BUNDLE: PREVENCIÓN DE LESIONES CUTÁNEAS RELACIONADAS CON ADHESIVOS MÉDICOS EN CUIDADOS INTENSIVOS DE ADULTOS

Rabelo, Ariana Luiza; Moraes, Juliano Teixeira

doi:10.1590/1980-265X-TCE-2022-0221en

Brasil

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Original article • Texto contexto - enferm. 31 • 2022 • https://doi.org/10.1590/1980-265X-TCE-2022-0221en linkcopiar

BUNDLE: PREVENCIÓN DE LESIONES CUTÁNEAS RELACIONADAS CON ADHESIVOS MÉDICOS EN CUIDADOS INTENSIVOS DE ADULTOS

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo construir y validar un bundle para la prevención de lesiones cutáneas relacionadas con adhesivos médicos en cuidados intensivos de adultos.

Método se trata de un estudio metodológico, realizado en tres etapas: elaboración de un Scoping Review, construcción del bundle y validación de contenido. La revisión del alcance siguió las recomendaciones del JBI y el proceso de validación de contenido se realizó mediante la técnica Delphi. En este proceso participaron seis jueces expertos. Para el análisis de validación de contenido se calculó el Coeficiente de Validez de Contenido y la prueba binomial. Se consideraron válidos para la prueba binomial los ítems que alcanzaron un coeficiente ≥0,80 y una proporción de concordancia del 80% entre los jueces.

Resultados la estructura del bundle tenía 21 recomendaciones, agrupadas en categorías: evaluación de la piel, identificación de pacientes en riesgo, selección de productos, preparación de la piel, técnica de aplicación de adhesivos, técnica de eliminación de adhesivos y educación continua de los profesionales de la salud. Los criterios establecidos para la evaluación lograron niveles de evaluación satisfactorios, siendo considerados adecuados por los jueces. En Delphi I, los ítems evaluados obtuvieron un Coeficiente de Validación de Contenido ≥0,83 y en Delphi II, ≥0,97.

Conclusión en este estudio fue posible construir y validar un bundle para la prevención de lesiones cutáneas relacionadas con los adhesivos médicos en cuidados intensivos de adultos.

DESCRIPTORES: Cuidados críticos; Heridas y lesiones; Unidades de cuidados intensivos; Estomaterapia; Paquetes de atención al paciente; Estudio de validación

Characterization of judges	n	%
Sex
Female	6	100
Age
30 to 40 years	1	16.7
41 to 54 years	2	33.3
51 to 60 years	2	33.3
61 to 70 years	1	16.7
Professional qualification
Doctoral degree	6	100
Stomatherapist	6	100
Professional activity
Research	4	66.7
Teaching	6	100
Care	1	16.7
Management	1	16.7
Clinical practice in stomatherapy
Yes	6	100
Operating time
1 to 5 years	1	16.7
11 to 20 years	3	50
21 to 35 years	2	33.3

Criteria	Skin assessment	Identification of patients at risk	Adhesive selection	Skin preparation	Adhesive application	Adhesive removal	Professionals’ education
	Delphi I	Delphi I	Delphi I	Delphi I	Delphi I	Delphi I	Delphi I
	Delphi II	Delphi II	Delphi II	Delphi II	Delphi II	Delphi II	Delphi II
Behavior	0.87	0.97	0.83	0.97	1.0	0.93	1.0
Behavior	0.97	1.0	0.97	1.0	1.0	1.0	1.0
Objectivity	0.87	0.97	0.93	1.0	0.87	1.0	0.97
Objectivity	1.0	1.0	0.97	1.0	1.0	1.0	1.0
Simplicity	0.93	0.93	0.93	1.0	0.97	0.97	0.97
Simplicity	0.97	0.97	0.97	1.0	1.0	1.0	1.0
Clarity	0.93	0.97	0.83	0.90	0.97	0.97	0.97
Clarity	0.97	0.97	0.97	0.97	0.97	1.0	0.97
Relevance	0.97	0.97	1.0	1.0	1.0	0.97	1.0
Relevance	1.0	1.0	0.97	0.97	1.0	1.0	1.0
Accuracy	0.87	0.97	0.93	1.0	1.0	1.0	1.0
Accuracy	1.0	1.0	0.97	0.97	1.0	1.0	0.97
Breadth	0.97	1.0	0.97	0.90	0.87	0.97	1.0
Breadth	1.0	1.0	1.0	1.0	1.0	1.0	1.0
Balance	0.97	1.0	0.93	1.0	1.0	0.97	1.0
Balance	1.0	1.0	1.0	1.0	1.0	0.97	0.97
Variety	0.97	0.93	0.93	0.87	1.0	1.0	1.0
Variety	1.0	1.0	0.97	0.97	1.0	1.0	1.0
Modality	0.93	0.97	0.90	0.97	0.90	1.0	1.0
Modality	1.0	1.0	0.97	0.97	1.0	1.0	1.0
Typicality	0.97	0.93	0.97	1.0	1.0	0.93	1.0
Typicality	1.0	1.0	0.97	1.0	1.0	1.0	1.0
Credibility	0.93	1.0	0.97	1.0	0.97	0.97	1.0
Credibility	0.97	1.0	1.0	0.97	1.0	1.0	1.0
CVC Total	Delphi I	Delphi II
CVC Total	0.96	0.99

