Medical Adhesive–related Skin Injury Prevalence At The PICC Insertion Site And Construction Of Prevention Strategies

Objectives(1)Our study was to identified the prevalence and risk factors of medical adhesive-related skin injury(MARSI)at peripherally inserted central catheters(PICC)insertion site among oncology patients.(2)We performed to construct prevention strategies for MARSI at PICC insertion site as to promote the quality of PICC maintenance and decrease PICC-related complications.Methods(1)A cross-sectional,multiple-center epidemiological study lasting two weeks was performed.Trained nurses examined and assessed all hospitalized tumor patients' skin exposed to medical adhesive after removal of the previous dressing during PICC maintenance process.Surveyors identified and classified skin injury according to each definition and classification system followed by recording the morphological features of the skin lesions and complains of the patient.The photographs of skin lesions were made,numbered and stored.The information of demography,PICC insertion,disease were collected through electronic medical records system.Prevalence of MARSI was calculated statistically and risk factors were examined by logistic regression model.(2)Johns Hopkins: Evidence Level and Quality Guide was used to evaluate the literatures searched from databases and website.The prevention strategies of MARSI at PICC insertion site were summarized.Delphi technique was used to justify and rectify the strategies.Results(1)A total of 697 patients(mean age,48.9years;range,18.0-89.0 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<0.05).Multivariate analysis identified 50 years or older(odds ratio [OR],2.202;95% confidence interval [CI],1.222-3.968;P=0.009),a history of MARSI(OR,14.834;95% CI,6.534-33.680;P<0.001),history of skin allergies(OR,2.569;95%CI,1.214-5.437;P=0.014)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=0.034).(2)The study constructed prevention strategies of MARSI including four dimensions.The positive coefficients of two rounds of expert consultation were 85.00% and 94.12% respectively.The expert authority scores of two rounds were 0.736 and 0.825.After two rounds of expert inquiry,the CVs of each items' importance and operability were 0.00—0.11,0.08—0.36 respectively.The result of Kendall-W test showed the importance with W=0.56,the operability with W=0.59;P<0.001.Conclusions(1)The prevalence of MARSI is significant.Our study provided new knowledge for the epidemiology of MARSI and identified high-risk population,which would guild clinical nursing operation better and ensure patient safety.(2)The evidence-based prevention strategies for MARSI at PICC insertion site are consistent with scientificity and operability principles,which could guide clinical practice better.