDRPIs acquired during the peak of our pandemic, April 1 to May 31, 2020, and compared these to injuries seen over a similar time period prior to the pandemic.CONCLUSIONS:Our experiences with MDRPIs during this time has led the WOC team to begin development of a quality improvement project aimed at improving management of high-risk respiratory illness patients requiring intubation and prone positioning.

Nursing strategies for the facial skin injuries caused by wearing medical-grade protective equipment

For effective resistance to virus attack and infection and reducing virus transmission chance, it is extremely important for the medical staff and related workers to have their own safe protection. The paper summarizes the occurrence causes, common locations, and prevention ways about the device related pressure ulcers on the face resulted from wearing medical-grade protective equipment for a long working time. The paper proposes the prevention and nursing strategies for device related pressure ulcers and other related skin injuries during application of medical-grade protective equipment. The paper aims to provide reference for the prevention and nursing of device related pressure ulcers and related skin diseases for clinical medical staff, especially to the respectable personnel in front line of fighting against coronavirus disease 2019.

Urgent recommendation protective measures of West China Hospital for medical personnel to prevent device related pressure injuries in 2019-nCoV epidemic situation

At present, the 2019-nCoV epidemic situation is in severe and complex period. In order to prevent the virus from invading and infecting, it is very important and urgent for medical personnel to protect themselves. However, in the process of using protective equipment by medical personnel, the performance of device related pressure injuries (DRPI) caused by pain, numbness, redness, and even breakage caused by the equipment has seriously endangered the health of medical personnel. This article, based on Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide 2019, references, and clinical experiences of wound specialists in West China Hospital of Sichuan University, summarize the preventive and protective measures of West China Hospital for medical personnel to prevent DRPI, so as to provide clinical preventive measurements for medical personnel.

Pressure Injury.

Pressure injury is seen across all healthcare settings and affects people of any age and health condition. It imposes a significant burden, with annual costs of up to $17.8 billion in the United States alone. Despite considerable resources it exhausts, the disease remains very prevalent, and the incidence is on the rise. This is in part due to aging population, growing number of nursing home residents, poorly understood biology, and dismal track record of clinical research in this field. In our Review Article, we discuss the disease pathophysiology, clinical manifestation, evidence based recommendations for risk assessment, prevention and timely management, existing challenges, and directions to improve research on the field. This article encompasses dedicated sections on the full spectrum of the pressure related pathologies including "conventional pressure ulcers", "medical device related pressure injuries", "pressure injuries in mucosal membranes", "pressure injuries in pediatric population", "pressure injury at end of life", and the "role of pressure in pathogenesis of diabetic foot ulcers".

Prevention and Treatment of Device-Related Hospital-Acquired Pressure Injuries.

Prevention and Treatment of Device-Related Hospital-Acquired Pressure Injuries.

Relationship between skin moisture and medical device related pressure injury (MDRPI) in intensive care units: Prospective study

To determine the relationship between skin moisture and the incidence of medical devices related to pressure injury (MDRPI). This was a prospective study in an intensive care unit. Measurement of changes in skin moisture is measured every two days until thirteenth. The skin moisture status between no MDRPI and presence of MDRPI analyzed using independent t-test. The independent t-test confirmed no difference of skin moisture between no MDRPI group (the range of moisture: 28.81±2.68 to 32.38±5.44) and presence MDRPI group (the range of moisture: 27.67±2.02 to 31.93±2.21) for intervention devices and presence MDRPI group (the range of moisture: 27.06±4.33 to 40.53±32.53) and presence MDRPI group (the range of moisture: 27.50±1.51 to 34.79±12.58) for intervention devices. Current study indicates the role of skin moisture in development of MDRPI remains unanswered.

Prevention and treatment strategy for skin injury of medical staff cased by COVID-19 protective device: a review

Among nurses and physicians against 2019-novel coronavirus (2019-nCoV), the skin injury caused by protective devicemainly manifests in skin pressure injury in head and face,moisture-associatedskin injury in hands and feet, armpit related to skin dipping which becomes the main issues puzzling health of nurses and physicians.This paper analyzed the clinical characteristics and causes, and proposed the prevention and treatment strategy on the view point evidence-based medicine so as to provide a reference for effectively preventing and curing those skin injuries. Key words: COVID-19; Medical device relatedpressure injury; Moisture-associated skin injury; Prevention and treatment

Strategy of nursing care on the face skin injuries caused by wearing medical-grade protective equipment

For effective resistance to virus attack and infection, reducing virus transmission chance, it is extremely important for the medical staff and related workers to have their own safe protection. This paper summarizes the development causes, common locations, and prevention ways about the device related pressure injuries on the face resulted from wearing medical-grade protective equipment for a long working time. The paper proposes the nursing strategy for device related pressure injuries and other nursing strategy is proposed to take care efficiently the device related pressure injuries. Meantime, a corresponding nursing strategy is also suggested to deal with the correlative skin diseases during the application of medical-grade protective equipment. These paper aims to provide reference for the prevention of device related pressure injuries and the care of skin-related diseases for clinical working staff, especially to the respectable personnel in front line of fighting against Corona virus disease 2019.

