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Chen G, Li X, Li X, Liu S, Xie J. Mucosal membrane pressure injury in intensive care units: A scoping review. Intensive Crit Care Nurs 2024; 80:103560. [PMID: 37918080 DOI: 10.1016/j.iccn.2023.103560] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/11/2023] [Accepted: 09/29/2023] [Indexed: 11/04/2023]
Abstract
AIM To describe published work on the current situation of mucosal membrane pressure injury of patients in the intensive care unit. BACKGROUND Device-related pressure injuries in critically ill patients are mostly focused on skin surface injuries, and less attention is paid to mucosal membrane pressure injury. METHODS We searched PubMed, Embase, Web of Science, CINAHL, and Cochrane Library from database construction until March 1, 2023. Two researchers independently screened and extracted data. RESULTS Eighteen articles met our criteria and were published in 2014-2023. The included studies showed that the incidence of mucosal membrane pressure injury in critically ill patients ranged from 0.83% to 88.2%, and the prevalence ranged from 0.16% to 55.6%. The most frequently reported site of mucosal injury is the oral mucosa, followed by the nasal mucosa. Ten studies used Braden to assess the risk of mucosal membrane pressure injury, and only six studies reported specific stages of mucosal membrane pressure injury. Thirteen studies described 30 risk factors for mucosal membrane pressure injury, with albumin being the most frequently reported risk factor, followed by the vasoconstrictive drugs use. Thirty risk factors were summarized in six aspects: medical device-related factors, disease-related factors, treatment- related factors, physiological and biochemical parameters, demographic-related factors, and microbial colonisation. CONCLUSIONS The incidence or prevalence of mucosal membrane pressure injury varies widely, and specific risk assessment tools and standardized staging criteria need to be further determined. The risk factors of mucosal membrane pressure injury involve multiple aspects, and some risk factors have only been explored in few studies and need to be further verified, in order to detect the risk group of mucosal membrane pressure injury early and take targeted preventive measures. IMPLICATIONS FOR CLINICAL PRACTICE We synthesized the current research status of mucosal membrane pressure injury in critically ill patients, which can provide a valuable reference for the clinical staff to develop preventive and management measures for such patients.
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Affiliation(s)
- Guanjie Chen
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China
| | - Xiaoqing Li
- Department of Nursing, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China.
| | - Xuezhu Li
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China
| | - Songqiao Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China
| | - Jianfeng Xie
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China
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Aydım Kudu A, Taşdemir N, Sönmez M. Incidence of medical device-related pressure injuries in the intensive care unit and related risk factors. J Tissue Viability 2023; 32:564-571. [PMID: 37407387 DOI: 10.1016/j.jtv.2023.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/18/2023] [Accepted: 06/16/2023] [Indexed: 07/07/2023]
Abstract
AIM At present, physicians employ medical devices extensively in the treatment of numerous diseases and in the care and follow-up of patients. However, these medical devices are a potential cause of pressure injuries.The study aimed to investigate the incidence and affecting risk factors of medical device-related pressure injuries (MDRPIs) in an adult intensive care unit. MATERIALS AND METHODS This is a longitudinal descriptive/analytical and cross-sectional study. The researchers conducted this study with 213 intensive care patients between 15.06.2021 and 15.12.2021. The skin and mucosa under and around each medical device were observed once a day for MDRPIs during the stay of patients who had been hospitalized in the intensive care unit for at least 24 h. The data were collected using Patient Information Form developed by the researchers based on the literature, Medical Device-Related Pressure Injury Monitoring Form, the Jackson/Cubbin Pressure Area Risk Calculator (Jackson/Cubbin BARHATr)-Turkish Version, the National Pressure Injury Advisory Panel (NPIAP) Pressure Injury Staging System and the Glasgow Coma Scale. RESULTS The incidence of MDRPIs was 28.6% (61/213). The study revealed that 48.4% (46/95) of these injuries were caused by medical devices for respiratory system, 26.3% (25/95) by devices for gastrointestinal and genitourinary system. The study also revealed that 70.5% of MDRPIs occurred on the skin and 29.5% on the mucosal membrane, and that 82.1% of the MDRPIs occurring on the skin were at Stage 1. In terms of anatomical location, 21.1% of these injuries developed on the fingers and 13.7% on the mouth/lip. In multivariate analysis, parenteral + enteral (p = 0.006, OR = 0.083, 95%CI = [0.014-0.497]) and oral nutrition (p = 0.037, OR = 0.210, 95%CI = [0.049-0.908]), a higher number of devices (nine or more) (p = 0.002, OR = 5.387, 95%CI = [1.840-15.772]) and the duration of device wear (p < 0.05) were identified as independent risk factors for the occurrence of MDRPIs. CONCLUSIONS The study showed that the incidence of MDRPIs was relatively high and was associated with various factors. It is critical for intensive care nurses, who encounter MDRPIs more frequently, to consider these factors while caring for their patients and to take appropriate preventive measures to reduce the incidence of these injuries.
