Medical Adhesive-related Skin Injury Research Articles

Proper Surgical Dressing Removal Technique in Obstetrics and Gynecology.

Medical adhesive-related skin injury is often caused by improper technique in removing surgical dressings and may lead to pain, infection, delayed healing, and litigation. It is rare for obstetrics and gynecology residents and staff to receive any training regarding the proper technique for removing surgical dressings. The proper technique for the removal of adhesive dressings is discussed, minimizing patient discomfort and lessening the risk of skin injury. A video is included. By using a slow rate of removal, the proper angle of traction, counter-traction with an index finger, and adhesive solvents when necessary, patients experience much less pain with dressing removal, and skin injury can be avoided. Using proper technique when removing adhesive dressings can reduce the incidence of skin injury. Obstetrician-gynecologists should be cognizant of the risk of iatrogenic medical adhesive-related skin injury.

Minimising pain and medical adhesive related skin injuries in vulnerable patients.

The skin is the largest and one of the most important organs of the body and as such it is essential that skin integrity is maintained to preserve normal body functions as much as possible at all times. Health professionals must endeavour to minimise any pain and trauma likely to be encountered by their patients through the use of a variety of medical products and devices that are designed to adhere to the skin, especially as the use of dermatological and wound-management products in particular, that incorporate adhesives to help keep them secure and in place, has grown in line with the increasingly ageing population and changing demographics throughout the UK. This article reviews the literature related to the causes of medical-adhesive-related skin injuries (MARSIs) and the reported patient effects, in particular pain and skin trauma and highlight some 'at-risk' patient groups and potential actions to minimise risk. A sterile silicone medical adhesive remover-Appeel Sterile-is introduced and the clinical benefits highlighted through the discussion of clinical evidence and case studies undertaken on a range of patients with varied aetiologies.

Skin considerations for older adults with wounds.

Ageing leads to a number of skin changes that not only place an older adult at risk of tissue damage, but can present as peri-wound problems for those with existing wounds, for example, incontinence-associated and moisture-associated dermatitis in individuals with pressure ulcers. Older adults with venous disease experience skin changes concomitant with venous hypertension, making the skin more at risk of breakdown, specifically the common complications of lipodermatosclerosis and venous eczema. In individuals with diabetic foot disease, skin changes related to autonomic neuropathy mean patients can experience dry skin that cracks easily, placing them at higher risk of infection. Common to all individuals with wounds requiring some sort of dressing is the risk of medical adhesive-related skin injury, where dressing application and removal need to be of the utmost priority to reduce the risk of injury. This article discusses some of the common peri-wound skin considerations in patients with chronic wounds.

Medical Adhesive-Related Skin Injuries and Associated Risk Factors in a Pediatric Intensive Care Unit.

To investigate the prevalence of medical adhesive-related skin injuries (MARSIs) and associated risk factors in a pediatric ICU (PICU). A cross-sectional design was adopted in the PICU of a university-based children's hospital in eastern China. A total of 232 patients were enrolled, and 611 person-days were analyzed. Researchers assessed all patients daily for 2 weeks. The use of adhesives and prevalence of MARSIs were recorded. The patients' clinical data were also collected. The prevalence of MARSIs was calculated daily, and the risk factors were examined statistically. The MARSI prevalence ranged from 23.53% to 54.17% (mean, 37.15%). Multivariate analysis identified being female, age 2 years or younger, hospital stays longer than 5 days, infection, edema, and surgery as independent risk factors. Prevalence by product ranged from 19 to 53 per 1,000 product-days with a mean of 34 MARSIs per 1,000 product-days. The major MARSI types were epidermal stripping and skin tear. The face was the most common MARSI site, and tracheal intubation was the most common inciting condition. Implicated products were acrylate tapes with elastic cloth backings. Researchers concluded that MARSI is common in the PICU. Skin stripping and skin tear were the most common types, and the face was the most vulnerable site for MARSI, typically attributable to the cloth tape used to affix tracheal intubation. Careful attention should be paid to children with identified risk factors (females, age 2 years or younger, longer hospital stays, edema, infection, or surgery).

Appeel® Sterile silicone medical adhesive remover may reduce the incidence of medical adhesive related skin injuries.

