Overlooked and underestimated: medical adhesive-related skin injuries

Abstract

Foreword I n July 2019, a panel of wound care experts, educators and researchers met in the UK to review the literature on medical adhesive-related skin injury and discuss best practice for its assessment and prevention. e two-day meeting resulted in this consensus document, which is intended for anyone who uses adhesive medical devices. e document aims to raise awareness of the widespread occurrence of medical adhesive-related skin injury and the burden it imposes on patients, health professionals and the health service. It seeks to encourage a change in culture, whereby risk assessment and prevention of medical adhesive-related skin injury are considered an integral part of patient care. e document, therefore, provides recommendations for the assessment and prevention of this type of injury, with a view to standardising care across all healthcare settings. It also highlights the need for education on this form of skin damage, which needs to become a core topic in skin care and wound management. Until this happens, there is scope for multidisciplinary teams to provide local training on this subject. In the light of the panel's concern that many health professionals are not only unaware of this avoidable harm but also its abbreviation, MARSI, the term is written in full throughout the document. e panel hopes that implementation of the guidance in this document will reduce avoidable patient su ering and promote better outcomes. Sian Fumarola, Senior Clinical Nurse Specialist, Tissue Viability and Continence, University Hospitals of North Midlands NHS Trust, UK Overview of medical adhesive-related skin injury  'Medical adhesive-related skin injury' is a term used to defi ne any skin damage related to the use of medical adhesive products or devices such as tapes, wound dressings, stoma products, electrodes, medication patches and wound closure strips. This type of injury is largely avoidable

Use of a novel silicone‐acrylic drape with negative pressure wound therapy in anatomically challenging wounds

“…Chronic and complex wounds with challenging anatomical locations often require the extended use of advanced wound care modalities, increasing a patient's risk of developing MARSI. 3 NPWT is commonly used to manage complex wounds and has traditionally required the use of a polyurethane drape with an acrylic adhesive over foam dressings to create a negative pressure seal. [4][5][6][7][8] However, this drape is unable to be removed and repositioned once it has been placed, and drape removal during dressing changes can be painful.…”

“…Use of the HA‐drape with NPWT may be beneficial for patient populations with complex wounds who are more at risk for developing MARSI. Typical higher‐risk patients for MARSI include those with chronic skin conditions (eg, eczema, dermatitis, chronic ulcers and epidermolysis bullosa); immunosuppression, patients in the intensive care unit, patients who have recently or are currently undergoing radiation therapy, and patients with malnutrition or dehydration 3,9 . Patients with peripheral arterial disease, venous insufficiency, cardiac insufficiency, and hypertension are also at risk for developing MARSI 9…”

“…A female patient presented for care with an infected femoral-popliteal bypass graft and site. The groin wound measured 6.5 × 3.8 × 4-cm 3 , and the left lower extremity wound measured 10 × 3 × 4.2-cm 3 . Previous medical history included diabetes, hyperlipidaemia, coronary artery disease, and peripheral vascular disease.…”

“…In one acute care setting, the incidence of MARSI was calculated to range from 3.4% to 25.0% 2 . Balancing wound care while preventing periwound skin injury can be difficult as chronic and complex wounds often require the use of advanced wound care modalities for extended periods, increasing the patient's risk of developing MARSI 3 …”

“…chronic and complex wounds often require the use of advanced wound care modalities for extended periods, increasing the patient's risk of developing MARSI. 3 Negative pressure wound therapy (NPWT), a commonly used advanced wound care modality, utilises a polyurethane drape with an acrylic adhesive over foam dressings to create a seal. [4][5][6][7][8] In anatomically challenging areas, it can be difficult to create a seal without the use of ancillary products.…”