Development and Testing of an Algorithm to Prevent Medical Device-Related Pressure Injuries

Protocols and their effects for medical device-related pressure injury prevention among critically ill patients: a systematic review

BACKGROUND

A pressure injury refers to localized damage to the skin and/or tissue due to prolonged pressure, and it has recently been defined to include pressure injuries related to medical devices. Medical device-related pressure injuries occur in various sites and are difficult to detect. Even if it is detected, medical devices are essential to life for critically ill patients. Thus, it is difficult to remove or change the position of the medical device; therefore, prevention is essential. This study aims to integrate the literature on medical device-related pressure injury prevention protocols among critically ill patients.

METHODS

The literature inclusion criteria were (1) critically ill patients, (2) device-related pressure injury interventions, (3) randomized controlled trials and quasi-experimental designs, and (4) written in Korean or English. The literature search and selection were performed following the Cochrane Handbook for Systematic Reviews of Interventions with the support of the PRISMA Guidelines.

RESULTS

Twelve articles were finally selected. The incidence of medical device-related pressure injury decreased from 8.1-96.7% before intervention to 0.3-53.3% after intervention, respectively. Medical device-related pressure injury prevention was effective in reducing medical device-related pressure injury incidence when applied to patients of all ages, from neonates to adults, in a variety of intensive care units. Medical device-related pressure injury prevention strategies include nurse education, assessment, documentation, and interventions (hygiene, repositioning, emergent therapy such as protective dressing or designed equipment reducing pressure) of pressure injury. Pressure injury dressings primarily included hydrocolloid foam dressings, but transparent hydrocolloid formulations also effectively reduced medical device-related pressure injury incidence rates.

CONCLUSIONS

In the future, it is necessary to increase the level of evidence by applying specialized medical device-related pressure injury prevention methods for different medical devices and areas of pressure injuries, and verifying their effectiveness.

TRIAL REGISTRATION

The review protocol was registered (PROSPERO registration number: CRD42022346450).

MEDICAL DEVICE-RELATED PRESSURE INJURY: FREQUENCY AND ASSOCIATED FACTORS

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.

LESÃO POR PRESSÃO RELACIONADA A DISPOSITIVOS MÉDICOS: FREQUÊNCIA E FATORES ASSOCIADOS

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.