Medical device-related pressure injuries in critical patients: prevalence and associated factors

Galetto, Sabrina Guterres da Silva; do Nascimento, Eliane Regina Pereira; Hermida, Patrícia Madalena Vieira; Busanello, Josefine; de Malfussi, Luciana Bihain Hagemann; Lazzari, Daniele Delacanal

doi:10.1590/1980-220X-REEUSP-2020-0397

Sabrina Guterres da Silva Galetto Corresponding author: Sabrina Guterres da Silva Galetto, Rua João Motta Espezim, 859 Bairro Sacos dos Limões, 88045401 – Florianópolis, SC, Brazil, sabrinaguterres@gmail.com

Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Enfermagem, Florianópolis, SC, Brazil.

http://orcid.org/0000-0003-4137-1687

Eliane Regina Pereira do Nascimento

Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Enfermagem, Departamento de Enfermagem, Florianópolis, SC, Brazil.

http://orcid.org/0000-0003-2215-4222

Patrícia Madalena Vieira Hermida

Prefeitura Municipal de Florianópolis, Secretaria Municipal de Saúde, Florianópolis, SC, Brazil.

http://orcid.org/0000-0002-7969-357X

Josefine Busanello

Universidade Federal do Pampa, Uruguaiana, RS, Brazil.

http://orcid.org/0000-0002-9950-9514

Luciana Bihain Hagemann de Malfussi

Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Enfermagem, Florianópolis, SC, Brazil.

http://orcid.org/0000-0002-3199-9529

Daniele Delacanal Lazzari

Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Enfermagem, Departamento de Enfermagem, Florianópolis, SC, Brazil.

http://orcid.org/0000-0003-1788-866X

Corresponding author: Sabrina Guterres da Silva Galetto, Rua João Motta Espezim, 859 Bairro Sacos dos Limões, 88045401 – Florianópolis, SC, Brazil, sabrinaguterres@gmail.com

*
Extracted from the thesis “Pressure injuries related to medical devices in critically ill patients: clinical characteristics and the nursing approach”, Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Enfermagem, 2018.

