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Zhang N, Li Y, Li X, Li F, Jin Z, Li T, Ma J. Incidence of medical device-related pressure injuries: a meta-analysis. Eur J Med Res 2024; 29:425. [PMID: 39155379 PMCID: PMC11331740 DOI: 10.1186/s40001-024-01986-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/17/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND Medical device-related pressure injures (MDRPIs) are common in critically ill patients and associated with negative clinical outcomes and elevated healthcare expenses. We aim to estimate worldwide incidence of MDRPI and explore associated factors through systemic review and meta-analysis. METHODS The PubMed, Web of Science, Cochrane Library, and Ovid EMBASE databases were systematically queried to identify relevant studies published from Jan 1, 2010 up until June 30, 2024. Studies were included if they provided data on the incidence or prevalence of MDRPI. Random-effect models were utilized to calculate the overall or domain-specific aggregated estimates of MDRPI. A meta-regression analysis was additionally performed to investigate the heterogeneity among studies. RESULTS We included 28 observational studies on 117,624 patients in the meta-analysis. The overall incidence of MDRPI was 19.3% (95% confidence interval (CI) 13.5-25.2%). The incidence of MDRPI in Europe, North America, Asia, South America, and Oceania was 17.3% (95% CI 12.7-21.9%), 3.6% (95% CI 0.0-8.5%), 21.9% (95% CI 14.3-29.6%), 48.3% (95% CI 20.8-75.7%), and 13.0% (95% CI 5.0-21.1%), respectively (p < 0.01). Multivariate meta-regressions revealed South America and special inpatient (critically ill patient, etc.) were independently associated with higher MDRPI incidence. CONCLUSIONS Nearly, 20% of the patients in ICU suffered from MDRPI. The incidence of MDRPI in underdeveloped regions is particularly concerning, highlighting the importance of focusing on measures to prevent it, in order to reduce the medical burden and enhance the quality of life for affected patients.
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Affiliation(s)
- Ning Zhang
- Department of ICU, The 305 Hospital of PLA, Jia13 Wenjin St, Beijing, 100017, China
| | - Yanan Li
- Department of General Surgery, Western Medical Branch of PLA General Hospital, Beijing, 100144, China
| | - Xiaogang Li
- Department of ICU, The 305 Hospital of PLA, Jia13 Wenjin St, Beijing, 100017, China
| | - Fangfang Li
- Department of ICU, The 305 Hospital of PLA, Jia13 Wenjin St, Beijing, 100017, China
| | - Zhaofeng Jin
- Department of General Surgery, Huatan Hospital of Hechuan, Chongqing, 401520, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China.
| | - Jinfu Ma
- Department of ICU, The 305 Hospital of PLA, Jia13 Wenjin St, Beijing, 100017, China.
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Neill S, Martin D. Nursing care bundles in the prevention of medical device related pressure ulcers: An integrative review. J Tissue Viability 2024; 33:376-386. [PMID: 38641481 DOI: 10.1016/j.jtv.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/04/2024] [Indexed: 04/21/2024]
Abstract
The aim of this integrative review was to explore the effect of care bundles in the prevention of Medical Device Related Pressure Ulcers (MDRPU). An MDRPU is a wound that occurs on the skin or mucosal membranes because of pressure or pressure in combination with shear. Like other types of pressure ulcers, they will have negative consequences for patients and healthcare organisations alike. Many MDRPU's are preventable. A literature search was undertaken from computerised databases using key search terms, Pressure Ulcer* Pressure Injur* and Medical Device*. Databases included CINAHL; Medline and SocIndex. A total of seven studies were found that met the criteria for inclusion in this review. When compared to the widely recognised and trusted international guidelines there was variation found between the individual interventions selected within each study for inclusion within the bundle. Skin assessment and device repositioning were the most frequently included interventions in the bundles, followed by use of prophylactic dressings, appropriate device selection and fitting. The least common intervention was monitoring the tension of the device and/or its securements. All studies reported a reduction in the number of MDRPU's when care bundles were used in clinical practice. However, there is variation in bundle designs and study methodologies employed. This review has demonstrated the potential benefit of care bundles in reducing MDRPU. However, due to heterogeneity in the study methods employed and the interventions within the care bundles, further, more robust research is required to establish which interventions show the most clinical and patient benefit.
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Affiliation(s)
- Sharon Neill
- School of Nursing and Paramedic Science, Ulster University, Northern Ireland.
| | - Daphne Martin
- School of Nursing and Midwifery, Queens University Belfast, Northern Ireland.