Appeel® Sterile silicone medical adhesive remover may reduce the incidence of medical adhesive related skin injuries.

Establishment and effect of extended nursing service model for outpatient intravenous treatment

Objective To establish an extended nursing service model for intravenous treatment in outpatient, so that patients with venous catheters nearby can receive catheter maintenance, which can reduce the medical cost and the incidence of complications during the maintenance of the catheters. Methods A three-level network of catheter maintenance was established in the area to evaluate the rate of return maintenance and the incidence of complications [catheter-related infection, medical adhesive-related skin injuries (MARSI) and catheter blockage] during catheterization. Results The rate of patient return maintenance as statistically significant between the first half of 2015 and the second half of 2016 (60.0% vs. 29.7%, P=0.000). Compared with the first half of 2015, the incidence of catheter-related infections decreased in the second half of 2016 from 8.6% to 3.3%, the incidence of MARSI decreased from 29.7% to 10.1%, and the incidence of catheter blockage decreased from 8.5% to 0.6%. (All P=0.000). Conclusion The comprehensive extended service mode for outpatient with venous catheters can reduce the incidence of complications during catheter maintenance, which can reduce the workload of outpatient intravenous treatment and also provide patients the convenience of catheter maintenance, and is worthy of clinical promotion. Key words: Outpatient intravenous treatment; Extended nursing service model; Complication of catherer maintenance

Multivariate analysis of medical adhesive-related skin injury in peripherally inserted central catheter implanted patients with lung cancer

Objective To analyze prevalence and determinants of medical adhesive-related skin injury (MARSI) in peripherally inserted central catheter implanted patients with lung cancer, to create evidence for improved clinical care. Methods A cross-sectional observational study design was adopted. Skin pictures and electronic medical records of 200 lung cancer patients who visited Shanghai Chest Hospital for PICC between June 2017 and September 2017 were analyzed to calculate prevalence of MARSI and identify related factors. Results The prevalence of MARSI was 31.5% (63/200), and mechanical trauma accounted for 50.8% of all cases (32/63). Age, diabetes and anaphylaxis were significantly related to MARSI. Conclusion Analysis of MARSI in PICC implanted patients with lung cancer provided evidence for improved clinical care of such patients. Key words: Peripherally inserted central catheter; Medical adhesive-related; Skin injury

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

The aim of our study was to identify the prevalence and risk factors of medical adhesive-related skin injuries (MARSI) at peripherally inserted central catheters (PICC) insertion site in oncology patients. A cross-sectional observational study lasting two weeks was carried out in four inpatient departments. Skin assessment data and photographs of skin were collected during PICC maintenance. Other related information came from medical records. The skin injuries were classified by dermatologists and PICC specialized nurses. MARSI prevalence was calculated and the associated factors were analyzed statistically. All 419 patients were included. The prevalence of total MARSI at PICC insertion site was 125, (29.83%), including mechanical skin injury (73, 17.42%), contact dermatitis (CD) (39, 9.31%), moisture-associated skin damage (11, 2.63%), folliculitis (2, 0.48%). Multivariate analysis identified two independent risk factors for MARSI including age ≥50 y (p = 0.031, odds ratio [OR] = 4.521, 95% confidence interval [CI] [1.389, 20.620]) and hematologic malignancies (p = 0.000, OR = 2.514, 95% CI [1.590,3.97]. Oxaliplatin and arsenic trioxide infusion through PICC, history of skin allergies was associated with CD, with p = 0.020, OR = 3.492, 95% CI (1.220, 9.990); p = 0.003, OR = 4.565, 95% CI (1.661,12.547); p = 0.000, OR = 12.333, 95% CI (3.669, 41.454), respectively. MARSI at PICC insertion site is a frequent event among oncology patients. Epidemiological data and independent risk factors are presented in our study, which provide a basis for future study in this area.

Medical Adhesive-Related Skin Injury Prevalence at the Peripherally Inserted Central Catheter Insertion Site: A Cross-sectional, Multiple-Center Study.