Characteristics	Descriptive measures^* * Descriptive measures = n (%) used for categorical variables; mean±standard deviation used to describe the quantitative variables with symmetrical distribution; median (interquartile range) used to describe variables with asymmetric distribution; †Other causes = respiratory, renal, neurological, hematological, metabolic, digestive tract diseases, infectious diseases and external causes; ‡ICU = Intensive Care Unit; §BMI = Body Mass Index; \|\|RASS = Richmond Agitation Sedation Scale; ¶SAPS 3 = Simplified Acute Physiology Score 3. Note: (N = 93).
Age	55.3 ± 15.3
Sex
Male	61 (65.6)
Female	32 (34.4)
Race/color
White	68 (73.1)
Black	7 (7.5)
Mixed race	17 (18.3)
Indigenous	1 (1.1)
Presence of comorbidities
Diabetes Mellitus	26 (28.0)
Arterial hypertension	45 (48.4)
Pulmonary diseases	22 (23.7)
Vascular diseases	12 (12.9)
Smoking
Active smoker	25 (26.9)
Ex-smoker	17 (18.3)
Nonsmoker	51 (54.8)
Edema
Sign of Godet 1+	19 (20.4)
Sign of Godet 2+	40 (43.0)
Sign of Godet 3+	29 (31.2)
Sign of Godet 4+	5 (5.4)
Diagnosis and length of hospital stay
Sepsis	24 (25.8)
Liver diseases	7 (7.5)
Respiratory failure	41 (44.1)
State of shock	21 (22.6)
Cardiovascular diseases	3 (3.2)
Decompensated diabetes	3 (3.2)
Surgery	28 (30.1)
Other causes^† * Descriptive measures = n (%) used for categorical variables; mean±standard deviation used to describe the quantitative variables with symmetrical distribution; median (interquartile range) used to describe variables with asymmetric distribution; †Other causes = respiratory, renal, neurological, hematological, metabolic, digestive tract diseases, infectious diseases and external causes; ‡ICU = Intensive Care Unit; §BMI = Body Mass Index; \|\|RASS = Richmond Agitation Sedation Scale; ¶SAPS 3 = Simplified Acute Physiology Score 3. Note: (N = 93).	54 (58.1)
Length of hospital stay (days)	7 (4 to 15)
Length of ICU stay^‡ * Descriptive measures = n (%) used for categorical variables; mean±standard deviation used to describe the quantitative variables with symmetrical distribution; median (interquartile range) used to describe variables with asymmetric distribution; †Other causes = respiratory, renal, neurological, hematological, metabolic, digestive tract diseases, infectious diseases and external causes; ‡ICU = Intensive Care Unit; §BMI = Body Mass Index; \|\|RASS = Richmond Agitation Sedation Scale; ¶SAPS 3 = Simplified Acute Physiology Score 3. Note: (N = 93). (days)	5 (4 to 9)
Other clinical data
BMI^§ * Descriptive measures = n (%) used for categorical variables; mean±standard deviation used to describe the quantitative variables with symmetrical distribution; median (interquartile range) used to describe variables with asymmetric distribution; †Other causes = respiratory, renal, neurological, hematological, metabolic, digestive tract diseases, infectious diseases and external causes; ‡ICU = Intensive Care Unit; §BMI = Body Mass Index; \|\|RASS = Richmond Agitation Sedation Scale; ¶SAPS 3 = Simplified Acute Physiology Score 3. Note: (N = 93).	26.9 ± 8.9
Sedated patient	72 (77.4)
RASS sedation scale^\|\| * Descriptive measures = n (%) used for categorical variables; mean±standard deviation used to describe the quantitative variables with symmetrical distribution; median (interquartile range) used to describe variables with asymmetric distribution; †Other causes = respiratory, renal, neurological, hematological, metabolic, digestive tract diseases, infectious diseases and external causes; ‡ICU = Intensive Care Unit; §BMI = Body Mass Index; \|\|RASS = Richmond Agitation Sedation Scale; ¶SAPS 3 = Simplified Acute Physiology Score 3. Note: (N = 93).	−5 (−5 to −3)
Glasgow scale	15 (11 to 15)
Braden scale	10.5 ± 1.8
Hematocrit	30.7 ± 8.5
SAPS 3^¶ * Descriptive measures = n (%) used for categorical variables; mean±standard deviation used to describe the quantitative variables with symmetrical distribution; median (interquartile range) used to describe variables with asymmetric distribution; †Other causes = respiratory, renal, neurological, hematological, metabolic, digestive tract diseases, infectious diseases and external causes; ‡ICU = Intensive Care Unit; §BMI = Body Mass Index; \|\|RASS = Richmond Agitation Sedation Scale; ¶SAPS 3 = Simplified Acute Physiology Score 3. Note: (N = 93).	64.4 ± 13.3
Use of vasoactive drugs	57 (61.3)
Time of use of vasoactive drugs (days)	4 (3–6)

Dispositivos	Patients evaluated N(%)	Prevalence n(%)	*95%CI^ * CI = Confidence Interval Note: (N = 93).**
Overall prevalence	93 (100)	58 (62.4)	52.2–71.8
Orotracheal tube	78 (83.9)	39 (50.0)	38.5–61.5
Tracheostomy tube	13 (14.0)	1 (7.7)	0.2–36.0
Non-invasive ventilation mask	24 (25.8)	4 (16.7)	4.7–37.4
Nasogastric tube	34 (36.6)	15 (44.1)	27.2–62.1
Nasoenteric tube	60 (64.5)	12 (20.0)	10.8–32.3
Urinary cateter	91 (97.8)	26 (28.6)	19.6–39.0
Pulse oximeter	93 (100)	11 (11.8)	6.1–20.2