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3
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Schattner A, Dubin I. Adverse device reaction: Chin decubitus. Geriatr Gerontol Int 2024; 24:322-323. [PMID: 38348758 DOI: 10.1111/ggi.14831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/14/2023] [Accepted: 01/27/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Ami Schattner
- Department of Medicine, Laniado University Hospital, Sanz Medical Center, Netanya, Italy
- Adelson School of Medicine, Ariel University, Ariel, Israel
- Faculty of Medicine, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Ina Dubin
- Department of Medicine, Laniado University Hospital, Sanz Medical Center, Netanya, Italy
- Adelson School of Medicine, Ariel University, Ariel, Israel
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He Y, Liu X, Zhong S, Fu Q. Neutrophil-to-lymphocyte ratio in relation to trauma severity as prognosis factors in patients with multiple injuries complicated by multiple organ dysfunction syndrome: A retrospective analysis. Immun Inflamm Dis 2023; 11:e1031. [PMID: 37773708 PMCID: PMC10521378 DOI: 10.1002/iid3.1031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/12/2023] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVE This study aimed to explore potential risk factors for the occurrence of multiple organ dysfunction syndrome (MODS) in patients with multiple injuries by evaluating neutrophil-to-lymphocyte ratio (NLR)-associated trauma severity. METHODS This retrospective case-control study included 95 patients with multiple injuries, who were admitted to our hospital (between January 2018 and December 2020). Clinical data including gender, age, underlying disease, number of injury sites (NIS), injury severity score (ISS), hemoglobin level within 24 h of admission (HL-24h), neutrophil count (NC), white blood cell count, platelet count (PC), NLR, d-dimer level, activated partial thromboplastin time (APTT), complicated shock within 24 h of admission (CS-24h), length of stay, as well as prognostic outcome was systematically analyzed. According to MODS occurrence, patients were divided into a MODS group (n = 27) and a non-MODS group (n = 68). The risk factors affecting patients with multiple injuries complicated by MODS were identified using univariate and multivariate logistic regression analyses. Candidate risk factors were further analyzed using receiver operating characteristic (ROC) curves. RESULTS Univariate analysis revealed a significant difference between the MODS and non-MODA groups in terms of NIS, ISS, HL-24h, PC, APTT, d-dimer level, CS-24h, NLR, NC, prognostic outcome, and other indicators (p < .05). Multivariate logistic regression analysis showed that d-dimer levels within 24 h of admission and ISS, NLR, and CS-24h were significantly associated with multiple injuries complicated by MODS. Compared with the non-MODS controls, the NLR in the MODS group showed a much higher level and tended to rise with the increase in ISS score, indicating a significant intergroup difference (p < .05). The ROC curve analysis results suggested that the NLR had good sensitivity and specificity for predicting the prognosis of patients with MODS with multiple injuries. CONCLUSION d-dimer level, ISS, NLR, and CS-24h are important risk factors for MODS in patients with multiple injuries. Notably, NLR expression may be a good indicator of injury severity and predictor of the occurrence of MODS in patients with multiple injuries. Therefore, assessment of injury severity and coagulation function, active resuscitation, as well as prevention of infection should be emphasized during treatment of multiple injuries, to reduce and prevent the risk of MODS in patients with multiple injuries.
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Affiliation(s)
- Yong‐Ming He
- Department of EmergencyShenzhen Longhua District Center HospitalShenzhenChina
| | - Xing Liu
- Department of EmergencyShenzhen Longhua District Center HospitalShenzhenChina
- Department of EmergencyThe Second People's Hospital of Futian DistrictShenzhenChina
| | - Si‐Yi Zhong
- Department of EmergencyThe Second People's Hospital of Futian DistrictShenzhenChina
- Department of Public HealthGuangdong Medical UniversityDongguanChina
| | - Qiu‐Hong Fu
- Department of EmergencyShenzhen Longhua District Center HospitalShenzhenChina
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Behnammoghadam M, Alimohammadi N, Riazi A, Eghbali-Babadi M, Rezvani M. Incidence of cervical collar-related pressure injury in patients with head and neck trauma: A scoping review study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:252. [PMID: 37727424 PMCID: PMC10506768 DOI: 10.4103/jehp.jehp_41_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/21/2023] [Indexed: 09/21/2023]
Abstract
The use of the cervical collar to support the head and neck is inevitable in many patients with head and spinal cord injuries. One of the consequences of using this instrument is the development of pressure injuries. Therefore, in this review study, the incidence of as well as the risk factors for cervical collar-related pressure injury in this group of patients was evaluated. The current study is a scoping review conducted in 2022. Five scientific databases (PubMed, Scopus, Web of Science, ProQuest, and CINAHL), as well as Google Scholar, were searched for relevant studies published from 1990 to 2022 using the following keywords: trauma, spinal cord injury, head injury, head trauma, collar, cervical collar, cervical immobilization, risk factors, incidence, pressure injury, pressure ulcer, and bed sore. The search was performed independently by two researchers. Articles from the initial search were first recorded in special tables, and then, were reviewed and analyzed separately by two researchers. After extraction, information from each article was entered into a special table categorized by year, country, study design, study population, the incidence of cervical collar-related pressure injury, risk factors for cervical collar-related pressure injury, and grades of pressure injury. Of the 10 articles, 6 were retrospective cohort studies, 3 were cross-sectional descriptive studies, and 1 was a case report study. In terms of the study population, one study was conducted on pediatric patients, one was conducted on elderly patients, and eight were conducted on adults with head and neck trauma. In eight articles, the incidence of cervical collar-related pressure injury was reported. The reported incidence varied between 1.1% and 78.4%. In eight articles, risk factors for cervical collar-related pressure injury were reported. The most common risk factors were duration of cervical collar use, hospitalization in intensive care units, low level of consciousness, and longer hospital stay. The current review study showed that a significant percentage of head and neck trauma patients for whom cervical collar is used suffer from different grades of pressure injuries. Hence, healthcare providers should consider this issue when caring for this group of patients and take the necessary preventive measures in this regard. It should be noted that previous studies in this field had significant limitations, and thereby, it is strongly recommended to conduct further studies with a stronger methodology.