We examined prevalence and associated risk factors of medical adhesive-related skin injury (MARSI) at the peripherally inserted central catheter (PICC) insertion site in hospitalized oncology patients in Guangxi, China. A cross-sectional, multiple-center epidemiological study. The sample comprised 697 adult inpatients at 4 tertiary hospitals (3 general hospitals and 1 oncology hospital). The facilities are located in the western China. Trained nurses examined and assessed all subjects' skin exposed to medical adhesive during PICC maintenance process followed by recording the morphological features of the skin lesions, complaints of the patients, and information of catheter maintenance. Data related to patient demographics, PICC insertion information, disease, and laboratory parameters were collected through the electronic medical record. The prevalence of MARSI was calculated statistically and risk factors were examined using a logistic regression model. A total of 697 patients (mean age, 48.86 years; range, 18-89 years) were enrolled. The prevalence of MARSI was 19.7% (137/697), including mechanical skin injury 5.0% (35/697), contact dermatitis 14.8% (103/697), folliculitis 1.0% (7/697), and moisture-associated skin damage 1.3% (9/697). There were significant differences in presence of MARSI and age, diagnoses, body mass index, smoking history, indwelling time of PICC, types of dressing, types of antiseptic, a history of MARSI, and skin allergies (P < .05). Multivariate analysis identified 50 years or older (odds ratio [OR], 2.202; 95% confidence interval [CI], 1.222-3.968; P = .009), a history of MARSI (OR, 14.834; 95% CI, 6.534-33.680; P = .000) as independent risk factors for MARSI. Additionally, type of transparent film dressing used was a risk factor for MARSI (OR, 3.292; 95% CI, 1.092-9.923; P = .034). The prevalence of MARSI is significant in hospitalized oncology patients in China. Our study provided new knowledge for the epidemiology of MARSI and identified high-risk population, which will guide clinical nursing practice and ensure patient safety.

Practice and effect evaluation of "PICC fixed standard operation flow chart" in PICC fixed quality management

Objective To evaluate the effects of fixed standard operation flow in PICC fixed quality management. Methods Patients with PICC were admitted to the control group from January to June in 2014, given the routine PICC fixed method. PICC patients in the observation group who were enrolled from July to December 2014 were given new PICC fixed method that obey the fixed standard operation flow chart, which was established from relevant norms and guidelines and related literature. The incidence rate of medical adhesive related skin injury and unplanned extubation of PICC were compared with those of the two groups. Results The incidence rate of medical adhesive related skin injury was decreased from 35.20% (70 034/198 962) to 18.03%(37 862/209 955) (Z=-3.363, P <0.01) and PICC unplanned extubation decreased from 1.31 ‰ (20/15 384) to 0.37 ‰ (7/18 919), the difference was statistically significant (χ2=6.940, P <0.05). Conclusions The PICC fixed standard operating flow chart can be used as a guide to implement the PICC fixation. Based on this, the quantitative management index is applied to the PICC fixed quality management, which can standardize the fixation of the PICC, reduce the related complications caused by the fixation of the catheter, prevent the occurrence of unplanned extubation of PICC, provide effective protection to ensure safe PICC long-term use and improve the patient's comfort. Key words: Catheterization, central venous; SOP; Fixed; Unplanned extubation; Specialist care

Medical adhesive related skin injury after dental surgery

An 87-year-old woman was referred for the extraction of residual teeth and removal of tori prior to prosthetic treatment. After surgery under general anesthesia, the surgical tape was removed to detach the bispectral index sensor and the hair cover. After the surgical tape was removed, skin injury occurred on the left side of her face. After epidermis repositioning and ointment application, a dressing was placed over the injury. Her wound was found to have healed completely on follow-up examination. Medical adhesive related skin injury (MARSI) is a complication that can occur after surgery and subjects at the extremes of age with fragile skin are at a higher risk for such injuries. Careful assessment of the risk factors associated with MARSI is an absolute necessity.

Understanding Moisture-Associated Skin Damage, Medical Adhesive-Related Skin Injuries, and Skin Tears.

To provide information on superficial skin issues related to moisture-associated skin damage, medical adhesive-related skin injury, and skin tears. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Examine the anatomy of skin, including changes that occur from aging and chronic wounds.2. Identify issues related to moisture-associated skin damage, medical adhesive-related skin injury, and skin tears, including techniques for prevention. The purpose of this continuing education article is to examine the superficial skin issues related to moisture-associated damage, medical adhesive-related skin injury, and skin tears. Similarities, differences, prevention, and treatment will be described.

