Medical Device-Related Pressure Injury in an Intensive Care Unit: A Cross-Sectional Study

Abstract

BACKGROUND: Medical devices can cause pressure injuries. PURPOSE: This study was conducted to determine the prevalence of and factors associated with medical device-related pressure injury (MDRPI) in an intensive care unit (ICU). METHODS: A cross-sectional study was performed among adult patients (at least 18 years of age) admitted to an ICU in a referral hospital in Brazil between December 2019 and February 2020. The skin of patients who consented to participate was assessed for the presence of an MDRPI, and the use of all medical devices was noted. Other independent variables (sociodemographic variables, medical history, pressure injury risk factors, medications, and length of hospitalization) were abstracted from the medical records. Bivariate data analysis included Pearson’s chi-square test or Fisher’s exact test; odds ratio and a confidence interval of 95% also were established. Correlation among independent variables and MDRPI was determined using the ρ Spearman correlation test, and a hierarchical binary logistic regression analysis was performed using statistically significant variables from the bivariate analysis. P < .05 was considered statistically significant. RESULTS: The 125 study participants ranged in age from 15 to 97 years (mean, 63.02 ± 19.2), 76 (60.8%) were men, and 76 (60.8%) were White. Of the 125 participants, 43 (34%) experienced MDRPI; the total number of MDRPIs was 58 (3 patients had 3 injuries, and 7 patients had 2 injuries). Of those 58 MDRPIs, 46 were stage 1, and 12 were stage 2. Polypharmacy (> 4 medications) was a significant risk factor for MDRPI. Use of a nasal catheter, cord for orotracheal tube fixation, oximeter, intra-abdominal pressure equipment, and indwelling urinary catheter was significantly associated with the presence of MDRPI. Renal and respiratory diseases and the presence of infection were positively related to the presence of MDRPI. CONCLUSION: Medical device-related pressure injury was prevalent in this patient population. Most of these injuries were stage 1, which suggests that frequent monitoring and device repositioning (when possible) may help prevent more serious injuries. Additional research involving other hospitals in Brazil is needed to increase the understanding of the prevalence and risk factors of MDRPIs in patients in the ICU.

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“… 2 , 3 Medical device‐related pressure injuries among patients treated in the intensive care unit have been discussed. 4 These discussions now include such injuries occurring in medical staff working in the frontline of COVID‐19. 5 Because of mild cases, they may be underestimated in the general population.…”

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“…The shape of the injury is often consistent with the shape of the medical devices. The prevalence of MDRPI in critically ill patients in the intensive care unit (ICU) is due to the frequent use of various medical devices, extensive drug therapy and patients' own characteristics such as skin edema 7‐10 . It is now one of the more serious adverse events in ICU patients 11,12 .…”

“…The prevalence of MDRPI in critically ill patients in the intensive care unit (ICU) is due to the frequent use of various medical devices, extensive drug therapy and patients' own characteristics such as skin edema. [7][8][9][10] It is now one of the more serious adverse events in ICU patients. 11,12 Some studies ICU nurses, as the closest caregivers to critically ill patients play a critical role in identifying critically ill patients at risk of MDRPI.…”