Medical adhesive-related skin injury in adult intensive care unit: scoping review

Rabelo, Ariana Luiza; Bordonal, Jéssica; Almeida, Thays Lopes de; Oliveira, Patrícia Peres; Moraes, Juliano Teixeira

doi:10.1590/0034-7167-2021-0926

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Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 75 (06) • 2022 • https://doi.org/10.1590/0034-7167-2021-0926 copy

Medical adhesive-related skin injury in adult intensive care unit: scoping review

Lesión cutánea relacionada con adhesivo médico en unidad de cuidado intensivo adulto: scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to identify and synthesize scientific evidence on preventing medical adhesive-related skin injuries in adult intensive care patients.

Methods:

this is a scoping review based on PRISMA-ScR recommendations and the technique proposed by Joanna Briggs Institute. PubMed, CINAHL, Web of Science, Scopus, LILACS, and Embase databases were searched using “Injuries AND Adhesives AND Skin AND Medical” descriptors”.

Results:

1,329 studies were identified, and after analysis, the final sample consisted of nine articles. We obtained two experts’ consensus, three case studies, two cross-sectional studies, one prospective cohort study, and one literature review regarding the type of studies.

Final Considerations:

the synthesized evidence allowed us to list health care measures to prevent medical adhesive-related skin injuries. The professional must know how to identify the skin injuries associated with medical adhesives and the main strategies for their prevention.

Descriptors:
Skin; Wounds and Injuries; Intensive Care Units; Critical Care; Enterostomal Therapy

