Prevalence and associated factors of medical adhesive-related skin injury in cardiac critical care units

Alcântara, Caroline Maria Pereira; Oliveira, Evellyn Lima da Silva; Campanili, Ticiane Carolina Gonçalves Faustino; Santos, Rayanne Suélly da Costa Silva; Santos, Vera Lúcia Conceição de Gouveia; Nogueira, Paula Cristina

doi:10.1590/S1980-220X2019035503698

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/S1980-220X2019035503698 copy

Prevalence and associated factors of medical adhesive-related skin injury in cardiac critical care units

Prevalencia de lesiones de la piel relacionadas con adhesivos médicos y factores asociados en unidades críticas cardiológicas

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To identify and analyze the point prevalence of medical adhesive-related skin injury in patients hospitalized in cardiac Intensive Care Units and demographic and clinical factors associated to their occurrence.

Method:

Cross-sectional study conducted in Intensive Care Units of two public hospitals, reference centers for cardiology, located in São Paulo city, with 123 patients. Demographic and clinical data from patients’ medical records were collected and lesions were identified through skin inspection. The data were analyzed through descriptive statistics and bivariate and multivariate analysis (Classification and Regression Tree).

Results:

Medical adhesive-related skin injury was presented by 28 patients, which amounts to a 22.7% prevalence. Its main causative agent was transparent polyurethane film (46.9%) and the cervical region was the most affected area (25.1%). From the multivariate analysis, the associated factors were found to be the presence of serum urea higher than or equal to 48.5 mg/dL and platelets lower than 193,500 mm³ or platelets higher than or equal to 193,500 mm³ and systolic blood pressure higher than or equal to 122 mmHg.

Conclusion:

This study has contributed to knowledge related to the epidemiology of this type of injury, favoring preventive care planning.

DESCRIPTORS:
Wounds and Injuries; Tissue Adhesives; Prevalence; Intensive Care Units; Nursing Care

	Types of injury
	Tension injury		Epidermis stripping		Skin tear		Irritant dermatitis		Total	Total	Total
Institution	A	B	A	B	A	B	A	B	A	B	A B
Type of adhesive
Polyurethane film	2 (6.2)	-	8 (25.1)	-	5 (15.6)	-	-	-	15 (46.9)	-	15 (46.9)
Eletrode	-	1 (3.1)	1 (3.1)	3 (9.4)	-	-	-	-	1 (3.1)	4 (12.6)	5 (15.7)
Adhesive elastic bandage	-	-	1 (3.1)	-	4 (12.6)	-	-	-	5 (15.7)	-	5 (15.7)
Microporous tape	-	1 (3.1)	-	-	1 (3.1)	1 (3.1)	-	-	1 (3.1)	2 (6.2)	3 (9.3)
Silk surgical tape	-	-	-	-	1 (3.1)	-	-	-	1 (3.1)	-	1 (3.1)
Adhesive tape	-	-	-	1 (3.1)	-	1 (3.1)	-	-	-	2 (6.2)	2 (6.2)
Collecting equipment	-	-	-	-	-	-	-	1 (3.1)	-	1 (3.1)	1 (3.1)
Total	2 (6.2)	2 (6.2)	10 (31.3)	4 (12.5)	11 (34.4)	2 (6.2)	-	1 (3.1)	23 (71.9)	9 (28.1)	32 (100.0)

Clinical variables	Medical adhesive-related skin injury		p
Clinical variables	Yes - Mean (SD)	No - Mean (SD)	p
Hospitalization time	30.59(26.7)	29.98(30.9)	0.32^* * Wilcoxon-Mann-Whitney test
Urea	82.86(45.0)	70.9(45.8)	0.09^* * Wilcoxon-Mann-Whitney test
Creatinine	1.53(0.8)	1.57(0.9)	0.73^* * Wilcoxon-Mann-Whitney test
Glasgow	14.75(0.9)	14.59(1.5)	0.96^* * Wilcoxon-Mann-Whitney test
Braden	12.32(4.0)	13.89(3.9)	0.06^* * Wilcoxon-Mann-Whitney test
BMI	24.88(5.4)	26.02(5.3)	0.32^ Two sample T test
Platelets	158,600(97070)	188,900(88290)	0.07^* * Wilcoxon-Mann-Whitney test
SBP	113.8(16.6)	115.9(18.5)	0.58^ Two sample T test
Number of devices	3.357(1.8)	3.484(1.9)	0.78^* * Wilcoxon-Mann-Whitney test

