MEDICAL-DEVICE-RELATED PRESSURE INJURY ON ADULTS: AN INTEGRATIVE REVIEW

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.

DESCRIPTORS:
Pressure injury; Pressure ulcer; Medical-device-related pressure ulcer; Equipments and supplies; Adult

Level	Description
I	Evidence from systematic review or meta-analysis of all relevant randomized controlled trials or from clinical guidelines based on systematic reviews of randomized controlled trials
II.	Evidence from at least one well-designed randomized controlled trial
III.	Evidence from well-designed clinical trials without randomization
IV.	Evidence from well-designed cohort and case-control studies
V	Evidence from systematic review of descriptive and qualitative studies
VI.	Evidence derived from a single descriptive or qualitative study
VII	Evidence from expert opinion and/or expert committee report

Authors	Country	NE	Sample	Number/etiology	Results
Kayser et al.,1313. Kayser SA, VanGilder CA, Ayello EA, Lachenbruch C. Prevalence and analysis of Medical Device-Related Pressure Injuries: Results from the International Pressure Ulcer Prevalence Survey. Adv Skin Wound Care. [Internet] 2018 [cited 2019 Jan 17];31(6):276-85. Available from: Available from: https://dx.doi.org/10.1097/01.asw.0000532475.11971.aa https://dx.doi.org/10.1097/01.asw.000053...	Canada	V	99,876 ICU patients, long-term care, rehabilitation, long-term acute care hospitals and palliative care centers.	Prevalence of 601 injuries. Nasal oxygen tubes, splints, non-invasive ventilation, positive pressure masks	Medical-device-related pressure injuries occur in the face and head region, specifically the ears. Efforts should be ongoing for assessment and prevention in critically ill patients who require these devices.
Zhao et al.,1414. Zhao H, He Y, Wei Q, Ying Y. Medical Adhesive-Related Skin Injury Prevalence at the Peripherally Inserted Central Catheter Insertion Site: A Cross-sectional, Multiple-Center Study. J Wound Ostomy Continence Nurs. [Internet] 2018 [cited 2019 Jan 17];45(1):22-5. Available from: Available from: https://dx.doi.org/10.1097/won.0000000000000394 https://dx.doi.org/10.1097/won.000000000...	China	V	697 patients, four tertiary hospitals (three general and one cancer hospital).	137 fixing stickers.	The prevalence and the risk factors associated with medical-device-related pressure injuries caused by the skin patch used to fix the peripheral insertion central catheter provided epidemiology and identification of the high-risk population, as well as improved care and patient safety.
Arnold-Long et al.,1515. Arnold-Long M, Ayer M, Borchert K. Medical Device-Related Pressure Injuries in Long-term Acute Care Hospital Setting. J Wound Ostomy Continence Nurs. [Internet] 2017 [cited 2019 Jan 17]; 44(4):325-30. [cited 2019 Jan 17]. Available from: Available from: https://dx.doi.org/10.1097/won.0000000000000347 https://dx.doi.org/10.1097/won.000000000...	United States	VI.	304 patients in three long-term acute care hospitals.	142 breathing devices, splints, straps and tubes.	Injuries caused by devices were discharged from long-term inpatients.
Otero et al.,1616. Otero D P, Domínguez DV, Fernández LH, Magariño AS, González VJ, Klepzing JV, et al. Preventing facial pressure ulcers in patients under non-invasive mechanical ventilation: a randomised control trial. J Wound Care. [Internet] 2017 [cited 2019 Jan 17];26(3):128-36. Available from: Available from: https://dx.doi.org/10.12968/jowc.2017.26.3.128 https://dx.doi.org/10.12968/jowc.2017.26...	Spain	II.	152 patients, hospital emergency department.	74 caused by non-invasive ventilation, nasal mask.	The incidence of facial injury was significantly lower in the group receiving hyper oxygenated fatty acid solution when compared with direct mask, thin patch and foam patch.