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Affiliation(s)
- Aslıhan Aydım Kudu
- Department of Nursing, Zonguldak Bülent Ecevit University Health Sciences Institute, Zonguldak, Turkey.
| | - Nurten Taşdemir
- Zonguldak Bülent Ecevit University, Health Sciences Faculty, Nursing Department, 67000, Zonguldak, Turkey.
| | - Münevver Sönmez
- Faculty of Health Science, Department of Fundamentals of Nursing, Atılım University, 06830, Ankara, Turkey.
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Semerci R, Umaç EH, Yılmaz D, Karadağ A. Analysis of the prevalence and risk factors of pressure injuries in the hospitalized pediatric population: A retrospective study. J Tissue Viability 2023; 32:333-338. [PMID: 37130768 DOI: 10.1016/j.jtv.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 03/11/2023] [Accepted: 04/15/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Pressure injury (PI) is an essential indicator of the quality of nursing care and affects hospitalized newborns and children. However, studies on the prevalence of PI and associated risk factors in children are limited. AIMS This study aimed to analyze the prevalence of PI and risk factors affecting the development of PI in the hospitalized pediatric population. METHODS This was a descriptive, retrospective study. Data were obtained via electronic medical records of 6350 pediatric patients admitted to a university hospital between January 2019 and April 2022. Ethics committee approval was obtained. Patient medical records and data associated with PI and medical treatment were collected through the 'Information Form,' 'Braden Scale,' 'Braden Q Scale,' 'Pressure Ulcer Staging Form,' and 'Pediatric Nutrition Risk Score (PNRS).' Data were analyzed using descriptive statistics, correlation analysis, Mann-Whitney U test, Kruskal Wallis test, and Multilinear Regression analysis. RESULTS More patients (66.2%) were males, and 49.2% of the children were 0-12 months old. 2368 out of 6350 pediatric patients were treated in the PICU. It was determined that a total of 143 PI occurred in 59 patients from PICU. The PI prevalence was 2.25% for all patients and 6.04% for PICU patients. Twenty-one percent of the patients had medical device-related PI (MDRPIs), 35.7% of PI occurred in the occiput, 13.3% in the coccyx/sacrum, and 67.1% of PI was Deep Tissue Injury. In the multiple regression model, children's albumin level, hemoglobin level, PNRS scores, Body Mass Index, and length of hospital stay significantly affected BRADEN scores. They were explained 30.3% of their scores of Braden. CONCLUSION Despite the limitations of the retrospective study, the prevalence of PI in the pediatric population in this study was lower than that reported in previous studies, but the prevalence of MDRPIs was higher. Based on the study results, it is recommended to implement preventive interventions for MDRPIs and plan prospective studies.
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Affiliation(s)
| | | | - Dilek Yılmaz
- Koç University Hospital, 34010, İstanbul, Turkey.
| | - Ayişe Karadağ
- Koç University, School of Nursing, 34010, İstanbul, Turkey.
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Demirci K, Uğur E, Öntürk ZK. Replacing Monitoring Electrodes on Infant Skin Every 12 Versus 24 Hours. Adv Skin Wound Care 2023; 36:1-8. [PMID: 37471452 DOI: 10.1097/asw.0000000000000010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To examine the effect of varying the frequency of monitoring electrode replacement on skin moisture and condition of infants hospitalized in the pediatric ICU. METHODS The population of the study consisted of 1- to 12-month-old infants receiving treatment in the pediatric ICU. The control group of the study (n = 33) included infants whose monitoring electrodes were replaced every 24 hours during monitoring, and the experimental group (n = 33) included infants whose monitoring electrodes were replaced every 12 and 24 hours during monitoring. Before assessment, the skin moisture of the monitoring areas was measured and evaluated with the Skin Condition Assessment Scale. RESULTS When the difference in skin moisture was compared for all measurement areas of the infants before monitoring and at the 24-hour mark, an increase in moisture was seen in both groups, and the difference in the experimental group was greater than that in the control group. Increased moisture is a risk factor for medical device-related pressure injuries. When comparing between-group differences in skin condition, the researchers noted a greater increase in skin condition score in the experimental group. An increased score indicates that the infant's skin condition is worsening. CONCLUSIONS Replacing the monitoring electrodes every 24 hours positively affected skin moisture and condition, whereas replacing them every 12 hours negatively affected skin moisture and condition.
