Incidence and risk factors for medical adhesive-related skin injury in catheters of critically ill patients: A prospective cohort study

Aim: To investigate the incidence and risk factors for medical adhesive-related skin injury (MARSI) in catheters of critically ill patients. Methods: A prospective cohort study was conducted in adult intensive care units of two Brazilian university hospitals. A total of 150 patients (439 catheters) were included. Skin exposed to the catheter fixation adhesives (central venous, nasogastric, nasoenteral and indwelling urinary) was examined daily by four trained researchers. The patients sociodemographic and clinical data were collected from their electronic medical records. The association between independent variables and MARSI was investigated by bivariate statistics, followed by multiple logistic regression. Results: The MARSI incidence was 42% (8.64 MARSIs per 100 patients/day). Advanced age, prolonged hospital stay, dry skin, repetitive adhesive removal, low Braden Scale score and hypoalbuminemia were associated with MARSI (p < .05). According to multivariate logistic regression, dry skin increased the chance of MARSI by 5.21 times (odds ratio [OR] 5.21; 95% confidence interval [95% CI] 2.43-11.11), while the Braden Scale score was a protective factor, showing 31% less chance of MARSI for each added score (OR 0.69; 95% CI 0.57-0.85). A higher incidence of MARSI was observed in nasoenteral catheters and in those fixed with adhesive using natural rubber. The MARSI types were predominantly mechanical (70.3%): skin stripping (41.3%), skin tear (26.1%) and tension injury or blister (2.9%). Conclusions: MARSI is a common event in adult intensive care units and most risk factors are modifiable. Preventive actions are potentially capable of reducing incidence, optimizing financial resources and improving clinical results.