Securing Orogastic and Nasogastric Tubes in Intubated Patients

Securing Orogastic and Nasogastric Tubes in Intubated Patients

Clinical Nurse Specialist–Facilitated Collaborative Skin Assessments for Respiratory Care Devices

Purpose/Aim: To evaluate a collaborative skin assessment intervention between respiratory therapists and registered nurses. Design: A quality improvement design was used to determine feasibility of a collaborative skin assessment. Methods: The collaborative skin assessment intervention included skin assessments, documentation of findings, and use of a treatment guideline for patients using a respiratory care device. Perceptions of the collaborative intervention and pressure injury numbers were measured after a 2-month intervention period. Results: Respiratory therapists and registered nurses reported satisfaction with the collaborative intervention; stating it was best practice and could prevent respiratory care device–related pressure injuries. However, timing the skin assessment together was difficult. One device-related pressure injury occurred during the intervention period. Conclusions: Respiratory therapists and nurses should partner to perform skin assessments under respiratory devices each shift and develop a plan of care to prevent skin injury. Protocol orders to prevent and treat skin alterations found under respiratory care devices and a dedicated area in the medical record to document skin assessments may be helpful to support efforts to prevent injuries. Additionally, as a result of these efforts, pressure injuries specific to endotracheal tubes declined greater than 50% in 2 critical care units in the year following this quality improvement project.

Finite element analysis to model ischemia experienced in the development of device related pressure ulcers.

Pressure ulcers are a common occurrence of damage to skin. Severity ranges from slightly discoloured skin to full thickness tissue damage which can be fatal in some cases. Engineering effort, typically developing computational models had made significant progress in the understanding and demonstration of the formation mechanism of pressure ulcers with the aetiology of excessive stress; however, relatively limited attempts had been made to develop relevant models for pressure ulcers caused by ischemia. The aim of this article is to present evidence of a computational model developed to simulate ischemic pressure ulcer formation and demonstrate the established relationship between the computational data and the acquired clinically relevant experimental data by utilising Laser Doppler Velocimetry. The application of the presented computational model and the established relationship allows the evaluation of the effect of a mechanical loading to the cutaneous blood flow velocity which is a step closer to understand and evaluate a mechanical load to the formation of pressure ulcers caused by ischemia.

Application effect of early warning management in medical device related stress injury

Objective To explore the application effect of early warning management in medical device related stress injury. Methods A total of 57 patients with high risk of stress injury reported in the coronary heart disease ICU of the hospital from June 2015 to May 2016 were selected as the control group, and routine management methods were adopted for nursing. 54 patients with high risk of stress injury reported from June 2016 to May 2017 were selected as the experimental group, and early warning management was adopted for nursing.The incidence of pressure injury related to medical devices was compared between the two groups before and after the implementation of early warning management. Results In the control group, 5 patients suffered from medical device-related stress injury, with an incidence of 8.8%.In the experimental group, 2 patients had medical device-related stress injury, with an incidence of 3.7%.The incidence of pressure injury related to medical devices was compared between the two groups, and the difference was statistically significant(P<0.05). Conclusions Early warning management can effectively reduce the incidence of medical device-related stress injury, which is worthy of clinical application. Key words: Warning management; Medical device related pressure injury; Effect

MDRPU -an uncommonly recognized common problem in ICU: A point prevalence study

BackgroundPressure ulcers (PU) usually occur over bony prominences in hospitalized patients. But they may occur due to medical devices referred also as Medical device related pressure ulcers (MDRPU). The United States National advisory panel (NPUAP) recognizes it as an important entity. MDRPU is one of the key quality indicators of hospital care, so far no data is available on MDRPU from the Indian Sub-continent. AimThe primary objective of the study was to examine prevalence and Risk factors of MDRPU in critically sick patients. DesignA Cross-sectional point prevalence study. MethodsAll patients above 18 years of age admitted in Intensive care units (ICU) on the date of the survey were included in the study. It was conducted in medical, cardiothoracic and neurosurgical ICUs. Demographic and MDRPU data were recorded. MDRPU was staged as per National Pressure ulcer advisory panel staging system. Ethics Committee approval was obtained prior to the start of the study. ResultsOne hundred and forty-six patients were included. The prevalence of PU was 26.0%. The prevalence of MDRPU was found to be 19.2%. MDRPUs most commonly occurred with non-invasive ventilation mask (NIV) and nasogastric tube (NGT) (20% and 12.3% respectively). MDRPUs were associated with a longer ICU Stay. ConclusionsMDRPUs pose a significant burden on healthcare. Our study showed significant prevalence rate of MDRPU which is comparable to those seen internationally. There is a compelling need to have continuous audits and structured training programs among healthcare professionals to prevent MDRPUs in critically sick patients.