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Affiliation(s)
- Mohammad Behnammoghadam
- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasrollah Alimohammadi
- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Riazi
- Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Eghbali-Babadi
- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Rezvani
- Department of Neurosurgery, Neurosciences Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Luo Z, Liu S, Yang L, Zhong S, Bai L. Ambulance referral of more than 2 hours could result in a high prevalence of medical-device-related pressure injuries (MDRPIs) with characteristics different from some inpatient settings: a descriptive observational study. BMC Emerg Med 2023; 23:44. [PMID: 37098503 PMCID: PMC10127406 DOI: 10.1186/s12873-023-00815-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/19/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Medical device-related pressure injuries(MDRPI) are prevalent and attracting more attention. During ambulance transfer, the shear force caused by braking and acceleration; extensive medical equipment crowed in a narrow space add external risk factors for MDRPIs. However, there is insufficient research on the relationship between MDRPIs and ambulance transfers. This study aims to clarify the prevalence and characteristics of MDRPI during ambulance transfer. METHOD A descriptive observational study was conducted with convenience sampling. Before starting the study, six PI specialist nurses certified by the Chinese Nursing Association trained emergency department nurses for three MDRPI and Braden Scale sessions, one hour for each session. Data and images of PIs and MDRPIs are uploaded via the OA system by emergency department nurses and reviewed by these six specialist nurses. The information collection begins on 1 July 2022 and ends on 1 August 2022. Demographic and clinical characteristics and a list of medical devices were collected by emergency nurses using a screening form developed by researchers. RESULTS One hundred one referrals were eventually included. The mean age of participants was (58.3 ± 11.69) years, predominantly male (67.32%, n = 68), with a mean BMI of 22.48 ± 2.2. The mean referral time among participants was 2.26 ± 0.26 h, the mean BRADEN score was 15.32 ± 2.06, 53.46% (n = 54) of participants were conscious, 73.26% (n = 74) were in the supine position, 23.76% (n = 24) were in the semi-recumbent position, and only 3 (2.9%) were in the lateral position. Eight participants presented with MDRPIs, and all MDRPIs are stage 1. Patients with spinal injuries are most prone to MDRPIs (n = 6). The jaw is the area most prone to MDRPIs, caused by the cervical collar (40%, n = 4), followed by the heel (30%, n = 3) and nose bridge (20%, n = 2) caused by the respiratory devices and spinal board. CONCLUSION MDRPIs are more prevalent during long ambulance referrals than in some inpatient settings. The characteristics and related high-risk devices are also different. The prevention of MDRPIs during ambulance referrals deserves more research.
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Affiliation(s)
- Zhenyu Luo
- Guanyuan Central Hospital, Guanyuan, Sichuan, China.
| | - Sihui Liu
- The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Linhe Yang
- Guanyuan Central Hospital, Guanyuan, Sichuan, China
| | - Shuyan Zhong
- Guanyuan Central Hospital, Guanyuan, Sichuan, China
| | - Lihua Bai
- Guanyuan Central Hospital, Guanyuan, Sichuan, China
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Jennings FL, Mitchell ML, Walsham J, Lockwood DS, Eley RM. Soft collar for acute cervical spine injury immobilisation -patient experiences and outcomes: A single centre mixed methods study. Int J Orthop Trauma Nurs 2022; 47:100965. [PMID: 36063776 DOI: 10.1016/j.ijotn.2022.100965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/05/2022] [Accepted: 08/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cervical collars are used as standard care for neck immobilisation after cervical spine injury. Although evidence for the most effective type of collar is lacking, there is evidence regarding adverse patient outcomes when managed in a semi or rigid collar. In response to the evidence of complications and adverse effects when using a hard collar, a large Australian adult trauma hospital that specializes in spinal care, changed its policy from hard to soft collars when managing acute cervical spine injury. OBJECTIVE The aim of this study was to investigate patients' experiences and outcomes when wearing a soft collar for acute cervical spine injury management in hospital. METHOD A single centre mixed method sequential study design was used. RESULTS Medical records from 136 patients were examined and no adverse events resulting from collar use were recorded. Interviews with 20 patients revealed that they understood the value of wearing a soft collar. The soft collars were considered supportive and well tolerated, with good adherence to recommendations for use. CONCLUSIONS Understanding the patients' experiences informs better care management. This study suggests that soft collars are well tolerated, do not result in pressure injuries or other adverse events and are suitable for managing acute cervical spine injury.
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Affiliation(s)
- Fiona L Jennings
- Trauma Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Marion L Mitchell
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
| | - James Walsham
- Dept of Intensive Care, PAH, School of Medicine, University of QLD, Australia.
| | - David Sr Lockwood
- Trauma Service, Department of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Robert M Eley
- Emergency Department Princess Alexandra Hospital Brisbane, Queensland, Australia; Southside Clinical Unit, Faculty of Medicine, University of Queensland, Australia.
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Celik S, Taskin Yilmaz F, Altas G. Medical
Device‐Related
Pressure injuries in adult intensive care units. J Clin Nurs 2022. [DOI: 10.1111/jocn.16516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Selda Celik
- Hamidiye Faculty of Nursing University of Health Sciences Turkey Istanbul Turkey
| | - Feride Taskin Yilmaz
- Faculty of Health Sciences Sakarya University of Applied Sciences Sakarya Turkey
| | - Gulnaz Altas
- University of Health Sciences, Haydarpasa Training and Research Hospital Istanbul Turkey
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Crunden EA, Worsley PR, Coleman SB, Schoonhoven L. Barriers and facilitators to reporting medical device-related pressure ulcers: A qualitative exploration of international practice. Int J Nurs Stud 2022; 135:104326. [DOI: 10.1016/j.ijnurstu.2022.104326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/13/2022] [Accepted: 07/11/2022] [Indexed: 10/31/2022]
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Cavalcante EDO, Kamada I. MEDICAL DEVICE-RELATED PRESSURE INJURY: FREQUENCY AND ASSOCIATED FACTORS. ESTIMA 2022. [DOI: 10.30886/estima.v20.1146_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: to analyze the occurrence of pressure injuries related to medical devices in patients admitted to an intensive care unit. Method: quantitative, observational, descriptive, prospective cohort study, carried out with 171 patients, from May 15 to August 31, 2018 in the intensive care units of a public hospital in the Federal District. Results: the main risk factors were the presence of pressure injuries at admission, with a significant association for the formation of pressure injuries related to medical devices (p=0.002), and patients who progressed to death, with an association for the formation of pressure injuries related to medical devices (p=0.012); medical device-related pressure injury incidence rate of 40.35%. Conclusion: the use of medical devices has grown, as well as the appropriation of these technologies in the critical care environment. The multidisciplinary team should be aware of the formation of pressure injuries related to medical devices that can affect hospitalized patients.