Clinical variables	Medical adhesive-related skin injury		p
Clinical variables	Yes n (%)	No n (%)	p
Kidney dysfunction			0.42^* * Pearson's chi-squared test
Yes No	4(16.6) 24(24.2)	20(83.3) 75(75.7)
Vasopressors			0.78^* * Pearson's chi-squared test
Yes No	12(24.0) 16(21.9)	38(76.0) 57(78.0)
Sedation			0.81^* * Pearson's chi-squared test
Yes No	8(24.2) 20(22.2)	25(75.7) 70(77.7)
Surgery			0.56^* * Pearson's chi-squared test
Yes No	15(25.0) 13(20.6)	45(75.0) 50(79.3)
Mechanical ventilation			0.22^* * Pearson's chi-squared test
Yes No	11(29.7) 17(19.7)	26(70.2) 69(80.2)
Orotracheal tube			0.64^* * Pearson's chi-squared test
Yes No	8(25.8) 20(21.7)	23(74.2) 72(78.2)
Tracheostomy			0.43^* * Pearson's chi-squared test
Yes No	3(33.3) 25(21.9)	6(66.6) 89(78.1)
Nasal catheter			0.74^* * Pearson's chi-squared test
Yes No	4(20.0) 24(23.3)	16(80.0) 79(76.7)
Peripheral catheter			0.01^* * Pearson's chi-squared test
Yes No	6(11.5) 22(30.9)	46(88.4) 49(69.1)
Central catheter			0.06^* * Pearson's chi-squared test
Yes No	24(27.2) 4(11.4)	64(72.7) 31(88.5)
Arterial catheter			0.93^* * Pearson's chi-squared test
Yes No	13(22.4) 15(23.1)	45(77.6) 50(76.9)
Urethral catheters			0.99^* * Pearson's chi-squared test
Yes No	15(22.7) 13(22.8)	51(77.2) 44(77.2)
Nasoenteral tube			0.27^* * Pearson's chi-squared test
Yes No	8(30.7) 20(20.6)	18(69.2) 77(79.4)
Gastrostomy			1.00^ Fisher's exact test
Yes No	- 28(23.3)	3(100.0) 92(76.6)
Mediastinal drain			0.90^* * Pearson's chi-squared test
Yes No	3(21.4) 25(22.9)	11(78.5) 84(77.1)
Pleural drain			0.70^* * Pearson's chi-squared test
Yes No	2(18.2) 26(23.2)	9(81.8) 86(76.8)
Hydrating creams			0.03^* * Pearson's chi-squared test
Yes No	21(25.3) 7(17.5)	62(74.7) 33(82.5)
Diaper			0.53^* * Pearson's chi-squared test
Yes No	22(24.2) 6(18.7)	69(75.8) 26(81.2)
Anal incontinence			0.40^* * Pearson's chi-squared test
Yes No	7(29.1) 21(21.2)	17(0.8) 78(78.7)
Urinary incontinence			1.000^ Fisher's exact test
Yes No	1(25.0) 27(22.7)	3(75.0) 92(77.3)
Use of ECC			0.48^* * Pearson's chi-squared test
Yes No	13(26.0) 15(20.5)	37(74.0) 58(79.4)

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Paula Cristina Nogueira, Escola de enfermagem da USP, Departamento de Enfermagem Médico-Cirúrgica, Av. Dr. Enéas de Carvalho Aguiar, 419, Cerqueira César, CEP 05403-000 - São Paulo, SP, Brazil. pcnogueira@usp.br