Catherine Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, University of Virginia Health System, Charlottesville, Virginia.
Andrew Barton, RN, Frimley Health NHS Foundation Trust, Frimley, UK.
J Wound Ostomy Continence Nurs. 2024;51(5S Suppl 5):S18-S23. doi: 10.1097/WON.0000000000001117. Epub 2024 Sep 20.
Medical adhesive-related skin injuries (MARSIs) are prevalent adverse effects associated with use of medical devices and increasingly recognized as potentially avoidable. Despite advances in preventive measures, MARSI events still occur, and individualized care must be designed to meet patient needs.
This article describes three cases where skin injuries occurred because of application, removal, and ongoing use of a medical adhesive device; all three cases occurred underneath dressings used to secure and protect the skin adjacent to a peripherally inserted central catheter (PICC). The first case describes evaluation and management of a skin tear in an elderly female with multiple comorbid conditions, and Case 2 describes assessment and care of contact irritant dermatitis occurring under a PICC dressing. In both cases, specialist nurses with knowledge of MARSI assessed and managed the skin underneath the medical adhesive device in a manner that allowed maintenance of the PICC and continuation of therapy. In contrast, Case 3 describes a female with irritant contact dermatitis underneath a PICC dressing that was responding to care by the nurse specialists of a vascular access team. In this case, the patient presented to their facility's emergency department with severe itching. The vascular access team initially was not consulted, and the PICC line was removed, although inspection revealed dry skin without signs of infection.
Medical adhesive-related skin injury is a clinically relevant and useful construct that identifies a variety of prevalent conditions associated with the use of medical adhesive device such as tapes and PICC dressings. These cases, in particular Cases 1 and 2, illustrate that the MARSI construct provides a framework for assessing and managing medical skin injuries with the possibility of preserving the PICC and the ongoing therapy these patients were receiving.
与医疗器械使用相关的医用黏胶相关性皮肤损伤（MARSIs）是一种普遍的不良反应，且其作为一种潜在可预防的损伤正受到越来越多的关注。尽管预防措施已经取得进展，但 MARSI 事件仍时有发生，因此必须设计个性化护理以满足患者的需求。
本文介绍了三例因应用、移除和持续使用医用黏胶装置而导致皮肤损伤的案例，这三例均发生在用于固定和保护外周静脉置入中心导管（PICC）附近皮肤的敷料下方。第一个案例描述了一位患有多种合并症的老年女性发生皮肤撕裂伤的评估和管理，第二个案例描述了 PICC 敷料下发生接触性刺激性皮炎的评估和护理。在这两种情况下，具有 MARSI 知识的专科护士对黏胶下的皮肤进行了评估和管理，使 PICC 得以保留并继续治疗。相比之下，第三个案例描述了一位患有 PICC 敷料下刺激性接触性皮炎的女性，该患者在接受血管通路团队的护士专家护理后症状得到缓解。在这种情况下，患者因严重瘙痒而到医院的急诊部就诊。血管通路团队最初并未进行会诊，尽管检查显示皮肤干燥，没有感染迹象，但 PICC 导管仍被移除。
医用黏胶相关性皮肤损伤是一种具有临床意义的有用结构，它可以识别与医用黏胶装置（如胶带和 PICC 敷料）使用相关的多种常见情况。这些案例，特别是案例 1 和 2，表明 MARSI 结构为评估和管理医用皮肤损伤提供了一个框架，有可能保留 PICC 导管，并继续为这些患者提供治疗。