Understanding Moisture-Associated Skin Damage, Medical Adhesive-Related Skin Injuries, and Skin Tears.

Understanding Moisture-Associated Skin Damage, Medical Adhesive-Related Skin Injuries, and Skin Tears.

Descriptive study of the frequency of medical adhesive–related skin injuries in a vascular clinic

A medical adhesive can be defined as a product used to secure a device (ie, tape, dressing, catheter, electrode, and ostomy pouch) to the skin. Skin injury related to medical adhesive usage occurs across all care settings with medical adhesive-related skin injuries (MARSIs) playing a significant role with patient safety. The purpose of this descriptive prospective study was to assess all adult patients with wounds seen in the vascular clinic for MARSI by the CWOCN NP over a 3-month time period. One hundred twenty patients comprising a total of 207 visits were seen by the CWOCN NP over the 3-month time frame. Seven patients presented to the clinic from home with MARSI for a frequency of 5.8%. There were four males and three females with ages ranging from 52 to 83 years with a mean age of 67.7years. All patients had a diagnosis of peripheral vascular disease with MARSI present on the lower extremities. Six of the seven MARSI cases were related to having paper tape removed from the periwound skin at home resulting in epidermal stripping either by the home health care professional (N=4) or by the patient themselves (N=2). The other MARSI was related to tension blister from steri-strips applied with benzoin by health care professional on a lower leg incision. Patients were unclear as far as when these injuries had occurred and often remarked that they thought that tape injuries were unpreventable. There is a need for additional research studies examining MARSI frequency across care settings such as the vascular population to identify those at risk and then implement measures to prevent it.

The incidence and risk factors analysis of medical adhesive related skin injury in neonates during the NICU stay

Objective To investigate the current status analysis the risk factors of medical adhesive related skin injury(MARSI) in neonates in NICU, in order to provide guidance in prevention and nursing of the skin injury. Methods Convenience sampling five NICU in Shenyang, prospective investigate the incidence of MARSI of neonates during the NICU stay, and analysis the incidence, injury type distribution and risk factors. Results The incidence of MARSI in neonates in NICU was 12.8%(53/413); the major injury type of MARSI was epidermal stripping (47.2%,25/53) and skin tear (35.8%,19/53) in mechanical injury; Logistic analysis showed that the independent risk factors of MARSI were the use of stomach tube, dehydrate skin and blue light therapy (χ2=5.953, 9.806 and 7.568, P < 0.05). Conclusions MARSI is frequency interrupted in neonates during the NICU stay, correct selection of medical adhesive products, application of suitable paste and remove skills are helpful to reduce the incidence of MARSI in neonates during the NICU stay. Key words: Neonatal intensive care unit; Neonates; Medical adhesive related skin injury; Risk cause analysis

Medical adhesive-related skin injury associated factors at PICC insertion site in patients with hematologic malignancies

Objective To measure the prevalence and analyzed associated factors of medical adhesive-related skin injuries (MARSI) at PICC insertion site in patients with hematologic malignancies. Methods A cross-sectional observational study lasting two weeks was carried out in Department of Hematology. Skin assessment data and photographs of skin were collected during PICC maintenances by the same investigator. The related information was got out from the medical record. The observed skin injuries were classified by the dermatologist and PICC specialized nurse together. MARSI prevalence was calculated. The associated factors were analyzed statistically. Results All of the 153 patients with hematologic malignancies were included. The prevalence of total MARSI at PICC insertion site was 33.99% (52/153), including mechanical skin injury (22.87%,35/153), contact dermatitis (CD) (9.80%,15/153), moisture-associated skin damage (0.65%,1/153), folliculitis(0.65%,1/153), respectively. Multivariate analysis identified two independent risk factors for mechanical skin injury including age≥ 50 years old, P=0.016, odds ratio (OR)=5.919, 95% CI 1.389-25.220 and non-specialist nurses in PICC maintenance, P=0.013, OR=8.333,95%CI 1.566-44.360. History of skin allergies (P=0.000, OR=12.333, 95%CI 3.669-41.454) and arsenic trioxide infusion through PICC (P=0.003, OR=4.565, 95%CI 1.661-12.547) were associated with CD. Conclusions MARSI at PICC insertion site is a prevalent event in the patients with hematologic malignancies. Epidemiological data and independent risk factors are presented in our study, which provide a basis for future study in this area. Key words: Hematologic neoplasms; Catheterization,central venous; Epidemiology; Factor analysis, statistical; Skin injury

Embracing the Concept, Defining the Practice, and Changing the Outcome: Setting the Standard for Medical Adhesive-Related Skin Injury Interventions in WOC Nursing Practice.