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Cavalcante EDO, Kamada I. LESÃO POR PRESSÃO RELACIONADA A DISPOSITIVOS MÉDICOS: FREQUÊNCIA E FATORES ASSOCIADOS. ESTIMA 2022. [DOI: 10.30886/estima.v20.1146_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo:analisar a ocorrência de lesões por pressão relacionadas a dispositivos médicos em pacientes internados em unidade de terapia intensiva. Método: estudo quantitativo, de caráter observacional descritivo, do tipo coorte prospectivo, realizado com 171 pacientes, no período de 15 de maio a 31 de agosto de 2018 nas unidades de terapia intensiva de um hospital público do Distrito Federal. Resultados: os principais fatores de risco foram presença de lesões por pressão na admissão, com associação significativa para a formação de lesão por pressão relacionada a dispositivos médicos (p=0,002), e pacientes que evoluíam ao desfecho óbito, com associação para formação de lesão por pressão relacionada a dispositivos médicos (p=0,012); taxa de incidência de lesão por pressão relacionada a dispositivos médicos de 40,35%. Conclusão: o uso de dispositivo médico tem crescido, bem como a apropriação dessas tecnologias no ambiente de cuidados críticos. A equipe multiprofissional deve ficar atenta para a formação das lesões por pressão relacionadas a dispositivos médicos que podem acometer os pacientes internados.
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Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, Ohura N, Waters N, Worsley P, Black J, Barakat-Johnson M, Beeckman D, Fletcher J, Kirkland-Kyhn H, Lahmann NA, Moore Z, Payan Y, Schlüer AB. Device-related pressure ulcers: SECURE prevention. Second edition. J Wound Care 2022; 31:S1-S72. [PMID: 35616340 DOI: 10.12968/jowc.2022.31.sup3a.s1] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Assistant Professor and Coordinator, Wounds Research Laboratory, Catholic University of Portugal, Institute of Health Sciences, Centre for Interdisciplinary Research in Health, Lisbon, Portugal
| | - Guido Ciprandi
- Chief Wound Care, Surgical Unit, Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Fiona Coyer
- Professor of Nursing (joint appointment), Intensive Care Services, Royal Brisbane and Women's Hospital, School of Nursing, Queensland University of Technology, Brisbane, Australia. Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - Catherine T Milne
- Connecticut Clinical Nursing Associates, Bristol Hospital Wound and Hyperbaric Medicine, Bristol, Connecticut, US
| | - Karen Ousey
- Professor of Skin Integrity, Director, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, Huddersfield University, UK; Clinical Professor, Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Norihiko Ohura
- Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Nicola Waters
- Senior Research Associate, Health, The Conference Board of Canada; Adjunct Professor, School of Nursing, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Peter Worsley
- Associate Professor in Rehabilitative Bioengineering, Clinical Academic Facility in the School of Health Sciences, University of Southampton, UK
| | - Joyce Black
- Professor, College of Nursing, University of Nebraska Medical Center. Nebraska, US
| | - Michelle Barakat-Johnson
- Clinical Lead and Skin Integrity Lead, HAC Pressure Injury Coordinator, Sydney Local Health District; Adj Associate Professor, Faculty of Medicine and Health, University of Sydney, Australia
| | - Dimitri Beeckman
- Professor, Skin Integrity Research Group (SKINT), Ghent University, Belgium; Professor and Vice-Head, School for Research and Internationalisation, Örebro University, Sweden
| | | | | | - Nils A Lahmann
- Deputy Director, Geriatrics Research Group, Charité University Berlin, Germany
| | - Zena Moore
- Professor and Head, School of Nursing and Midwifery. Director, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Yohan Payan
- Research Director, Laboratoire TIMC-IMAG, Grenoble Alpes University, France
| | - Anna-Barbara Schlüer
- Advanced Nurse Practitioner, Paediatric Skin and Wound Management, Head of the Paediatric Skin Centre, Skin and Wound Management and Department of Nursing Science, University Children's Hospital, Zurich, Switzerland
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Galetto SGDS, do Nascimento ERP, Hermida PMV, Busanello J, de Malfussi LBH, Lazzari DD. Medical device-related pressure injuries in critical patients: prevalence and associated factors. Rev Esc Enferm USP 2021; 55:e20200397. [PMID: 34435611 DOI: 10.1590/1980-220x-reeusp-2020-0397] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/16/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the prevalence of medical device-related pressure injuries in critical patients and analyze the associated factors. METHOD Epidemiological, cross-sectional study. Sociodemographic, clinical and medical device data were collected. Inspection of the skin/mucous membranes was performed to identify and classify the injuries. Analysis using descriptive statistics, Poisson regression and the Spearman correlation coefficient. RESULTS Ninety-three patients were evaluated and 58 developed injuries, with a prevalence of 62.4%. Injuries by the orotracheal tube (50%), nasogastric tube (44.1%) and urinary catheter (28.6%) were the most prevalent, and the most affected regions were, respectively, the auricular (79.5%), nasal ala (86.7%) and urethral meatus (76.9%). Factors associated with injuries were severe edema (p = 0.005), low Braden (p<0.001) and Glasgow (p = 0.008) scores, length of stay in intensive care (p<0.001) and hospitalization diagnosis classified as other causes (p<0.001). The use of more than one device (p<0.001) and a longer time of use (p<0.001) were correlated. CONCLUSION The high prevalence of injuries and the associated factors indicate the need for preventive measures and risk monitoring.
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Affiliation(s)
| | | | | | | | | | - Daniele Delacanal Lazzari
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Enfermagem, Departamento de Enfermagem, Florianópolis, SC, Brazil
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Abstract
PURPOSE The purpose of this study was to describe medical device-related pressure injuries (MDRPIs) in hospitalized pediatric patients. DESIGN A prospective, descriptive study. SAMPLE/SUBJECTS AND SETTING 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. METHODS 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. RESULTS 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. CONCLUSION Medical devices are common in hospitalized infants and children and these medical devices place patients at risk for MDRPI.