Application of foam dressings in preventing medical device related pressure injuries in patients with neck fixation

Objective To observe the effects of foam dressings on preventing medical device related pressure injuries in patients with neck fixation. Methods Totally 156 patients who received neck fixation in Xingtai People's Hospital between January and June 2017 were selected and equally randomized into the towel group, the hydrocolloid group and the foam dressing group (n=52) depending on different protective materials used on the interface between neck fixation and skin. The incidence and severity of local pressure injuries on the neck and the auricle were compared between the three groups. Results There were no phase-2 local pressure injuries on the neck or the auricle in any patient in the three groups; the incidences of pressure injuries in the foam dressing group, the towel group and the hydrocolloid group were 15.38%, 56.60% and 41.18%, respectively (χ2=20.008, P<0.001) . Conclusions Foam dressings can effectively prevent the incidence of medical device related pressure injuries in patients with neck fixation. Key words: Pressure ulcer; Foam dressing; Neck fixation; Medical device related

Application of Care Bundles to Reduce Medical-Device-Related Pressure Injury (MDRPI) Incidence in a Coronary Care Unit

Pressure injuries increase the cost of medical care and prolong hospitalization. The incidence of pressure injury at the target coronary care unit (CCU) from January to August 2016 was 1.1%, which was significantly higher than the 0.4% defined in the 2015 Taiwan Clinical Performance Indicators (TCPI) system. Medical device related pressure injury (MDRPI) accounted for 73.1% of the pressure injuries (incidence: 0.8%). The main causes of the high incidence of MDRPI were: (1) inadequate decompression dressing and restraint equipment, (2) incomplete implementation of prevention interventions in the CCU, (3) inadequate knowledge of MDRPI prevention among nurses, (4) deficient standards for preventing MDRPI, (5) ineffective MDRPI-related education, and (6) insufficient auditing frequencies. To reduce the incidence of MDRPI in the target CCU to 0.4% or less. Promote a seed-teacher system and a care bundle that "increased skin tolerance, decompression, medical dressing, change, and removal" using education, the adoption of PE-foam binding gloves, and regular audits. The incidence of MDRPI was reduced from 0.8% to 0.3% between October 2016 and April 2017 and further reduced to 0.1% during the maintenance phase between May and July 2017. The results indicate that the improvement program effectively reduced the incidence of MDRPI and thus increased the quality of nursing care. Therefore, the use of a care bundles should be promoted in intensive care units.

Medical Device Related Pressure Injury in the Treatment of Chronic Pain: An Early Sign of Explantation in Suspected Infection

Chronic back pain is a prevalent disease and has a high impact in daily life. Implantable devices (IDs) for chronic pain management include spinal cord stimulation (SCS) systems and intrathecal drug delivery (ITDD) pumps. The number of ITDD implants have increased exponentially in the last decade. The number of complications, such as infections, are also more prevalent. Infection management guidelines are needed to standarize our clinical practice and define protocols of explantation. The primary outcome is to define the likelihood of device explantation regarding some covariates related to the patient, antibiotic therapy or surgerical procedures. The secondary outcome is to evaluate performance compared to the results published in the literature. Retrospective study. Hospital General of Valencia. Valencia. Spain. A retrospective study of 288 implantable device surgeries was conducted at the Hospital General Universitary of Valencia (Spain) from 1994 to 2015. Demographical and infection data were collected. We have followed the "guidelines for the diagnosis, prevention and management of implantable electronic cardiac device infection" due to the lack of a specific guideline in our field. Forty-three out of 288 procedures were identified as suspected device-infected interventions. Half of the patients had microbiologically confirmed infection after wound, blood or lumbar fluid culture. The odds ratio (OR) for explantation of the device was 19 for the presence of decubitus, a sign of medical device related pressure injury (P < 0.0005) and 5 for positive wound culture (P < 0.0452). Medical indication leading to device implantation and the antibiotics on discharge also played a role in the decision of device explantation. Lack of external validity and others. In this study, presence of decubitus is the defining variable for device explantation when a infection is suspected rather than waiting to culture results. Due to a high variability in infection rates, multidisciplinary guidelines are needed to provide an approach that focuses on accurate data monitoring, rigurous implantation technique and standardized protocols. Chronic pain, spinal cord stimulation infection, neurostimulator, intrathecal drug delivery pump, complication, infection, explantation.