Barakat-Johnson et al.,1717. Barakat-Johnson M, Barnett C, Wand T, White K. Medical device-related pressure injuries: An exploratory descriptive study in an acute tertiary hospital in Australia. J Tissue Viability. [Internet] 2017 [cited 2019 Jan 17]; 6(4)246-53. Available from: Available from: https://dx.doi.org/10.1016/j.jtv.2017.09.008 https://dx.doi.org/10.1016/j.jtv.2017.09...	Australia	VI.	179 patients, tertiary referral hospital with acute, subacute care and ICU.	50, 34 of them in intensive care/with endotracheal tube, CPAP (Continuous Positive Airway Pressure) and nasal parts, nasogastric probe, pulse oximeter	The most common sites are in the ear due to the endotracheal tube in intensive care unit patients. Additional support, education and monitoring are required for nurses to prevent injury.
Coyer et al.,1818. Coyer FM, Stotts NA, Blackman VS. A prospective window into medical device related pressure ulcers in intensive care. Int Wound J. [Internet] 2014 [cited 2019 Jan 17];11:656-64. Available from: Available from: https://dx.doi.org/10.1111/iwj.12026 https://dx.doi.org/10.1111/iwj.12026...	United States	IV.	483 patients, six intensive care units in Australia and the United States.	20 injuries were followed-up for seven days continuously. Endotracheal devices and nasogastric tube	They were identified in overweight white men, low risk of organ failure and long stay in the intensive care unit.
Asti et al.,1919. Asti E, Sironi A, Milito P, Bonavina G, Bonitta G, Bonavina L. Prevalence and risk factors of nasal pressure ulcers related to nasogastric intubation: an observational study. Eur Surg. [Internet] 2017 [cited 2019 Jan 17];49:171-4. Available from: Available from: https://dx.doi.org/10.1007/s10353-017-0476-y https://dx.doi.org/10.1007/s10353-017-04...	Italy	IV.	2,131 patients who underwent surgery.	102 nasogastric probes	Secondary injuries due to the nasogastric probe in surgical patients, which can cause irreversible sequelae in the patient's nasal wing.
Ambutas et al.,2020. Ambutas S, Staffileno BA, Fogg L. Reducing nasal pressure ulcers with an alternative taping device. Medsurg Nurs. [Internet] 2014 [cited 2019 Jan 17];23(2):96-100. Available from: Available from: https://europepmc.org/abstract/med/24933786 https://europepmc.org/abstract/med/24933...	United States	III.	205 patients in the operating room and hospitalization.	5 injuries using a nasogastric probe-specific fixative and 19 lesions with a conventional fixative	Comparison between the use of 2 nasogastric probe fixatives, in which the evaluation of the underlying skin and nursing intervention are fundamental for the recognition of a potential injury.
Schallom et al.,2121. Schallom M, Cracchiolo L, Falker A, Foster J, Hager J, Morehouse T, et al. Pressure ulcer incidence in patients wearing nasal-oral versus full-face noninvasive ventilation masks. Am J Crit Care. [Internet] 2015 [cited 2019 Jan 17]; 24(4):349-56. Available from: Available from: https://dx.doi.org/10.4037/ajcc2015386 https://dx.doi.org/10.4037/ajcc2015386...	United States	IV.	Two groups of 100 patients who used the nasal-oral mask or the face mask in five ICUs.	20 pressure injuries in the nasal-oral mask group and two in the face mask group	The facemask resulted in a smaller number of pressure injuries and was more comfortable for patients, being a good alternative for non-invasive ventilation.
O’Toole et al.,2222. O’Toole TR, Jacobs N, Hondorp B, Crawford L, Boudreau LR, Jeffe J, et al. Prevention of tracheostomy-related hospital-acquired pressure ulcers. Otolaryngol Head Neck Surg. [Internet] 2017 [cited 2019 Jan 17]; 156(4):642-51. Available from: Available from: https://dx.doi.org/10.1177/0194599816689584 https://dx.doi.org/10.1177/0194599816689...	United States	III.	155 patients for tracheostomy protection protocol intervention and 183 pre-intervention patients for comparison.	20 pre-intervention injuries and two post-intervention injuries. Tracheostomy	The adoption of the preventive care package resulted in a significant reduction in the incidence of the pressure injury related to hospital tracheostomy