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Galetto SGDS, Nascimento ERPD, Hermida PMV, Lazzari DD, Reisdorfer N, Busanello J. Percepção de profissionais de enfermagem sobre lesões por pressão relacionadas a dispositivos médicos. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2020-0225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Conhecer a percepção de profissionais de enfermagem atuantes em unidade de terapia intensiva acerca das lesões por pressão relacionadas a dispositivos médicos. Método Pesquisa qualitativa, descritiva, realizada com 12 profissionais de enfermagem de um hospital público de ensino de Santa Catarina. A coleta de dados se deu por entrevista semiestruturada, e análise pela técnica do discurso do sujeito coletivo com o emprego do software QualiQuantiSoft®. Resultados Emergiram cinco Ideias Centrais: tipos de dispositivos e ocorrência das lesões por pressão relacionadas a dispositivos médicos; (in)visibilidade e (des)valorização destas lesões no cuidado ao paciente crítico; lesões por pressão relacionadas a dispositivos médicos podem ser inevitáveis; perfil do paciente crítico e risco para desenvolver a lesão; e (des)conhecimento profissional sobre o impacto da lesão na vida das pessoas após alta da terapia intensiva. Conclusão e implicações para a prática A percepção da enfermagem acerca das lesões por pressão relacionadas a dispositivos médicos está vinculada aos tipos de dispositivos, a ocorrência das lesões na terapia intensiva, ao cuidado ofertado e ao impacto das lesões na vida das pessoas.
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16
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Cervical Spine Clearance in Trauma Patients with an Unreliable Physical Examination. World J Surg 2020; 44:1113-1120. [PMID: 31802188 DOI: 10.1007/s00268-019-05307-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The objective of this study was to describe and compare the timing of cervical spine clearance in trauma patients with an unreliable physical examination. METHODS We prospectively included adult trauma patients admitted with a cervical collar and an unreliable clinical examination (as defined by the NEXUS criteria) at two level 1 trauma centers: one in the USA (US) and one in Denmark (DK). We excluded patients with cervical spine injuries requiring a collar or surgery as treatment and patients with a collar placed after hospital arrival. The primary outcome was time from emergency department (ED) arrival to collar removal. Secondary outcomes included time to CT of the cervical spine (CTCS). At the US trauma center, an institutional protocol allowing cervical spine clearance exclusively by CTCS was in place. At the Danish trauma center, cervical spine clearance was based on a clinical evaluation by an orthopedic surgeon, usually after CTCS. RESULTS A total of 113 patients were included (US: n = 56; DK: n = 57). The median age was 47 years, and 68% were males. The main reasons for an unreliable physical examination were a Glasgow Coma Scale score below 14 (35%), distracting injuries (26%), cervical spine tenderness (13%) and intoxication (13%). The injury severity score at the US trauma center was higher than at the DK trauma center (median: 17 vs. 11, p = 0.03). Both time to CTCS (median: 41 vs. 18 min, p < 0.0001) and time to collar removal (median: 1042 vs. 49 min, p < 0.0001) were significantly greater at the US trauma center. CONCLUSIONS Time to collar removal was significantly greater in a trauma center utilizing a cervical spine clearance protocol based on CTCS. As patients may develop complications related to the collar, future studies should clarify how early removal can be implemented without increasing the risk of morbidity.
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17
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Higgins J, Casey S, Taylor E, Wilson R, Halcomb P. Comparing the Braden and Jackson/Cubbin Pressure Injury Risk Scales in Trauma-Surgery ICU Patients. Crit Care Nurse 2020; 40:52-61. [PMID: 33257967 DOI: 10.4037/ccn2020874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The occurrence of pressure injury in the critical care environment has multiple risk factors. Prevention requires reliable assessment tools to help predict injury risk. The Braden scale, a commonly used risk assessment tool, has been shown to have poor predictive properties in critical care patients. The Jackson/Cubbin scale was developed specifically for pressure injury risk stratification in critically ill patients and has demonstrated acceptable predictive properties in the general critical care population but has not been examined in critically ill trauma-surgical patients. OBJECTIVE To compare the predictive properties of the Braden and Jackson/Cubbin scales in a trauma-surgical critical care population. METHODS A retrospective medical records review was performed to evaluate the clinical characteristics of 366 trauma-surgical critical care patients. Additionally, the negative predictive value, positive predictive value, sensitivity, specificity, and receiver operating characteristic curve with area under the curve of the Braden and Jackson/Cubbin scales were determined. RESULTS The sample consisted of primarily middle-aged (mean [SD], 56 [19] years) men (64%) admitted after trauma (71%). The participants who developed pressure injuries were older, more often required vasopressors and mechanical ventilation, and were less mobile. Predictive properties for the Braden and Jackson/Cubbin scales, respectively, were as follows: negative predictive value, 78% versus 87%; positive predictive value, 53% versus 66%; sensitivity, 17% versus 54%; specificity, 95% versus 92%; and area under the curve, 0.710 versus 0.793. CONCLUSION The Jackson/Cubbin scale demonstrated superior predictive properties and discrimination compared with the Braden scale for pressure injury risk prediction in critically ill trauma-surgical patients.