A clinical study on blood oxygenation changes in SpO2 monitoring induced medical device related pressure injury tissues in children patients

Objective To evaluate the oxygenation changes in medical device related pressure injury (MDRPI) tissues in children patients induced in SpO2 monitoring, and to provide prevention, nursing and intervention measures for SpO2 induced MDRPI in early clinical stages. Methods Totally 118 critical children patients who were admitted in the Medical Extensive Care Unit of Zhengzhou Children's Hospital between January and December 2016 were randomly selected. The oxygen saturation (rSQ2) of SpO2 monitoring induced MDRPI tissues in these children patients were monitored with near-infrared spectrometer in combination with their critical illness scores and nursing interventions. Results The lower the critical illness score, the lower the rSQ2 was (F=24.65, 3.90, 79.45; P<0.05) . The rSQ2 in children patients with SpO2 induced MDRPI increased gradually alongside the nursing interventions, but was still lower than the level in children patients without SpO2 induced MDRPI (t=48.87, 30.03, 25.49, 14.36; P<0.05) . Conclusions The pressure of related medical devices on local tissues which leads to ischemia-hypoxia and oxygenation changes is an important cause of SpO2 induced MDRPI, and near-infrared spectroscopy may be used to monitor and evaluate the blood oxygen in SpO2 induced MDRPI tissues. Key words: Near-infrared spectroscopy; SpO2; Medical device related pressure injury; Tissue oxygenation

Device Related Pressure Ulcers Pre and Post Identification and Intervention

ProblemFrom 2014 to 2016, device related pressure injuries accounted for 62–81% of all hospital acquired pressure injuries. From January to June 2014, there were 5 BiPAP/CPAP pressure injuries noted, accounting for 3.579 injuries per 1000 ventilator days. In 2015, hospital data revealed that 26.5% of all hospital acquired pressure injuries occurred to prone surgical spine patients. MethodsCollaborative teams including respiratory therapists and operating room staff were convened and crafted new strategies. InterventionsAdhesive foam dressings on patient faces with BiPAP/CPAP masks and prior to orthopedic spinal surgery were used to prevent device and operating room positioning pressure injuries. ResultsFrom July to December 2014 there were 0 BiPAP/CPAP pressure injuries. After interventions in March of 2016 through the remainder of 2016, zero pressure injuries occurred when the adhesive foam dressings were applied to the potential pressure injury areas pre-operatively. ConclusionsWe used real time patient data to drive efforts and create a new culture in the pediatric setting that honors critical airway maintenance, operative room positioning, and preventative skin protection.

Preventing Pressure Injuries in Neonates Undergoing Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy: An Interprofessional Quality Improvement Project.

Hospital-acquired pressure injuries (HAPIs) can be caused by multiple factors including pressure, shear, friction, moisture/incontinence, device-related pressure, immobility, inactivity, and nutritional deficits. Along with immobility, medical device-related (MDR) HAPIs are a primary cause of pressure injury in neonates, as the clinical practice setting has become increasingly technologically advanced. It is estimated that up to 50% of HAPIs are MDR in pediatric patients. Neonates are at particular risk for HAPI because of their specific anatomical, physiological, and developmental vulnerabilities. A specific example of confluent factors that may increase risk for HAPI is the application of therapeutic hypothermia (TH) and continuous electroencephalography monitoring for neonates with hypoxic-ischemic encephalopathy (HIE). An interprofessional team collaborated to expand upon existing evidence-based standards of care to address the needs of this specific population within the neonatal intensive care unit (NICU). Interventions centered on revision of current protocols, with efforts to optimize product selection, hardwire assessment practices, and refine documentation of patient care and outcomes. The team primarily utilized plan-do-study-act (PDSA) cycles to test and refine specific methods and strategies to reduce HAPIs. Tested solutions were adopted, adapted, or abandoned. A sustained zero HAPI rate in the HIE population resulted. The team continues to collect, report, and utilize near-miss data to continue to refine the process as new risks are identified. Recognizing the unique skin protection needs of special populations within the NICU, such as those undergoing TH, is crucial. When evidence-based standards of care fail to adequately meet such needs, a collaborative approach to identifying, testing, and implementing population-specific solutions is essential. A paucity of literature regarding the unique skin protection needs for babies undergoing TH exists. Work should be done to better describe the influence of TH on skin integrity, with the goal of identifying population-specific protective measures.