Glasgow et al.,2323. Glasgow D, Millen IS, Nzewi OC, Varadarajaran B. Device-related atypical pressure ulcer after cardiac surgery. J Wound Care. [Internet] 2014 [cited 2019 Jan 17];23(8):383-4, 386-7. Available from: Available from: http://dx.doi.org/10.12968/jowc.2014.23.8.383 http://dx.doi.org/10.12968/jowc.2014.23....	United Kingdom	VII	One patient, clinical case report after extensive cardiac surgery.	One injury due to tube fixation at the cervical posterior, stage 4	Injuries are reported in nursing journals, but rarely in medical journals, so multidisciplinary care is important for injury prevention and for reducing patient stay length.
Ham et al.,2424. Ham WH, Schoonhoven L, Schuurmans MJ, Leenen LP. Pressure ulcers in trauma patients with suspected spine injury: a prospective cohort study with emphasis on device-related pressure ulcers. Int Wound J. [Internet] 2016 [cited 2019 Jan 17];14(1):104-11. Available from: Available from: https://dx.doi.org/10.1111/iwj.12568 https://dx.doi.org/10.1111/iwj.12568 ...	Netherlands	IV.	254 patients at the trauma center.	88 cervical collars and immobilizers, urinary tubes, endotracheal tube and nasogastric probe	16 different spots with medical-device-related pressure injuries found; in trauma patients, it is very high
Ham et al.,2525. Ham HW, Schoonhoven LL, Galer AA, Shortridge-Baggett LL. Cervical collar-related pressure ulcers in trauma patients in intensive care unit. J Trauma Nurs. [Internet] 2014 [cited 2019 Jan 17];21(3):94-102. Available from: Available from: https://dx.doi.org/10.1097/jtn.0000000000000046 https://dx.doi.org/10.1097/jtn.000000000...	England	V	88 patients, trauma and surgical ICU.	One injury, stage 4, in the occipital region, resulting from the use of cervical collar	In this study, the incidence of pressure injury due to the cervical collar was low, but prevention for this device cannot be ruled out. Further research studies should be conducted to obtain data for future effective interventions
Padula et al.,2626. Padula CA, Paradis H, Goodwin R, Lynch J, Hegerich-Bartula D. Prevention of Medical Device-Related Pressure Injuries Associated with Respiratory Equipment Use in a Critical Care Unit: A Quality Improvement Project. J Wound Ostomy Continence Nurs. [Internet] 2017 [cited 2019 Jan 17]; 44(2):138-41. Available from: Available from: https://dx.doi.org/10.1097/won.0000000000000311 https://dx.doi.org/10.1097/won.000000000...	Iceland	III.	130 patients in ICU.	Five injuries in the study intervention period, 12 months	With incorporation of multiple interventions, including health education, interdisciplinary follow-up and analysis of the main causes for subsequent intervention, are factors that reduce the incidence of medical-device-related pressure injury in the intensive care unit.
Monarca et al.,2727. Monarca MC, Marteka P, Breda K. Decreasing incidence of medical device-related pressure injuries in a small community hospital a quality improvement project. J Wound Ostomy Continence Nurs. [Internet] 2018 [cited 2019 Jan 17];45(2):137-40. Available from: Available from: https://dx.doi.org/10.1097/won.0000000000000419 https://dx.doi.org/10.1097/won.000000000...	United States	III.	250 patients, project intervention for 12 months for prevention of PI due to GNS. Midsize Hospital	42 injuries before the intervention and 33 injuries after the project.	Health education, development of a scientific evidence-based preventive intervention package, documentation and tracking of pressure injuries combination has resulted in reduced cases

Level I	Level II	Level III	Level IV	Level V	Level VI	Level VII
0	One randomized clinical trial	Three well-designed clinical trials without randomization	Four prospective cohort studies	Three systematic review of descriptive studies	Two descriptive studies	A case report study

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

Acompanhe os números deste periódico no seu leitor de RSS

[1] CORRESPONDENCE AUTHOR Euni de Oliveira Cavalcanti euni.cavalcanti@hotmail.com