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Affiliation(s)
- Kader Demirci
- At Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey, Kader Demirci, MSc, is Nurse, Pediatric Intensive Care Unit, Atakent Hospital; Esra Uğur, PhD, RN, is Associate Professor, Department of Nursing; and Zehra Kan Öntürk, PhD, RN, is Assistant Professor, Department of Nursing. The authors have disclosed no financial relationships related to this article. Submitted September 24, 2022; accepted in revised form October 20, 2022
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Luo WJ, Zhou XZ, Lei JY, Xu Y, Huang RH. Predictive risk scales for development of pressure ulcers in pediatric patients admitted to general ward and intensive care unit. World J Clin Cases 2021; 9:10956-10968. [PMID: 35047606 PMCID: PMC8678852 DOI: 10.12998/wjcc.v9.i35.10956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/26/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND More than ten special scales are available to predict the risk of pressure ulcers in children. However, the performances of those scales have not yet been compared in China.
AIM To compare the Waterlow, Braden Q, and Glamorgan scales, and identify more suitable pressure ulcer evaluation scale for the pediatric intensive care unit (PICU).
METHODS Trained nurses used the Waterlow, Braden Q, and Glamorgan scales to assess pediatric patients at Sun Yat-sen Memorial Hospital (China) within 24 h of admission from May 2017 to December 2020 in two stages. Skin examination was carried out to identify pressure ulcers every 3 d for 3 wk.
RESULTS The incidence of pressure ulcers was 3/28 (10.7%) in the PICU and 5/314 (1.6%) in the general pediatric ward. For children in the general ward, the Waterlow, Braden Q, and Glamorgan scales had comparable area under the operating characteristic curve (AUC) of 0.870, 0.924, and 0.923, respectively, and optimal cut-off values of 14, 14, and 29 points. For PICU, the Waterlow, Braden Q, and Glamorgan scales had slightly lower AUC of 0.833, 0.733, and 0.800, respectively, and optimal cut-off values of 13, 16, and 27 points. Braden Q demonstrated a satisfactory specificity, and during the second stage of the study for PICU patients, the AUC of the Braden Q scale was 0.810, with an optimal cut-off value of 18.35 points.
CONCLUSION The Waterlow, Braden Q, and Glamorgan scales have comparable performance, while the Braden Q scale demonstrates a better specificity and can be successfully used by pediatric nurses to identify patients at high risk of pressure ulcers in PICU.
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Affiliation(s)
- Wen-Jun Luo
- Sun Yat-sen Memorial Hospital, Guangzhou 510235, Guangdong Province, China
| | - Xue-Zhen Zhou
- Sun Yat-sen Memorial Hospital, Guangzhou 510235, Guangdong Province, China
| | - Jia-Ying Lei
- Sun Yat-sen Memorial Hospital, Guangzhou 510235, Guangdong Province, China
| | - Ying Xu
- Sun Yat-sen Memorial Hospital, Guangzhou 510235, Guangdong Province, China
| | - Rui-Hua Huang
- Sun Yat-sen Memorial Hospital, Guangzhou 510235, Guangdong Province, China
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Zhang YB, Gou L, Pei JH, Nan RL, Shen XP, Ge L, Chen HX, Wang XL, Dou XM, He L. Development of a nomogram for predicting nasogastric tube-associated pressure injuries in intensive care unit patients. J Tissue Viability 2021; 30:324-330. [PMID: 34176736 DOI: 10.1016/j.jtv.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
Here, we aimed to build a nomogram model to estimate the probability of nasogastric tube-associated pressure injuries (NTAPIs) in intensive care unit(ICU)patients. This prospective cohort study included 219ICU patients with nasogastric tube between September 2019 and January 2020.Univariate and multivariate logistic regression analyses were used to develop the nomogram model. The resulting nomogram was tested for calibration, discrimination, and clinical usefulness. Of the included patients, 58 developed NTAPIs, representing an incidence rate of 26.5%. Binary logistic regression analysis revealed that the prediction nomogram included C-reactive protein, vasopressor use, albumin level, nasogastric tube duration, and Sequential Organ Failure Assessment score. The value of these predictors was again confirmed using theLasso regression analysis. Internal validation presented a good discrimination of the nomogram, with an area under the curve value of 0.850, and good calibration (Hosmer-Lemeshow test, P = 0.177). The decision curve analysis also demonstrated preferable net benefit along with the threshold probability in the prediction nomogram. The nomogram model can accurately predict the risk factors for NTAPIs, to formulate intervention strategies as early as possible to reduce NTAPI incidence.
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Affiliation(s)
- Ya-Bin Zhang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Ling Gou
- School of Nursing, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Ju-Hong Pei
- School of Nursing, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Rui-Ling Nan
- School of Nursing, Lanzhou University, Lanzhou, Gansu, People's Republic of China; Department of EICU, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China
| | - Xi-Ping Shen
- Lanzhou University School of Public Health, Lanzhou, Gansu, People's Republic of China
| | - Long Ge
- Lanzhou University School of Public Health, Lanzhou, Gansu, People's Republic of China; Lanzhou University Evidence Based Social Science Research Center, People's Republic of China
| | - Hai-Xia Chen
- School of Nursing, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Xing-Lei Wang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, People's Republic of China; Department of Liver Diseases Branch, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China
| | - Xin-Man Dou
- School of Nursing, Lanzhou University, Lanzhou, Gansu, People's Republic of China; Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China.
| | - Li He
- Department of Emergency, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China.
