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

Prevention and management of medical adhesive-related skin injuries in tumor patients with peripheral central venous catheters: a best practice implementation project

INTRODUCTION

Peripheral central venous catheters are common vascular access devices used in patients with tumors. To prevent catheter shedding and displacement, it is essential to use medical adhesives to secure the catheters. Repeated adhesion and removal of medical adhesives can weaken the barrier function of the skin, leading to medical adhesive-related skin injuries (MARSI), which can increase the patients' pain and medical expenses.

OBJECTIVES

The objective of this project was to utilize the best evidence to prevent and manage MARSI in tumor patients with peripheral central venous catheters.

METHODS

This evidence-based audit and feedback project was theoretically informed by the JBI Evidence Implementation Framework. The framework involves seven phases in which a project team was established; measurable criteria were selected; baseline data were collected; improvement strategies were implemented to address gaps in compliance; a follow-up audit was conducted to assess improvements in compliance; and sustainability measures were considered. The project also used the JBI Practical Application of Clinical Evidence System (PACES) for project management, including data collection and analysis. The JBI Getting Research into Practice (GRiP) approach was also used to support implementation and compliance.

RESULTS

In the baseline audit, the compliance rate for the nine audit criteria was low. In the follow-up audit, the compliance rate significantly improved, with each audit criterion exceeding a minimum of 80%, and four audit criteria reaching 100%. Knowledge of MARSI among nurses and patients significantly improved (p  < 0.05) and the incidence of MARSI among patients with peripheral central venous catheters decreased.

CONCLUSIONS

This project successfully enhanced nurses' compliance with MARSI prevention and management and increased the knowledge and skills of both nurses and patients about MARSI.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A285.

Medical Adhesive-Related Skin Injury at 10 Years: An Updated Consensus

Awareness of medical adhesive-related skin injury (MARSI) has increased in the decade since a foundational consensus report was published in 2013. Additional research has provided greater knowledge of the epidemiology of MARSI, along with its assessment, prevention, and management. To summarize knowledge generated in the past decade and review our current understanding of MARSI, a panel of nine clinical experts from four countries (United States of America, United Kingdom, Canada, and Brazil) convened to discuss the literature published since the initial 2013 document and develop updated recommendations for clinical practice. The group formulated 20 updated consensus statements covering the assessment, prevention, and management of skin injuries related to adhesive medical devices and proposed next steps to address remaining gaps in research and knowledge of this complex and clinically relevant condition.

Risk factors for medical adhesive-related skin injury at the site of peripherally inserted central venous catheter placement in patients with cancer: a single-centre prospective study from China

OBJECTIVES

This study aims to explore the incidence of, and risk factors for medical adhesive-related skin injury (MARSI) at peripherally inserted central venous catheter (PICC) sites in patients with cancer.

DESIGN

A prospective observational cohort study was conducted at a tertiary hospital in Shenzhen, China.

SETTING

This was a single-centre study conducted in a tertiary hospital in Shenzhen, China.

PARTICIPANTS

A total of 340 patients with cancer and PICC placement from January 2022 to June 2023 were selected using a convenience sampling method.

METHODS

Factors potentially associated with PICC-related MARSI (PICC-MARSI) were recorded, including patient demographics, and catheter placement and maintenance. Patients were divided into MARSI and non-MARSI groups. Univariate analysis was performed to screen for associated variables, and logistic regression analysis was used to identify independent risk factors for PICC-MARSI.

RESULTS

Of all 340 patients enrolled, 33 (9.7%) developed PICC-MARSI, including skin tear (8, 24.2%), tension injury (5, 15.2%), irritant contact dermatitis (10, 30.3%), allergic dermatitis (7, 21.2%) and maceration (3, 9.1%). Multivariable analysis showed that age (OR=1.058, p=0.001, 95% CI 1.023-1.094), wet skin (OR=4.873, p=0.003, 95% CI 1.728-13.742), dry skin (OR=6.247, p<0.0001, 95% CI 2.239-17.431), oedema (OR=3.302, p=0.008, 95% CI 1.365-7.985), allergy history (OR=6.044, p=0.001, 95% CI 2.040-17.906), dressing type (OR=3.827, p=0.003, 95% CI 1.595-9.185), body mass index (BMI) <18.5 (OR=4.271, p=0.015, 95% CI 1.327-13.742) and BMI 25-30 (OR=2.946, p=0.027, 95% CI 1.131-7.678) were independent risk factors for PICC-MARSI.

CONCLUSIONS

Proper catheter maintenance and appropriate dressing selection are crucial for the prevention of this condition.