Device/region	n(%)^* * Percentages of body region and stages calculated on the number of patients who developed medical device-related pressure injuries; †UN = Unstageable; ‡NIV = Non-Invasive Ventilation.	Staging^* * Percentages of body region and stages calculated on the number of patients who developed medical device-related pressure injuries; †UN = Unstageable; ‡NIV = Non-Invasive Ventilation.
Device/region			1	2	3
Orotracheal tube (N = 39)
Lip/labial commissure	15 (38.5)	NC^† * Percentages of body region and stages calculated on the number of patients who developed medical device-related pressure injuries; †UN = Unstageable; ‡NIV = Non-Invasive Ventilation.
Face	2 (5.1)			2 (100.0)
Auricular region	31 (79.5)		3 (9.7)	15 (48.4)	13 (41.9)
Tracheostomy tube (N = 1)
Cervical region	1 (100.0)			1 (100.0)
NIV mask^‡ * Percentages of body region and stages calculated on the number of patients who developed medical device-related pressure injuries; †UN = Unstageable; ‡NIV = Non-Invasive Ventilation. (N = 4)
Front region	2 (50.0)		1 (50.0)	1(50.0)
Jugal region	1 (25.0)			1 (100.0)
Face	2 (50.0)			2(100.0)
Auricular region	1 (25.0)			1 (100.0)
Nasogastric tube (N = 15)
Nasal ala	13 (86.7)			8 (61.5)	5 (38.5)
Nasal mucosa	4 (26.7)	NC^† * Percentages of body region and stages calculated on the number of patients who developed medical device-related pressure injuries; †UN = Unstageable; ‡NIV = Non-Invasive Ventilation.
Nasoenteric tube (N = 12)
Nasal ala	8 (66.7)			6 (75.0)	2 (25.0)
Nasal mucosa	6 (10.0)	NC^† * Percentages of body region and stages calculated on the number of patients who developed medical device-related pressure injuries; †UN = Unstageable; ‡NIV = Non-Invasive Ventilation.
Urinary catheter (N = 26)
Urethral meatus	20 (76.9)	NC^† * Percentages of body region and stages calculated on the number of patients who developed medical device-related pressure injuries; †UN = Unstageable; ‡NIV = Non-Invasive Ventilation.
Thighs	3 (11.5)		1 (33.3)	2 (66.7)
Perianal region	4 (15.4)			4 (100.0)
Pulse oximeter (N = 11)
Fingers	9 (81.8)		4 (44.4)	5 (55.6)
Auricular region	3 (27.3)			2 (66.7)	1 (33.3)