Medical adhesive-related skin injury (MARSI) is a comparatively new category of skin damage. Our current understanding of MARSI originates from an interdisciplinary consensus conference held in 2012 that generated and disseminated 25 statements pertaining to the assessment, prevention, and management of MARSI, along with gaps in research and knowledge related to this area. The 2012 MARSI Consensus Group also challenged each organization to refine the original statements to make them more relevant to their particular area of practice. In order to accomplish this refinement for WOC specialty nursing practice, the WOCN Society appointed a task force to create statements that extended recommendations to patients with an acute or chronic wound, ostomy, or incontinence. This article describes the formal consensus process used to generate consensus statements concerning MARSI in our specialty practice, presents the 8 statements, and provides a brief overview of the advances that underlie the medical adhesive end products used by WOC and other clinicians practicing in all health care settings.

Extremely Preterm Infant Skin Care: A Transformation of Practice Aimed to Prevent Harm.

The skin of extremely preterm infants is underdeveloped and has poor barrier function. Skin maintenance interventions initiated in the neonatal intensive care unit (NICU) have immediate and lifelong implications when the potential for infection, allergen sensitization, and altered aesthetic outcomes are considered. In addition, the high-level medical needs of extremely preterm infants demand skin-level medical interventions that too often result in unintended skin harm. We describe the use of a harm prevention, or consequence-centered, approach to skin care, which facilitates safer practice for extremely premature infants. Neonatal and pediatric Advanced Practice Registered Nurses (APRN) came together for monthly meetings to review the evidence around best skin care practices for extremely preterm infants, with an emphasis on reduction of skin harm. Findings were focused on the population of interest and clinical implementation strategies. Skin care for extremely preterm infants remains overlooked by current literature. However, clinical practice pearls were extracted and applied in a manner that promotes safer skin care practices in the NICU. Gentle adhesives, such as silicone tapes and hydrogel-backed electrodes, can help to reduce medical adhesive-related skin injuries. Diaper wipes are not appropriate for use among extremely preterm infants, as many ingredients may contain potential allergens. Skin cleansers should be pH neutral to the skin and the prophylactic use of petrolatum-based emollients should be avoided. Further exploration and understanding of skin care practices that examine issues of true risk versus hypothetical risk of harm.

Descriptive Study of the Incidence of Medical Adhesive-Related Skin Injuries (MARSI) in the Ambulatory Wound Clinic

Descriptive Study of the Incidence of Medical Adhesive-Related Skin Injuries (MARSI) in the Ambulatory Wound Clinic

Status survey on ICU nurses′ cognition on medical adhesive-related skin injury

Objective To investigate cognition degree and learning demands of medical adhesive-related skin injury (MARSI) of ICU nurses in a hospital, so as to provide reference basis for corresponding knowledge training and improve nursing quality of clinical wound care. Methods In November 2014, a self-designed questionnaire about cognition and learning demands of MARSI was given to 234 nurses in this hospital from intensive care units of Comprehensive Department, Department of Surgery, Thoracic and Cardiovascular Department, PediatricsDepartment, Department of Neurology, and Department of Pneumology. The data was analyzed by SPSS 17.0. Results Total cognition score was(24.50±9.35); there was no statistical significance from different genders and races. The scores from nurses with different ages, educational backgrounds, job titles, job posts, working years, working years in ICU and wound specialist nurses or not were statistically significant. Only 4.7% of ICU nurses had never encountered this kind of skin injury; only 2.1% of the nurses had had confidence in handling such injury; their knowledge mainly came from past experience and communication between colleagues; 88.5% of the nurses thought it was necessary to take learning courses of MARSI. Conclusions ICU nurses′ cognition scores of MARSI are low, but their learning demands are high. So the nurse managers should provide knowledge training of MARSI. Key words: Nurse; Cognition; Intensive care unit; Medical adhesive-related skin injury; Demands