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Affiliation(s)
- Jacob Higgins
- Jacob Higgins is an assistant professor, University of Kentucky College of Nursing, and a nurse-scientist, UK HealthCare, Lexington, Kentucky
| | - Sherri Casey
- Sherri Casey is a quality assurance nurse for trauma-surgical services, UK HealthCare
| | - Erin Taylor
- Erin Taylor is the medical-surgical clinical nurse specialist at WakeMed Health and Hospitals, Raleigh, North Carolina
| | - Riley Wilson
- Riley Wilson is a registered nurse in the trauma intensive care unit at UK HealthCare
| | - Paula Halcomb
- Paula Halcomb is a clinical nurse specialist for the trauma-surgical intensive care units, UK HealthCare
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18
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Verberne JWR, Worsley PR, Bader DL. A 3D registration methodology to evaluate the goodness of fit at the individual-respiratory mask interface. Comput Methods Biomech Biomed Engin 2020; 24:1-12. [PMID: 33241703 DOI: 10.1080/10255842.2020.1849156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/16/2020] [Accepted: 11/04/2020] [Indexed: 02/08/2023]
Abstract
Respiratory masks are used to deliver non-invasive ventilation for cardiorespiratory pathologies. Masks must minimize skin tissue compression while maintaining a seal at the interface. Ill-fitting masks or those applied too tightly are implicated in pressure ulcer formation. This study aimed to analyse respiratory mask goodness of fit in a cohort of face shapes. A number of parameters were identified and analysed with a novel registration protocol. In the majority of cases, mask indentation exceeded the thickness of the interface material and significant gapping was observed. The size range was most appropriate for males, with only one size suitable for females.
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Affiliation(s)
- J W R Verberne
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - P R Worsley
- School of Health Sciences, University of Southampton, Southampton, UK
| | - D L Bader
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- School of Health Sciences, University of Southampton, Southampton, UK
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19
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Indentation marks, skin temperature and comfort of two cervical collars: A single-blinded randomized controlled trial in healthy volunteers. Int Emerg Nurs 2020; 51:100878. [PMID: 32505019 DOI: 10.1016/j.ienj.2020.100878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 04/07/2020] [Accepted: 05/01/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Collar-related pressure ulcers (CRPU) are a problem in trauma patients with a suspicion of cervical cord injury patients. Indentation marks (IM), skin temperature (Tsk) and comfort could play a role in the development of CRPU. Two comparable cervical collars are the Stifneck® and Philadelphia®. However, the differences between them remain unclear. AIM To determine and compare occurrence and severity of IM, Tsk and comfort of the Stifneck® and Philadelphia® in immobilized healthy adults. METHODS This single-blinded randomized controlled trial compared two groups of immobilized participants in supine position for 20 min. RESULTS All participants (n = 60) generated IM in at least one location in the observed area. Total occurrence was higher in the Stifneck®-group (n = 95 versus n = 69; p = .002). Tsk increased significantly with 1.0 °C in the Stifneck®-group and 1.3 °C in the Philadelphia®-group (p = .024). Comfort was rated 3 on a scale of 5 (p = .506). CONCLUSION The occurrence of IM in both groups was high. In comparison to the Stifneck®, fewer and less severe IM were observed from the Philadelphia®. The Tsk increased significantly with both collars; however, no clinical difference in increase of Tsk between them was found. The results emphasize the need for a better design of cervical collars regarding CRPU.
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20
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Wang HRN, Campbell J, Doubrovsky A, Singh V, Collins J, Coyer F. Pressure injury development in critically ill patients with a cervical collar in situ: A retrospective longitudinal study. Int Wound J 2020; 17:944-956. [PMID: 32239663 DOI: 10.1111/iwj.13363] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 11/27/2022] Open
Abstract
Trauma patients with a serious injury to the head or neck can remain immobilised with a cervical collar (C-collar) device in situ and are subsequently exposed to device-related skin integrity threats. This study aimed to determine the incidence and risk factors associated with the development of C-collar-related pressure injures (CRPIs) in an intensive care unit. This retrospective longitudinal cohort study was conducted in an Australian metropolitan intensive care unit. Following ethical approval, data from patients over 18 years, who received a C-collar were retrieved over a 9-year period. Chi square and t-tests were used to identify variables associated with CRPI development. A logistic regression model was employed to analyse the risk factors. Data from 906 patients were analysed. Nine-year pressure injury incidence was 16.9% (n = 154/906). Pressure injury development directly associated with a C-collar increased by 33% with each repositioning episode (odds ratio 1.328, 95% confidence interval 1.024-1.723, P = .033). Time in the C-collar (10.4 to 2.5 days, P = .002) and length of stay in intensive care unit (ICU) (20.1 to 16.1 days, P < .001) were associated with pressure injury development. Patients with C-collar devices are a vulnerable group at risk for pressure injury development because of their immobility and length of ICU stay.