Characteristics	Gross PR^* PR = Prevalence Ratio; †CI = Confidence Interval; ‡p-value = p value from Poisson Regression; §Other causes = respiratory, renal, neurological, hematological, metabolic, digestive tract diseases, infectious diseases and external causes; \|\|ICU = Intensive Care Unit; ¶BMI = Body Mass Index; RASS = Richmond Agitation Sedation Scale; ††SAPS 3 = Simplified Acute Physiology Score 3. (95%CI^† PR = Prevalence Ratio; †CI = Confidence Interval; ‡p-value = p value from Poisson Regression; §Other causes = respiratory, renal, neurological, hematological, metabolic, digestive tract diseases, infectious diseases and external causes; \|\|ICU = Intensive Care Unit; ¶BMI = Body Mass Index; **RASS = Richmond Agitation Sedation Scale; ††SAPS 3 = Simplified Acute Physiology Score 3. )	p-value^‡ PR = Prevalence Ratio; †CI = Confidence Interval; ‡p-value = p value from Poisson Regression; §Other causes = respiratory, renal, neurological, hematological, metabolic, digestive tract diseases, infectious diseases and external causes; \|\|ICU = Intensive Care Unit; ¶BMI = Body Mass Index; *RASS = Richmond Agitation Sedation Scale; ††SAPS 3 = Simplified Acute Physiology Score 3.	Adjusted PR^* PR = Prevalence Ratio; †CI = Confidence Interval; ‡p-value = p value from Poisson Regression; §Other causes = respiratory, renal, neurological, hematological, metabolic, digestive tract diseases, infectious diseases and external causes; \|\|ICU = Intensive Care Unit; ¶BMI = Body Mass Index; RASS = Richmond Agitation Sedation Scale; ††SAPS 3 = Simplified Acute Physiology Score 3. (95%CI^† PR = Prevalence Ratio; †CI = Confidence Interval; ‡p-value = p value from Poisson Regression; §Other causes = respiratory, renal, neurological, hematological, metabolic, digestive tract diseases, infectious diseases and external causes; \|\|ICU = Intensive Care Unit; ¶BMI = Body Mass Index; **RASS = Richmond Agitation Sedation Scale; ††SAPS 3 = Simplified Acute Physiology Score 3. )	p-value^‡ PR = Prevalence Ratio; †CI = Confidence Interval; ‡p-value = p value from Poisson Regression; §Other causes = respiratory, renal, neurological, hematological, metabolic, digestive tract diseases, infectious diseases and external causes; \|\|ICU = Intensive Care Unit; ¶BMI = Body Mass Index; *RASS = Richmond Agitation Sedation Scale; ††SAPS 3 = Simplified Acute Physiology Score 3.
Age	0.7 (0.4–1.3)	0.729
Male sex	1.3 (0.9–1.8)	0.212
Race/color
White	1.5 (0.9–2.5)	0.154
Black	0.9 (0.3–2.5)	0.854
Mixed race	Ref
Indigenous	Insufficient nr
Presence of comorbidities
Diabetes Mellitus	1.1 (0.8–1.5)	0.701
Arterial hypertension	0.9 (0.6–1.2)	0.381
Pulmonary diseases	0.9 (0.6–1.4)	0.725
Vascular diseases	0.8 (0.4–1.4)	0.405
Smoking
Active smoker	1.2 (0.8–1.7)	0.330
Ex-smoker	1.2 (0.8–1.8)	0.276
Nonsmoker	Ref
Edema
Sign of Godet 1+	Ref
Sign of Godet 2+	2.5 (1.1–5.4)	0.024
Sign of Godet 3+	3.0 (1.4–6.5)	0.005
Sign of Godet 4+	3.0 (1.3–7.3)	0.012
Diagnosis
Sepsis	1.2 (0.9–1.6)	0.285
Liver diseases	0.9 (0.5–1.8)	0.780
Respiratory failure	0.9 (0.7–1.3)	0.807
State of shock	1.1 (0.8–1.6)	0.630
Cardiovasculary diseases	0.5 (0.1–2.6)	0.434
Decompensated diabetes	1.1 (0.5–2.4)	0.868
Surgery	0.9 (0.6–1.3)	0.512
Other causes^§ PR = Prevalence Ratio; †CI = Confidence Interval; ‡p-value = p value from Poisson Regression; §Other causes = respiratory, renal, neurological, hematological, metabolic, digestive tract diseases, infectious diseases and external causes; \|\|ICU = Intensive Care Unit; ¶BMI = Body Mass Index; *RASS = Richmond Agitation Sedation Scale; ††SAPS 3 = Simplified Acute Physiology Score 3.	1.6 (1.1–2.3)	0.013	1.8 (1.3–2.5)	0.001
Length of hospital stay	1.01 (1.00–1.03)	0.120	1.01 (1.00–1.03)	0.138
Length of ICU stay^\|\| PR = Prevalence Ratio; †CI = Confidence Interval; ‡p-value = p value from Poisson Regression; §Other causes = respiratory, renal, neurological, hematological, metabolic, digestive tract diseases, infectious diseases and external causes; \|\|ICU = Intensive Care Unit; ¶BMI = Body Mass Index; *RASS = Richmond Agitation Sedation Scale; ††SAPS 3 = Simplified Acute Physiology Score 3.	1.03 (1.02–1.05)	<0.001
Other clinical data
BMI^¶ PR = Prevalence Ratio; †CI = Confidence Interval; ‡p-value = p value from Poisson Regression; §Other causes = respiratory, renal, neurological, hematological, metabolic, digestive tract diseases, infectious diseases and external causes; \|\|ICU = Intensive Care Unit; ¶BMI = Body Mass Index; *RASS = Richmond Agitation Sedation Scale; ††SAPS 3 = Simplified Acute Physiology Score 3.	1.01 (1.00–1.02)	0.283
Sedated patient	1.3 (0.8–1.9)	0.328
RASS scale^** PR = Prevalence Ratio; †CI = Confidence Interval; ‡p-value = p value from Poisson Regression; §Other causes = respiratory, renal, neurological, hematological, metabolic, digestive tract diseases, infectious diseases and external causes; \|\|ICU = Intensive Care Unit; ¶BMI = Body Mass Index; *RASS = Richmond Agitation Sedation Scale; ††SAPS 3 = Simplified Acute Physiology Score 3.	0.9 (0.8–1.1)	0.303
Glasgow scale	0.9 (0.8–1.0)	0.008
Braden scale	0.8 (0.8–0.9)	<0.001	0.8 (0.8–0.9)	<0.001
Hematocrit	1.01 (0.98–1.02)	0.941
SAPS 3^†† PR = Prevalence Ratio; †CI = Confidence Interval; ‡p-value = p value from Poisson Regression; §Other causes = respiratory, renal, neurological, hematological, metabolic, digestive tract diseases, infectious diseases and external causes; \|\|ICU = Intensive Care Unit; ¶BMI = Body Mass Index; *RASS = Richmond Agitation Sedation Scale; ††SAPS 3 = Simplified Acute Physiology Score 3.	1.01 (1.00–1.02)	0.173	1.01 (1.00–1.02)	0.173
Use of vasoactive drugs	1.1 (0.8–1.6)	0.533