Title		Author/year	Country	LE^{^* * LE- level of evidence.}	Type of study	Objective	Preventive Care
A1	Medical adhesives and patient safety: state of the science consensus statements for the assessment prevention(²2 McNichol L, Lund C, Rosen T, Gray M. Medical adhesives and patient safety: state of the science consensus statements for the assessment, prevention, and treatment of adhesive-related skin injuries. J Wound Ostomy Continence Nurs. 2013;40:365-380. https://doi.org/10.1097/WON.0b013e3182995516 https://doi.org/10.1097/WON.0b013e318299... )	McNichol L, Lund C, Rosen T, Gray M. 2013	USA	5	Expert consensus	Establish consensus statements on the assessment, prevention, and treatment of MARSI.	Identification of high-risk patients. Skin care. Maintain good nutrition and hydration, select the most appropriate adhesive product, and assess skin conditions. Consider using a barrier film to the skin before applying an adhesive product. Limit the use of products that increase adherence to the adhesive. Use proper techniques for adhesive removal. Consider using removers.
A2	Minimising pain and medical adhesive- related skin injuries in vulnerable patients(¹⁵15 Collier M. Minimizing pain and medical adhesive related skin injuries in vulnerable patients. Br J Nurs. 2019;28:S26-S32. https://doi.org/10.12968/bjon.2019.28.15.S26 https://doi.org/10.12968/bjon.2019.28.15... )	Collier, M. 2019	United Kingdom	4	Case Study	Review the literature about medical adhesive-related injuries and present an adhesive remover pointing out its benefits.	Recommends removal of adhesive products using Appeel Sterile, a sterile silicone medical adhesive remover clinically indicated for several patients whose skin is at risk of being easily compromised. It can be used on intact and injured skin around the central lines and for the safe removal of a variety of other medical devices and connections.
A3	Overlooked and underestimated: medical adhesive-related skin injuries. J Wound Care(¹¹11 Fumarola S, Allaway R, Callaghan R, Collier M, Downie F, Geraghty J. Overlooked and underestimated: medical adhesive-related skin injuries. J Wound Care. 2020;29(Sup3c):S1-S24. https://doi.org/10.12968/jowc.2020.29.Sup3c.S1 https://doi.org/10.12968/jowc.2020.29.Su... )	Fumarola S, Allaway R, Callaghan R, Collier M, Downie F, Geraghty J 2020	United Kingdom	5	Expert consensus	Increase awareness of MARSI. Encourage a change in culture whereby risk assessment and prevention of these injuries are considered essential parts of patient care.	All patients should have their skin routinely evaluated. The choice of medical adhesive should be based on the patient’s skin type, considering the risk factors. Perform proper technique for patch application and removal. Keep a skin care routine. Consider the use of barrier products and removers. Teach health professionals and patients about the subject and the preventive measures.
A4	Medical adhesive-related skin injuries associated with vascular access(¹⁶16 Hitchcock J, Savine L. Medical adhesive-related skin injuries associated with vascular access. Br J Nurs. 2017;26:S4-S12. https://doi.org/10.12968/bjon.2017.26.8.S4 https://doi.org/10.12968/bjon.2017.26.8.... )	Hitchcock J, Savine L. 2017	United Kingdom	4	Case Study	Discuss the maintenance of skin integrity, association of products and dressings more appropriate and recognize patients at risk of MARSI, and protection of venous access.	Presents an intervention algorithm for preventing medical adhesive-related skin injuries. Recommendations: Remove the dressing slowly from the distal edges at a low angle, providing support to the skin at the removal line. Consider using a removal product. Apply a barrier film. Apply the dressing without tension, without pulling or stretching when the skin is dry. Address malnutrition and dehydration. Assess the skin daily. Record the procedure thoroughly.
A5	Prevalence and associated factors of medical adhesive-related skin injury in cardiac critical care units(⁷7 Alcântara CMP, Oliveira ELS, Campanili TCGF, Santos RSCS, Santos VLCG, Nogueira PC. Prevalência de lesão de pele relacionada a adesivos médicos e fatores associados em unidades críticas cardiológicas. Rev Esc Enferm USP. 2021;55(e03698). https://doi.org/10.1590/S1980-220X2019035503698 https://doi.org/10.1590/S1980-220X201903... )	Alcântara CMP, Oliveira ELS, Campanili TCGF, Santos RSCS, Santos VLCG, Nogueira PC. 2021	Brazil	4	Cross-sectional study	Identify and analyze the point prevalence of MARSI in patients admitted to a cardiology intensive care unit and the demographic and clinical factors associated with its occurrence.	Appropriate choice of medical adhesive considering clinical purpose, anatomical location, adhesive properties, time of permanence, and skin conditions. Trim hair at the application site. When applying the liquid solution, allow it to dry completely to avoid humidity; avoid tension and asymmetrical areas at the time of application. During removal, take it off slowly, in a horizontal position, according to the hair growth, and hold the skin close to the removal point. Consider using an adhesive remover. Avoid excessive, unnecessary dressing changes.
A6	Clinical evaluation of a silicone adhesive remover for prevention of MARSI at dressing change(¹⁷17 Hadfield G, Freitas A, Bradbury S. Clinical evaluation of a silicone adhesive remover for prevention of MARSI at dressing change. J Commun Nurs. 2019;33:36-41.)	Hadfield G, De Freitas A, Bradbury S 2021	United Kingdom	4	Case Study	Provide an overview of MARSI and its impact on clinical practice, followed by the results of a clinical evaluation of the effectiveness of a remover in preventing MARSI and dressing-related pain in vascular access devices.	A structured approach to assess risk and select the appropriate adhesive products. Consider proper techniques for applying and removing them. Normal skin and patient assessment. Train the staff on early recognition of MARSI. The use of silicone remover prevented further MARSI episodes, reduced existing skin damage, and decreased patient pain and anxiety during the dressing change procedure.
A7	Incidence and Influencing Factors of Medical Adhesive-Related Skin Injury in Critically Ill Patients(¹1 Zhang YMS, Wang SBS, Zhang XMS, Zhang WBS, Wang XBS. Incidence and influencing factors of medical adhesive-related skin injury in critically ill patients. Adv Skin Wound Care. 2020;33(Issue 5):260-6. https://doi.org/10.1097/01.ASW.0000658584.09988.fa https://doi.org/10.1097/01.ASW.000065858... )	Zhang YMS, Wang SBS, Zhang XMS, Zhang WBS, Wang XBS. 2020	China	3	Prospective cohort	Determine the incidence and factors influencing medical adhesive-related skin injury (MARSI) in ICU patients.	Follow good practice guidelines when applying and removing adhesive products to prevent MARSI. Do not use adhesive products with tension because this can cause stress injuries. It is recommended to smooth the adhesive product in its place with gentle, firm pressure, avoiding gaps and wrinkles. Removal of the adhesive should be slow while keeping the adhesive product horizontal and folded over on itself, with the skin support. An edge can also be folded, forming a (skin) flap to facilitate removal.
A8	Incidence of and Risk Factors for Medical Adhesive-Related Skin Injuries Among Patients: A Cross-sectional Study(¹⁸18 Gao C, Yu C, Lin X, Wang H, Sheng Y. Incidence of and risk factors for medical adhesive-related skin injuries among patients a cross-sectional study. J Wound Ostomy Continence Nurs. 2020;47:576-81. https://doi.org/10.1097/WON.0000000000000714 https://doi.org/10.1097/WON.000000000000... )	Gao C, Yu C, Lin X, Wang H, Sheng Y 2020	China	4	Cross-sectional study	Identify the incidence of MARSI injuries developed in an intensive care unit and to pinpoint relevant risk factors associated with the injuries.	It is necessary to follow good clinical practice recommendations to ensure patient safety. The occurrence of MARSI can be reduced by the proper use of appropriate adhesives, with more education and awareness. The suggested correct angle for removal of an adhesive is 0° or 180° in a very slow movement.
A9	Management of Central Venous Access Device-Associated Skin Impairment(¹⁹19 Broadhurst D, Moureau N, Ullman AJ. Management of central venous access device-associated skin impairment. J Wound Ostomy Continence Nurs [Internet]. 2017 [cited 2021 Nov 2];44:211. https://doi.org/10.1097/WON.0000000000000322 https://doi.org/10.1097/WON.000000000000... )	Broadhurst D, Moureau N, Ullman AJ 2017	Europe, Australia, and North American countries	4	Literature review	Develop an algorithm to improve the identification and diagnosis of skin injuries around central venous access; guide decision-making for the best management for that access; and improve the clinic confidence when caring for patients with skin injuries at the location of the central venous access device.	Interventions are described in three sequential domains: assessment, skin protection, and comfort. Training is a key strategy to prevent and manage skin compromise associated with central venous access. Many injuries can be prevented with the use of proper dressing application and removal techniques and application of antiseptics. Nurses and patients who perform dressing changes should be trained on how to safely perform the procedures to prevent injuries.

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[1] Corresponding author: Juliano Teixeira Moraes E-mail: julianotmoraes@ufsj.edu.br