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Affiliation(s)
- Harn-Rong N Wang
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Jill Campbell
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Skin Integrity Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Anna Doubrovsky
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | | | | | - Fiona Coyer
- Joint appointment Intensive Care Services, Royal Brisbane and Women's Hospital and School of Nursing, Queensland University of Technology, Herston, Queensland, Australia.,Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
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21
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Gefen A, Alves P, Ciprandi G, Coyer F, Milne C, Ousey K, Ohura N, Waters N, Worsley P, Black J, Barakat-Johnson M, Beeckman D, Fletcher J, Kirkland-Kyhn H, Lahmann NA, Moore Z, Payan Y, Schlüer AB. An international consensus on device-related pressure ulcers: SECURE prevention. ACTA ACUST UNITED AC 2020; 29:S36-S38. [DOI: 10.12968/bjon.2020.29.5.s36] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Catherine Milne and colleagues present the findings of their review, ccna2@juno.com
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Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel
| | - Paulo Alves
- Assistant Professor and Coordinator Wounds Research Laboratory, Institute of Health Sciences, Center for Interdisciplinary Research in Health, Portugal
| | - Guido Ciprandi
- Chief Wound Care Surgical Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Fiona Coyer
- Professor of Nursing, Intensive Care Services, Royal Brisbane and Women's Hospital and School of Nursing, Australia, and Visiting Professor, University of Huddersfield, UK
| | - Catherine Milne
- Connecticut Clinical Nursing Associates, Bristol Hospital Wound and Hyperbaric Medicine, Bristol, Connecticut, USA
| | - Karen Ousey
- Professor of Skin Integrity, School of Human and Health Sciences, Huddersfield University, UK; Clinical Professor, Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons in Ireland, Dublin
| | - Norihiko Ohura
- Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Japan
| | - Nicola Waters
- Associate Professor, School of Nursing, Thompson Rivers University, British Columbia, Canada
| | - Peter Worsley
- Assistant Professor in Rehabilitative Bioengineering, University of Southampton, UK Review panel
| | - Joyce Black
- Professor at College of Nursing, University of Nebraska Medical Center, USA
| | - Michelle Barakat-Johnson
- Skin Integrity Lead, Sydney Local Health District; Clinical Senior Lecturer, University of Sydney, Australia
| | - Dimitri Beeckman
- Professor of Skin Integrity and Clinical Nursing, Ghent University, Ghent Belgium
| | | | | | - Nils A. Lahmann
- Deputy Director, Geriatrics Research Group, Charité University Berlin, Germany
| | - Zena Moore
- Professor and Head, School of Nursing and Midwifery; Director, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Yohan Payan
- Research Director, Laboratoire TIMC-IMAG, University Grenoble Alps, France
| | - Anna-Barbara Schlüer
- Advanced Nurse Practitioner in Paediatric Skin and Wound Management and Head of the Paediatric Skin Centre, University Children's Hospital Zurich, Switzerland
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22
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Cooper KD, McQueen KM, Halm MA, Flayter R. Prevention and Treatment of Device-Related Hospital-Acquired Pressure Injuries. Am J Crit Care 2020; 29:150-154. [PMID: 32114625 DOI: 10.4037/ajcc2020167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Kim D. Cooper
- Kim D. Cooper is a quality improvement clinical specialist registered nurse, UCHealth Memorial Hospital, Colorado Springs, Colorado
| | - Kevin M. McQueen
- Kevin M. McQueen is director, Respiratory Services, Hyperbaric, and Wound Care, Southern Colorado Region, UCHealth Memorial Hospital
| | - Margo A. Halm
- Margo A. Halm is associate chief nurse executive, nursing research and evidence-based practice, VA Portland HealthCare System, Portland, Oregon
| | - Rochelle Flayter
- Rochelle Flayter is senior director, Trauma Services, Southern Colorado Region, UCHealth Memorial Hospital
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23
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Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, Ohura N, Waters N, Worsley P, Black J, Barakat-Johnson M, Beeckman D, Fletcher J, Kirkland-Kyhn H, Lahmann NA, Moore Z, Payan Y, Schlüer AB. Device-related pressure ulcers: SECURE prevention. J Wound Care 2020; 29:S1-S52. [DOI: 10.12968/jowc.2020.29.sup2a.s1] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, the Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Assistant Professor and Coordinator Wounds Research Laboratory, Universidade Católica Portuguesa, Institute of Health Sciences, Center for Interdisciplinary Research in Health, Portugal
| | - Guido Ciprandi
- Chief Wound Care Surgical Unit, Division of Plastic and Maxillofacial Surgery, Bambino Gesu’ Children’s Hospital, Research Institute, Rome, Italy
| | - Fiona Coyer
- Professor of Nursing, Joint appointment, Intensive Care Services, Royal Brisbane and Women’s Hospital and School of Nursing, Queensland University of Technology, Australia. Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - Catherine T Milne
- Connecticut Clinical Nursing Associates, Bristol Hospital Wound and Hyperbaric Medicine, Bristol, Connecticut, US
| | - Karen Ousey
- Professor of Skin Integrity, Director, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, Huddersfield University, UK; Clinical Professor, Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Norihiko Ohura
- Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Japan
| | - Nicola Waters
- Associate Professor, School of Nursing, thompson Rivers University, Kamloops, British Columbia, Canada
| | - Peter Worsley
- Assistant Professor in Rehabilitative Bioengineering, Clinical Academic Facility in the School of Health Sciences, University of Southampton, UK
| | - Joyce Black
- Professor at College of Nursing, University of Nebraska Medical Center. Nebraska, US
| | - Michelle Barakat-Johnson
- Skin Integrity Lead, Sydney Local Health District; Clinical Senior Lecturer, Faculty of Medicine and Health, University of Sydney, Australia
| | - Dimitri Beeckman
- Professor of Skin Integrity and Clinical Nursing, Ghent University, Ghent, Belgium
| | | | | | - Nils A. Lahmann
- Deputy Director, Geriatrics Research Group, Charité University Berlin, Germany
| | - Zena Moore
- Professor and Head, School of Nursing and Midwifery. Director, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Yohan Payan
- Research Director, Laboratoire TIMC-IMAG, University Grenoble Alps, France
| | - Anna-Barbara Schlüer
- Advanced Nurse Practitioner in Paediatric Skin and Wound Management and Head of the Paediatric Skin Centre, Skin and Wound Management and Department of Nursing Science, University Children’s Hospital Zurich, Switzerland
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24
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Cavalcanti EDO, Kamada I. MEDICAL-DEVICE-RELATED PRESSURE INJURY ON ADULTS: AN INTEGRATIVE REVIEW. ACTA ACUST UNITED AC 2020. [DOI: 10.1590/1980-265x-tce-2018-0371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
ABSTRACT Objective: to identify factors associated with medical-device-related pressure injury. Method: an integrative review of published articles on the subject related to the adult population in the databases of PUBMED, Scopus, MEDLINE, Latin American and Caribbean Health Sciences Literature (Literatura Latino-Americana e do Caribe em Ciências da Saúde, LILACS), Web of Science and Nursing Database (Banco de Dados em Enfermagem, BDENF), between 2013 and 2018. Results: medical-device-related pressure injuries were common in adults, especially in the elderly, due to capillary fragility, among other changes. Other observed factors were length of stay, critically ill patients or those requiring any type of medical device. Numerous medical devices have been associated with skin lesions; among the most frequent were breathing, feeding, and orthopedic devices, tubes, oximeters, neck collars, patches and nasogastric tubes. Conclusion: the first step towards prevention is exploration in terms of identifying the types of injury-causing devices and evidence-based interventions, and disseminating information to the entire multidisciplinary team.