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Aghazadeh A, Lotfi M, Asgarpour H, Khajehgoodari M, Nobakht A. Frequency and risk factors of pressure injuries in clinical settings of affiliated to Tabriz University of Medical Sciences. Nurs Open 2021; 8:808-814. [PMID: 33570276 PMCID: PMC7877138 DOI: 10.1002/nop2.685] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/29/2020] [Accepted: 08/13/2020] [Indexed: 11/18/2022] Open
Abstract
AIM Pressure injuries are considered a common and costly problem in the care of patients. Prevention and identification of risk factors for pressure injuries are very important due to the high cost of treatment and the adverse consequences of pressure injuries. This study aimed to assess the prevalence of pressure injuries and its risk factors in clinical settings of affiliated to Tabriz University of Medical Sciences. DESIGN A descriptive-analytical study. METHODS This study was performed on 200 patients who were selected by random sampling. The data collection tool was a 3-part questionnaire. Data were analysed using a t test, chi-square, Fisher's exact test and logistic regression in SPSS v. 24. RESULTS The mean age of the participants was 51.93 (SD 14.99) years. The rate of pressure injuries in this study was 19.5%. The most susceptible area for pressure injuries were sacral (35.89%) and gluteal (20.51%), respectively. The pressure injuries was significantly associated with Braden's criteria, age, disease diagnosis and length of hospital stay (p < .05). But there was no statistically significant difference between sex and incidence of pressure injuries (p > .05).
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Affiliation(s)
- AhmadMirza Aghazadeh
- Department of Basic SciencesParamedical FacultyTabriz University of Medical SciencesTabrizIran
| | - Mojgan Lotfi
- Department of Medical Surgical NursingFaculty of Nursing and MidwiferySina HospitalTabriz University of Medical SciencesTabrizIran
| | - Hossein Asgarpour
- Department of Surgical NursingFaculty of Health SciencesÇanakkale Onsekiz Mart UniversityCanakkaleTurkey
| | - Mohammad Khajehgoodari
- Department of Medical Surgical NursingFaculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
| | - Afsaneh Nobakht
- Faculty of Nursing and MidwiferySina HospitalTabriz University of Medical SciencesTabrizIran
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Rashvand F, Shamekhi L, Rafiei H, Nosrataghaei M. Incidence and risk factors for medical device-related pressure ulcers: The first report in this regard in Iran. Int Wound J 2019; 17:436-442. [PMID: 31854116 DOI: 10.1111/iwj.13290] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/30/2019] [Accepted: 12/05/2019] [Indexed: 02/06/2023] Open
Abstract
Few studies, especially among developing countries such as Iran, have been conducted on the incidence and risk factors for medical device-related pressure ulcers (MDRPUs). Given the importance of this issue and the lack of previous studies, the present study aimed to investigate the incidence and risk factors for MDRPUs in Iran. The present descriptive-analytical study was conducted at three hospitals in Qazvin, Iran, from June 1, 2019, to September 1, 2019. Data collection took approximately 3 months from July to September 2019. Sampling was carried out through a convenience sampling method, and the samples consisted of 404 patients. For data collection, a checklist for demographic variables, a checklist for patient-connected medical devices, Braden Scale, Glasgow Coma Scale, National Pressure Ulcer Advisory Panel Pressure Grading Scale, and Nutrition Risk Screening 2002 were used. Of the 404 patients studied, 20.54% (n = 83) developed some degree of MDRPUs. From those, 61 (70.11%) were in stage I, 17 (19.5%) were in stage II, and 9 (10.34%) were in stage III. Among the nine medical devices that caused pressure ulcers, the most commonly reported ones were nasal oxygen tubes (31 cases), oxygen face masks (23 cases), and endotracheal tubes (17 cases). The mean score of Braden Scale (P = .004), the mean score of NRS 2002 (P = .037), older age (P = .007), male gender (P = .002), the average length of stay in hospitals (P = .001), and having pressure ulcers in body (P = .025) significantly increased the possibility of occurring MDRPUs. In the present study, the incidence of MDRPUs was high. Taking the necessary measures into consideration in order to prevent the MDRPUs is essential in Iranian hospitals. Further studies in this regard are strongly recommended.
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Affiliation(s)
- Farnoosh Rashvand
- Social Determinants of Health Research Center, Research Institute for prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Lida Shamekhi
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Hossein Rafiei
- Social Determinants of Health Research Center, Research Institute for prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
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