Criteria	Skin assessment	Identification of patients at risk	Adhesive selection	Skin preparation	Adhesive application	Adhesive removal	Professionals’ education
	ρ-value	ρ-value	ρ-value	ρ-value	ρ-value	ρ-value	ρ-value
	Delphi I	Delphi I	Delphi I	Delphi I	Delphi I	Delphi I	Delphi I
	Delphi II	Delphi II	Delphi II	Delphi II	Delphi II	Delphi II	Delphi II
Behavior	0.345	0.738	0.345	0.738	0.738	1	1
Behavior	0.738	1	0.738	1	1	1	1
Objectivity	0.345	0.738	0.738	1	1	0.345	1
Objectivity	1	1	0.738	1	1	1	1
Simplicity	0.345	0.345	0.738	1	0.738	0.738	1
Simplicity	0.738	0.738	0.738	1	1	1	1
Clarity	0.345	0.738	0.345	0.738	0.345	0.738	1
Clarity	0.738	0.738	0.738	0.738	0.738	1	0.738
Relevance	0.738	0.738	1	1	1	0.738	1
Relevance	1	1	0.738	0.738	1	1	1
Accuracy	0.345	0.738	0.345	1	0.345	1	1
Accuracy	1	1	0.738	0.738	1	1	0.738
Breadth	0.738	1	0.738	1	1	1	1
Breadth	1	1	1	1	1	1	1
Balance	0.738	1	0.345	1	1	1	1
Balance	1	1	1	1	1	0.738	0.738
Variety	0.738	0.345	0.738	0.345	1	0.738	1
Variety	1	1	0.738	0.738	1	1	1
Modality	0.345	0.738	0.345	0.738	0.738	0.738	1
Modality	1	1	0.738	0.738	1	1	1
Typicality	0.738	0.345	0.738	0.738	0.738	0.738	1
Typicality	1	1	0.738	1	1	1	1
Credibility	0.345	1	0.738	1	0.738	1	1
Credibility	0.738	1	1	0.738	1	1	1

Final version - Bundle: Medical Adhesive-Related Skin Injury Prevention in the Adult Intensive Care Unit
Category	Nursing interventions	LoE^*
Skin assessment	1- Examine the skin of all patients upon admission and thereafter, daily, above all, before medical adhesive application and after its removal.	4
	2- Assess skin integrity, its coloration, temperature, humidity, turgor, fragility, edema and signs of local irritation.	4
	3- Previously recognize the types of skin injuries caused by medical adhesives (Mechanical: skin stripping, tension injury and friction injury. Dermatitis: irritant contact dermatitis and allergic dermatitis. Others: maceration and folliculitis).	5
Identification of patients at risk	4- Obtain patient history of known allergies and sensitivities, particularly to components of the medical adhesive.	4
Identification of patients at risk	5- Identify patients at risk through the following factors: Extremes of age (older adults); Underlying clinical conditions (diabetes, immunosuppression, renal failure, chronic venous insufficiency); Dermatological conditions (dermatitis, eczema, underlying injuries); Exposure to humidity; Malnutrition; Dehydration; Dry skin; Use of certain medications (chemotherapy, vasoconstrictors, long-term corticosteroids, anticoagulants); Recurrent use of medical adhesive.	3
Product selection	6- Select the most appropriate adhesive product for patients’ skin considering its particularities assessed.	5
Product selection	7- To choose the adhesive, consider: Patients’ skin conditions; Expected adhesive action (e.g., critical, non-critical device fixation, dressing, wound dressing); Time of permanence of the adhesive product. Adhesive properties (e.g., cohesiveness over time, softness, flexibility, strength); Anatomical location/area (whether the site is flat, subject to movement or friction, exposure to moisture, exudate and/or body fluids); Potential adverse effects of insufficient adherence Adhesive failure when the purpose is fixing a critical device;	4
Skin preparation	8- Prepare the skin, making sure it is clean and dry;	4
	9- Shave the hair, if necessary, preferably with scissors, avoiding using blades;	4
	10- Avoid using products that increase adhesive adhesion to the skin (e.g., benzoin);	5
	11- Consider using a barrier film before applying the medical adhesive (available in foams, wet wipes or sprays), especially in patients at risk of skin injury;	4
	12- Wait for liquid solutions to dry completely when applied to the skin, in order to avoid moisture;	5
Adhesive product application technique	13- Apply adhesive without straining, pulling or stretching;	5
	14- Use firm and gentle pressure to put the adhesive product in place, avoiding gaps and wrinkles;	5
	15- Fold a small edge of the adhesive over itself to form a small flap that facilitates its removal later;	5
	16- Apply adhesive only to the required area	5
Removal technique	17- Start removal from the edges of the adhesive product;	5
	18- With the fingers of the opposite hand, support the skin, keeping it firm; remove the adhesive product slowly on itself in the direction of hair growth, keeping it horizontal and at a low angle close to skin surface. As the product is removed, continue to move the fingers of the opposite hand supporting the newly exposed skin;	5
	19- Consider the possibility of using adhesive remover products (available in liquid solution, wipes, sprays);	4
	20- The use of lotion, petrolatum or mineral oil can be considered as alternative products for removing the adhesive;	5
Health professionals’ education	21- Promote permanent education for health professionals, addressing: Identification and recognition of medical adhesive-related skin injuries; Skin preparation; Application and removal techniques; Use of skin barrier products and adhesive removers; Strategies for skin injury prevention.	5

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Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[TFN1] *LoE: Level of Evidence