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25
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Galetto SGDS, Nascimento ERPD, Hermida PMV, Malfussi LBHD. Medical Device-Related Pressure Injuries: an integrative literature review. Rev Bras Enferm 2019; 72:505-512. [DOI: 10.1590/0034-7167-2018-0530] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/06/2018] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objetives: To identify and analyze the scientific evidence regarding the occurrence of Medical Device-Related Pressure Injuries, considering the development sites; and to describe the devices of risk and the measures of prevention and treatment. Method: Integrative, search-based review: CINAHL, PubMed, Wiley InterScience, Scopus, and Web Of Science. The terms “pressure ulcer” and “medical devices” were used, including original articles and case studies published between 2010 and 2015. Nine studies were selected. Results: Posterior cervical region and nose had the highest injury frequencies, respectively, 66.0% and 40.0%. Eleven risk devices were identified, with emphasis on Non-Invasive Ventilation masks and orotracheal tube. For prevention and treatment emerged recommendations specific to the device employed and general measures. Conclusion: Medical Device-Related Pressure Injuries are frequent problems, however, they can be prevented and treated based on the recommendations of the articles raised in this review.
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26
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Liu Y, Wu X, Ma Y, Li Z, Cao J, Jiao J, Liu G, Li F, Song B, Jin J, Liu Y, Wen X, Cheng S, Lin F. The prevalence, incidence, and associated factors of pressure injuries among immobile inpatients: A multicentre, cross-sectional, exploratory descriptive study in China. Int Wound J 2019; 16:459-466. [PMID: 30672116 DOI: 10.1111/iwj.13054] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to assess the prevalence, incidence, and the associated factors of pressure injuries (PIs) among immobile hospitalised patients in China. Being immobile during hospitalisation put these patients at a higher risk of PIs. There is little literature about pressure injury (PI) prevalence or PI incidence in immobile hospitalised patients in hospitals in China. This was a multicentre, cross-sectional, exploratory descriptive study. A total of 23 985 immobile patients were recruited from 25 general hospitals in six provinces of China from November 1, 2015 to March 18, 2016. Information was collected on demographic characteristics, physical assessment information, and treatment and nursing care measures. The PI period prevalence was 3.38%, and the PI cumulative incidence was 1.23%. Most PIs (84.03%) were Stage 1 or Stage 2. A total of 48.22% of PIs occurred in the sacrum or heel region. In the multivariate analysis, the following factors were associated with higher PI prevalence: age, gender, length of immobility, type of hospital, modified Braden Scale score, urinary incontinence, faecal incontinence, low serum albumin, the usage of fixation or restraint devices, and patient's discharge diagnosis (lower limb fracture, malnutrition, and spinal cord injury). PI prevalence for immobile hospitalised patients in the study was lower than those reported in literature. However, because of the large population in China, the number of patients who suffer with PIs can be very high. The relating factors of higher PI prevalence identified in this study were consistent with current literature. Patients with a higher number of these associated factors should be monitored more closely, and preventative measures should be taken to prevent PI occurrence in high-risk populations.
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Affiliation(s)
- Ying Liu
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Xinjuan Wu
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Yufen Ma
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Zhen Li
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Jing Cao
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Jing Jiao
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Ge Liu
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Fangfang Li
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Baoyun Song
- Department of Nursing, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yilan Liu
- Department of Nursing, Wuhan Union Hospital, Wuhan, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China
| | - Shouzhen Cheng
- Department of Nursing, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Frances Lin
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia
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27
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Worsley PR, Stanger ND, Horrell AK, Bader DL. Investigating the effects of cervical collar design and fit on the biomechanical and biomarker reaction at the skin. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2018; 11:87-94. [PMID: 29588621 PMCID: PMC5858544 DOI: 10.2147/mder.s149419] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Research has shown that up to 33% of pressure ulcers (PUs) acquired in hospitals result from the application of a medical device. Cervical collars (C-collars) have been implicated in causing PUs, due to the mechanical force they apply to the skin. In order to improve our understanding of collar-related PUs, the present study aimed to assess the biomechanical, biochemical, and microclimate effects of C-collar design and fitting tension. Methods A cohort of 15 healthy volunteers was fit with two different C-collars according to the manufacturer guidelines. Two further collar tensions were also defined as loose and tight for each device. Each collar condition was applied for 15 minutes, with a 10 minute refractory period. Measurements at the device–skin interface included interface pressures, inflammatory biomarkers, microclimate, range of cervical motion, and comfort scores. Results The interface pressures at each tissue site increased monotonically with greater collar tension (p<0.01), irrespective of collar design. Biomarker analysis revealed that inflammatory cytokines (IL-1a) were elevated during collar application, with the highest increase during the tight fit condition, representing over a fourfold increase from unloaded conditions. Regardless of collar tension or type, there was an increase in temperature 1.5°C ±0.8°C compared to baseline values. Range of motion significantly decreased with greater strap tension (p<0.05), with an associated increase in discomfort. Conclusion The present findings revealed that increasing C-collar tensions caused elevated contact pressures at the device–skin interface, with a corresponding inflammatory response at the skin. These peak contact pressures were highest at the occiput, corresponding with reported PU locations. Devices should be designed to uniformly distribute pressures, and appropriate guidance is needed for their application.
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Affiliation(s)
- Peter R Worsley
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Nathan D Stanger
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Aran K Horrell
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Dan L Bader
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton, UK
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