Hitchcock Jan, Savine Louise
General Manager Infection Prevention & Control Directorate, Imperial College Healthcare NHS Trust, London.
Tissue Viability Lead Nurse, Imperial College Healthcare NHS Trust, London.
Br J Nurs. 2017 Apr 27;26(8):S4-S12. doi: 10.12968/bjon.2017.26.8.S4.
Establishing vascular access and preventing infection, both at insertion and during ongoing care is generally the top priority; the maintenance of optimal skin integrity is often a distant secondary consideration. Skin can react to different types of dressings or adhesives, or problems can arise relating to the securement of lines or the development of sensitivities to cleaning solutions. Clearly, these scenarios are not limited to the securement of vascular access devices; however, a patient with a long-term vascular access device may not have other options for vascular access, which makes this a very important and yet largely unrecognised area. A review of the limited literature that existed up to March 2015 showed it was typically concerned with skin tears connected with dressings and removal, and contact irritant dermatitis. The tissue viability team and vascular access team reviewed the current products associated with a typical vascular access dressing to ensure it was fit for purpose and where at all possible had good scientific literature for validation. The team worked proactively to recognise those patients at risk with the early identification of potential medical adhesive-related skin injuries (MARSI). To facilitate this an algorithm was developed that offers a step-by-step approach, clearly outlining what to do to prevent MARSI and its treatment should it develop. These reactions can result from other factors than the dressing alone, and an increase in these kinds of skin reaction in patients who are on chemotherapy regimens is being explored further. Through the implementation of an algorithm, education for both staff and patients and collaborative working between vascular access and tissue viability teams, a reduction in these phenomena has been seen despite an increasing number of at-risk patients.
建立血管通路并防止在穿刺时以及后续护理过程中发生感染，通常是首要任务；而维持最佳的皮肤完整性往往是次要得多的考虑因素。皮肤可能会对不同类型的敷料或粘合剂产生反应，或者在管路固定或对清洁溶液产生敏感性方面出现问题。显然，这些情况并不局限于血管通路装置的固定；然而，对于长期使用血管通路装置的患者来说，可能没有其他血管通路选择，这使得这成为一个非常重要但在很大程度上未得到认识的领域。对截至2015年3月的有限文献进行回顾发现，这些文献通常关注与敷料及去除相关的皮肤撕裂以及接触性刺激性皮炎。组织活力团队和血管通路团队对与典型血管通路敷料相关的现有产品进行了审查，以确保其符合用途，并且在可能的情况下有良好的科学文献进行验证。该团队积极主动地识别那些有风险的患者，尽早发现潜在的与医用粘合剂相关的皮肤损伤（MARSI）。为了便于做到这一点，开发了一种算法，该算法提供了一种循序渐进的方法，清楚地概述了预防MARSI的措施以及如果发生MARSI应如何治疗。这些反应可能由多种因素导致，而不仅仅是敷料本身，并且正在进一步探讨接受化疗方案的患者中这类皮肤反应增加的情况。通过实施一种算法、对医护人员和患者进行教育以及血管通路团队与组织活力团队之间的协作，尽管有风险的患者数量在增加，但这些现象仍有所减少。