Devices	Gross PR^* PR = Prevalence Ratio; †CI = Confidence Interval; ‡p-value from Poisson Regression. (95%CI^† PR = Prevalence Ratio; †CI = Confidence Interval; ‡p-value from Poisson Regression. )	*p-value^‡ PR = Prevalence Ratio; †CI = Confidence Interval; ‡p-value from Poisson Regression.**
Orotracheal tube	1.7 (0.9–3.2)	0.117
Orotracheal tube time	1.07 (1.04–1.10)	<0.001
Tracheostomy tube	1.7 (1.3–2.1)	<0.001
Tracheostomy tube time	0.99 (0.975–1.01)	0.472
Non-invasive ventilation mask	0.7 (0.4–1.1)	0.094
Non-invasive ventilation mask time	0.8 (0.5–1.3)	0.406
Nasogastric tube	1.2 (0.9–1.7)	0.197
Nasogastric tube time	1.03 (1.00–1.05)	0.024
Nasoenteric tube	1.3 (0.9–1.9)	0.138
Nasoenteric tube time	1.03 (1.01–1.04)	0.002
Urinary catheter	1.3 (0.3–5.1)	0.752
Urinary catheter time	1.05 (1.03–1.07)	<0.001
Pulse oximeter	0.6 (0.5–0.7)	<0.001
Pulse oximeter time	1.03 (1.02–1.05)	<0.001

[1] Corresponding author: Sabrina Guterres da Silva Galetto, Rua João Motta Espezim, 859 Bairro Sacos dos Limões, 88045401 – Florianópolis, SC, Brazil, sabrinaguterres@gmail.com

Brasil

Brasil

Lesiones por presión relacionadas con dispositivos médicos en pacientes críticos: prevalencia y factores asociados

ABSTRACT

Objective:

Method:

Results:

Conclusion: