Wound Ostomy Department - Providence St Joseph Medical Center

Thursday, August 24, 2023

 August 2023 Wound and Ostomy Journal

Incidence and Predictive Model of Medical AdhesiveRelated Skin Injury in Cancer Patients Managed With Central Venous Access Devices


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36 comments:

  1. Discuss the sample size used in the study

    The study took place in the First Affiliated Hospital of Xi’an Jiaotong University, located in Xi’an, China. The sample size in the study consisted of 1172 consecutive patients who underwent the implantation of a central venous access device (CVAD) between February 2018 and February 2019. The patients had to be older than 18 years of age, given informed consent, survived more than 3 months after implantation of a CVAD, and had a diagnosis of cancer.

    Describe the method used by the author of the study

    The principal investigator of the study chose to do a retrospective review of 1172 electronic records of patients who met the criteria for inclusion. The data collected were the demographics, if patient was on chemotherapy, type of adhesive dressing used, type of cancer, history of an allergy, and what type of CVAD was implanted. All patients were followed up for 1 year. Photographs of the skin lesions were taken by nurses who had been trained in medical adhesive-related skin injury (MARSI) and numbered and stored. The training session on MARSI was given by the principal investigator and it focused on basic knowledge of MARSI, the methods of data collection and study procedures. A Three Item Severity (TIS) was used to assess the severity of irritant contact dermatitis and the Skin Tear Audit Research classification instrument was used to calculate skin tear severity. Each MARSI occurrence was counted separately.

    I think a retrospective study with a large number of participants such as this study was a good way to retrieve data although it may be good in the future to include the patients who do not have a diagnosis of cancer to compare if a diagnosis of cancer alone makes a difference in outcomes. Also one must take into account that the TIS score interobserver reliability was fair (0.58) and the intrarater reliability was 0.74 for the Skin Tear Audit classification instrument, noting that although nurses did receive training there may be a difference in opinion when scoring the contact dermatitis.

    Responses by Eileen Laureano, RN

    ReplyDelete
    Replies
    1. We see so many times that the medical Adhesive skin injury causes more pain to the patient then the actual wound we are trying to cover. I have found that coban are safe in using and home wound in tact and provide compression. An example I can provide is when we have to do UNNA BOOTS and compression. The Actual compression has to be supported with tape, which sometimes doesn’t even hold the compression in place. Then trying to remove the adhesive from the skin is so hard that sometimes we have skin tears. So the coban wrap that the lab usually uses to cover the blood draw and provide compression has been working better with UNNA BOOTS. I also found a patient information on therapeutic compression with coban, It has been proven to reduce edema and help ulcers heal. Here is the link.
      3m-coban-2-patient-information-sheets.pdf


      The study had advantages to med surg oncology staff since it has been proven that cancer patients who have TPN, PICC line, ports and other tubes that need adhesive dressings were more at risk for developing Medical Adhesive related skin injury (MARSI). Also the methods used were the photograph that was taken before and after the adhesive tape injury. Sometimes we don’t have any choices and we have to this devices for our patients but every shift assessment can help prevent major injuries.

      Delete
  2. Methods:

    The researchers retrospectively reviewed electronic records of 1172 consecutive patients who underwent CVAD implantation between Feb 2018 and Feb 2019 in First Affiliated Hospital of Xi’an Jiaotong University in Xi’an China. Demographic and pertinent clinical data were collected, and trained nurses examined and assessed the participants skin that had been exposed to medical adhesive after removal of the previous dressing during the CVAD maintenance process. Routine maintenance including dressing changes and catheter care was performed every 7 days for PICCs or 28 days for ports, except in patients with existing skin injuries. All were followed for up to 1 year. Photographs of skin lesions were obtained, numbered, and then stored for subsequent quality improvement initiate and treatment evaluation. Skin injuries persisting 30 minutes+ were classified according to the MARSI definition and classification standards. A Three-Item Severity score was used to assess the severity of irritant contact dermatitis, while the Skin Tear Audit Research classification instrument was used to calculate skin tear severity. Each MARSI occurrence was counted separately, including patients who experienced more than 1 occurrence.

    Sample Size:

    Inclusion criteria were those older than 18 years, who underwent CVAD implantation, survived for more than 3 months after CVAD implantation and had a diagnosis of cancer. 1286 patients who underwent CVAD implantation were identified during the data collection period, however 96 were excluded due to incomplete data and analysis is based on records of 1172 patients.

    ReplyDelete
  3. Describe the sample size used in the study:
    It is compromised by 1172 consecutive patient who underwent CVAD implantation between 2018 and February 2019 with an average age of 55.7 years. Data were collected at they First Affiliated Hospital of Xi'an Jiaotong University in Xi'an China

    How does this research compare to our policy and procedure ?
    As part of quality improvement, we identify patient with central lines including PICCs, Dialysis catheters, Triple lumen catheters, accessed porta caths. Every shift central lines are assessed and evaluated for signs of infection, edema, infiltration,patency, dressing change, cleanliness at the site and dressing. Dressing changes are implemented every 7 days and as needed per policy. Appropriate actions are taken immediately and are reported to MD's if any adverse symptoms occur.

    ReplyDelete
  4. Discuss the sample size used in the study.

    In this study, 1172 people were used. Participants included cancer patients who had a central venous access device (CVAD) placed between February 2018 and February 2019. This study excluded patient’s 18 years and younger and who passed away within 3 months of having their CVAD placed. The average age in this particular study was 55.7 years old. This took place at a University hospital in Xi’an, China.


    Describe the method used by the author of the study

    The electronic records of the participants were evaluated. This included the patient’s demographic, clinical data and image data. Information such as age, sex, chemotherapy, adhesive dressing type, allergy history and type of CVAD were collected. Methods of CVAD placement, dressing type and maintenance remained consistent across all participants to prevent deviations. A group of specially trained nurses assessed the patient’s skin every dressing change. Routine maintenance of the dressings occurred every 7 days for PICCs and 28 days for ports. Photos were taken of any formed skin lesions and monitored. A Three-Item Severity (TIS) score was utilized. This score was based on level of erythema, edema, and excoriations. The Skin Tear Audit Research classification instrument was also utilized. This consisted of 3 categories from high skin restoration potential to low skin restoration potential. Analysis was done for 1 year.

    - Alyssa Mendoza RN

    ReplyDelete
  5. Discuss the sample size used in the study.
    The study included 1172 cancer patients, both male and female, who were older than 18 years and underwent central venous access devices (CVAD) implantation between February 2018 and February 2019. These patients survived at least 3 months after CVAD implantation to be considered participants of the study. The study setting was the First Affiliated Hospital of Xi’an Jiaotong University in Xi’an, China. Participants’ mean age was 55.7 years.

    How does this research article compare to our practice, policy and/or procedure?
    In the study, trained nurses assessed each patient’s skin after the removal of the previous dressing. Routine maintenance included dressing changes and catheter care every 7 days for PICCs or 28 days for ports, except for those patients with existing skin injuries. Compared to the study, PSJMC requires more frequent dressing changes to be provided. For short-term nontunneled central VAD, long-term tunneled central VAD, PICC, and Porta-a-Cath, transparent dressing and caps should be changed on a weekly basis and PRN. Gauze dressings should also be changed within Q24-48 hours. Assessments are done every shift, and we check for patency, any signs of infection, infiltration, phlebitis, pain, and any other signs of problem.

    Jung Eun Lee, RN.

    ReplyDelete
  6. Describe the method used by the author of the study
    - The method of the study was a retrospective single center study which used a demographic and pertinent clinical data collection from patient records.
    Discuss the sample size used in the study.
    - the sample size included 1172 consecutive patients who underwent CVAD implantation between feb 2018 to feb 2019 with a mean age of 55.7 years

    ReplyDelete
  7. Describe the method used by the author of the study
    A retrospective, single-center study was utilized which included 1172 consecutive patients who underwent CVAD implantation between February 2018 and February 2019. Demographic and pertinent clinical data were collected from patient records. Routine dressing changes were performed every 7 days for peripherally inserted central venous catheters (PICCs) or 28 days for ports except in patients with existing skin injuries. Skin injuries related to use of medical adhesives and persisting for more than 30 minutes were classifies MARSI. Data were used to develop a nomogram for predicting MARSI. The accuracy of the nomogram was verified by calculating the concordance index (C-index) and drawing a calibration curve.

    Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
    Generalizability of findings may be influenced by certain factors, such as the fact that the same medical dressings were used for patients who received PICC and other types of CAVD, which make it difficult to pinpoint the cause of the MARSI occurrence. Another limitation is the limited sample size which only came from a single clinical site which contained a narrowly defined patient group, necessitating further research in more diverse population settings.

    ReplyDelete
  8. Describe the method used by the author of the study:
    Demographic and clinical data were collected from patient records. Dressing was change routinely which was 7 days for peripherally inserted central venous catheter and or 28 days for ports. Data was being used to develop a monogram for predicating MARSI.

    Discuss the sample size used in the study

    1172 patients have picc insertion and out of 1172; 282 of those patients 1 or more incident of MARSI's occur. The incident rate of 1.7 events per 1000 CVAD days.


    ReplyDelete
  9. 1.Describe the method used by the author of the study.
    Demographic and pertinent data were use from patients records. Dressings were change every week for PICC lines and every 28 days for ports. Patients with existing skin injury were excluded. Skin injuries that were related to the use of medical adhesives and lasted for more than 30 minutes classified as MARSA. Using this data they were able to create a monogram which show a good ability to predict patients who are at risk of developing MARSI and will help nurses to predict it in patients with cancer.

    2.Discuss the sample size used in the study.
    The study was done with 1172 patients who had undergone CVAD between feb 2018 to feb 19. Their average age was 55.7 years old. The data was collected from a hospital located in China.



    ReplyDelete
    Replies
    1. Patricia Rios
      How does this research article compare to our practice, policy and/or procedure?
      Central venous catheters (CVC) is essential in patients with cancer, and the need for intravenous access devices for the administration of cancer therapy has increased proportionally with the increasing number of patients diagnosed with cancer. Unfortunately, central venous catheter insertion represents a risk of infection and CVC-related vein thrombosis.
      On top of the above risk. The MARSI such as latex particles that may create a hypersensitivity response manifested as irritant contact dermatitis and formation of blisters. Nutritional status of patients has been postulated to influence the risk for MARSI and we found that patients who developed MARSI were more likely to require TPN for nutritional support, as the article suggested. AT PSJMC is trying to avoid Central venous catheters in particular with Cancer patient. They are immune to compromise, and our policy is to avoid to prevent further compromised to their health. The cancer patients that required a central venous access needs to have an every shift CHG bath to minimized the risk of infection, per policy.

      what are the advantages and disadvantages to the proposed recommendations in the article?

      The advantage of this article is that they provide with accurate information in this study. As we know the central venous catheters have a high risk for infection. Unfortunately, many of these patients requires CVC to continue with their therapy regarding their risks and the precautions taken to prevent central venous infections.

      Delete
  10. How does this research article compare to our practice, policy and/or procedure?
    In our floor, I often see Cancer patients with septic shock after recent chemo and/or radiation, who admitted due to their requirement of pressors because of hypotension. I feel like most of them have an implanted port, instead of PICC. Because of using an implanted port for cancer patients, I may not see much cases of MARSI in our floor as this study pointed out. I rarely see the cancer patients on TPN during their ICU stay, either. We don’t have a particular policy and procedure for MARSI.

    What ate the advantages and disadvantages to the proposed recommendations in the articles?
    Advantages are that this is a good opportunity to learn deeper about MARSI including 5 risk factors for MARSI; MARSI history, use of TPN, other catheter-related complications such as thrombosis and catheter-associated blood stream infection, a history of allergy, and PICC implantation. Although I don’t see much incidents of MARSI specifically in cancer patients of ICU as this research mentioned, I often see a complication of use of medical adhesive products to other ICU patients, such as skin stripping, tension injury/blister. Although the subjects of this study were middle aged, their risk of MARSI was high due to their multiple comorbidity. Thus, ICU patients can have high risk of MARSI. We should review possible contributing factors of the choice of medical adhesive device, duration of its use and techniques for applying and removing tapes.
    I don’t think there are disadvantages from this paper.

    ReplyDelete
  11. 1. what are the advantages and disadvantages to the proposed recommendations in the article?
    The Advantages of a Central line it can stay in place longer,makes it easier to draw blood,and pts can get a lot of fluid of medicines like chemo that might not go to aregular IV, can alsl give more than 1 treatment at a time and can reduced the risk of drugs leaking outside the vein.While the disadvantage it can carry sigificant risk for serious complications such as pneumothorax, stroke, arrthymias ,and nerve damage.

    2.Discuss the sample size used in the study.
    The sample comprised 1172 consecutive patients who underwent CVAD implantation between February 2018 and February 2019 their mean age was 55.7 years ( SD13.9 ).Data were collected at the first affiliated Hospital of Xi an Jiatong Univerisy, located in Xi an,China


    ReplyDelete
  12. David k
    Describe the method used by the author of the study
    The study reviewed patient data over the course of 1 year at 1 hospital in China. They reviewed electronic medical records of over 1 thousand patients.they excluded data where they could not definitively determine MARSI or if there were incomplete records/data.
    Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
    The article states it could not differentiate between incidences of MARSI between the different types of ports. I would have liked to see if incidence of MARSI were different between different types of infusion therapies (tpn vs antibiotics). Also it would be interesting to know if location of the port changed likelihood of MARSI.

    ReplyDelete
  13. August 2023 Wound and Ostomy Journal
    Incidence and Predictive Model of Medical Adhesive Related Skin Injury in Cancer Patients Managed With Central Venous Access Devices

    Describe the method used by the author of the study
    Both pertinent clinical data and demographic were extrapolated from patient records. Dressing changes to PICC lines every seven days and port dressings changed every 28 days excluding those with skin injuries. Data was used to create a nomogram to predict medical adhesive related skin injuries in cancer patients.
    Discuss the sample size used in the study
    The sample size consisted of a total of 1268 however 96 patients were excluded due to incomplete data leaving 1172 subjects for the study.
    -Valarie Renaux RN, ICU-

    ReplyDelete
  14. Discuss the sample size used in the study:

    Electronic record data collected for this retrospective study was collected at the First Affiliated Hospital of Xi’an Jiaotong University, which is located in Xi’an, China. Initially, 1268 patients were identified who underwent central venous access device (CVAD) implantation during the data collection period between February 2018 and February 2019. Ninety-six patients were excluded due to incomplete data and analysis based on their records. This reduced the sample group number down to 1172 patients. Inclusion criteria were patients older the 18 years old, who had an CVAD implantation, survived for more that three months after the CVAD implantation, and had been diagnosed with cancer. The average age of the sample group was 57 years old. Within the group, 49.2% were male and 50.8% were female. Most of the patients had PICC line implantations (28.2%). Fifty-two patients had a history of allergies. And 259 patients had a previous history of Medical Adhesive Related Skin Injury (MARSI). This sample size appears to be quite large. However, I don’t believe a retrospective chart review is as accurate a real time data collection.

    Advantages / Disadvantages of implementing the article.

    This study identified five associated factors associated with the occurrence of MARSI. These factors include; previous MARSI history, use of TPN, allergic history, PICC implantation, and other catheter-related complications. In addition to these factors, the type of medical adhesive device used, the duration of its use, and the technique(s) used for its application and removal, likely influence the incidence of MARSI. So clearly, it is advantageous for nurses to know and understand these risk factors and how to mitigate their effects. To assist nurses, this study developed a nomogram, (Graphical Calculating Device). This nomogram helps nurses predict the MARSI risk of their patients. However, caution should be taken when referring to nomograms. Always keep in mind the individuality of your patients. Their uniqueness may not apply to predictions within the nomogram.

    ReplyDelete
  15. Describe the sample size used in the study:
    Electronic records of “1172 consecutive patients who underwent CVAD implantation between 2018 and February 2019” with an average age of 55.7 years were used as the sample size for the study. The data was collected at First Affiliated Hospital of Xi'an Jiaotong University in Xi'an, China.

    How does this research compare to our policy and procedure?
    I believe that our ministry’s current quality improvement is more focused on overall infection as it relates to Central Line-associated bloodstream Infection (CLABSI) than medical adhesive-related skin injury (MARSI). Although skin assessment is part of an RN’s patient assessment, perhaps implementing a nomogram to predict MARSI risk may be a good tool to have, just as the Morse Scale is used for falls.

    ReplyDelete
    Replies
    1. Nice recommendation. maybe you can think of a nursing process/ intervention in which risk assessment of MARSI can be beneficial and make a proposal for that as a research question.

      Delete
  16. Was the correct method used? Why or why not?

    I believe the correct method was used as this was a retrospective study in which
    researchers reviewed the electronic records of the 1172 patients between January 2018 and February 2019. This was a large
    enough sample size and the time frame this was reviewed is fairly recent.

    Discuss the sample size used in the study.
    This study used a bivariate analysis in a group of 1172 patients. 96 were excluded due to incomplete data . The average age of
    the sample was 55.7 years and there was 49.2% male and 50.8% female in the study. Of this 1172 group - 330 had PICC implantations, 52 had a
    history of allergies, 259 had a history of MARSI, 921 patients were receiving chemotherapy, and the remaining patients received either TPN or long term antibiotic administration.

    Suzanne Kang

    ReplyDelete
  17. Describe the sample size used in the study.
    The sample was comprised of 1172 patients who underwent central venous access device (CVAD) implantations at the First Affiliated Hospital of Xi’an Jiaotong University, location in Xi’an, China, between February 2018 to February 2019. Each patient was over the age of 18 years old with a mean age of 55.7 years. In addition, the patients had to have had a diagnosis of cancer and survive more than 3 moths after implantation of the CVAD.

    Describe the method used by the author in the study.
    The study collected demographic and pertinent clinical data, such as age, sex, chemo, dressing type, type of cancer, allergies, and type of CVAD, from patients for up to one year. Dressing changes were performed every 7 days for PICCS and every 28 days for ports except patients with existing skin injuries. Trained nurses assessed for skin injuries, which they classified and recorded using the MARSI definition and classification standards.

    ReplyDelete
  18. Describe the method used by the author of the study:

    A retrospective electronic review of patients who underwent CVA implantation between February 2018 and February 2019 was used at a hospital in Xi'an, China. Only patients who were older than 18, survived at least 3 months after CVAD implantation and had a diagnosis of cancer were included in the study. Routine PICC line dressing changes occurred every 7 days and for ports every 28 days unless patients had existing skin injuries. Skin injuries related to medical adhesives persisting more than 30 minutes were classified as MARSI, and this data was used to create a nomogram for predicting MARSI.

    Discuss the sample size used in the study:

    1172 consecutive patients who underwent CVAD implantation between February 2018 and February 2019 were used at the First Affiliated Hospital of Xi'an Jiaotong University in Xi'an, China.

    ReplyDelete
  19. 1) Discuss the sample size used in the study:
    This study used 1172 consecutive patients who underwent CVAD implantation between February 2018 and February 2019. It was performed at Xi’an Jiaotong University, located
    in Xi’an, China.
    2)Discuss the limitations of the article: limited sample size, design flaws, and/or author
    this is very limited because its a small number of patient plus it was performed at another country in which they could have different practice skills

    ReplyDelete
  20. 1. Discuss the sample size used in the study
    The sample size in this study consisted of 1172 patients from Hospital of Xi'an Jiaotong University in Xian, China. The criterias for patients were older than 18 years of age, central venous access device (CVAD) implanted, and survivor after 3 months of CVAD implantation of cancer patients. On an average patient data collected was a mean of 55.7 years of age both males and females. In addition, patients who did not surive 3 months post VAD implantation were not included during the study. Upon data collection, surgeons and nurses with special training were part of the CVAD maintenance process and observbed patients every 7 days for PICC's or 28 days for ports without any skin injuries. The result presented 1268 patients total with CVAD implantation.

    2. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
    One limitation during this study was the use of identical medical dressing for both patients with PICC and other types of CAVD. This was a challenge because it was difficult to identify ports selection associated with medical adhesive skin injury and potential risks. Identifying in single clinic and cancer patients with CVAD was a challenge as well due to the need for a broader model.

    ReplyDelete
  21. 1. Discuss the sample size used in the study:
    The sample size in the study included 1172 consecutive patients who underwent CVAD implantationfrom Xi'an Jiaotong University Hospital located in China.

    2. Discuss the method used by the Author:
    The author used a retrospective study conducted at the first affiliated hospital of Xi'an Jiaotong University in China between February 2018 and February 2019. The study included 1172 consecutive patients who underwent CVAD implantation and met specific criteria: they were older than 18, survived for at least three months after the procedure, and had a cancer diagnosis. Patients who did not survive for at least three months after the implantation were excluded from analyzing the impact of drugs and other interventions on MARSI occurrences. The hospital's ethics committee approved the study, and after obtaining written consent, patient demographic, clinical, and image data were collected for analysis.

    ReplyDelete
  22. Discuss the sample size used in the study

    The sample size used in the study consisted of 1172 consecutive patients who underwent CVAD implantation between February 2018 to February 2019.

    Describe the method used by the author of the study

    A retrospective review was utilized when collecting electronic medical records of 1172 consecutive patients at the First Affiliated Hospital of Xi'an Jiaotong University in Xi'an China who underwent CVAD implantation between February 2018 to February 2019. The inclusion criteria were those over the age of 18, underwent CVAD implantation, had a cancer diagnosis, and survived three months after implantation.

    ReplyDelete
    Replies
    1. Discuss the sample size:
      The sample used was made up of 1172 consecutive patients who underwent CVAD implantation between February 2018 and February 2019. The study was done at the First Affiliated Hospital of Xi’an Jiaotong University, located in Xi’an, China.

      Describe the method used by the author of the study:
      Electronic records of 1172 consecutive patients were examined who underwent CVAD implantation between February 2018 and February 2019. The study setting was the
      First Affiliated Hospital of Xi’an Jiaotong University, located
      in Xi’an, China. Inclusion criteria were those who were older
      than 18 years, underwent CVAD implantation, survived for
      more than 3 months after CVAD implantation, and had a diagnosis of cancer. patients who did not survive at least 3 months after CVAD implantation were excluded.
      After obtaining written informed consent, the patients’ demographic, clinical data, and image data were collected for
      further analysis.

      Delete
  23. Discuss the sample size used in the study.
    Sample size for this study consistent of 1172 consecutive patients who underwent CVAD implantation, mean age was 55.7 years.



    Discuss the limitations of the article: limited sample size, design flaws, and/or author bias:
    It was difficult to identify the likelihood of MARSI occurrences based on port selection because they used the same medical dressings for patients who received PICC and other types of CAVD. they used a bivariate model to determine multiple factors potentially influencing MARSI occurrences as opposed to multivariate analysis raising the possibility of experiment type 2 errors. The study evaluated MARSI risk at a single clinical site and with a narrowed patient group, cancer patients with a CVAD. This study needs to use broaden models for predicting MARSI risk.

    ReplyDelete
  24. 1.Discuss the sample size used in the study.
    The study was conducted at
    First Affiliated Hospital of Xi’an Jiaotong University,
    in Xi’an, China, the electronic medical records of 1172 consecutive patients who underwent CVAD implantation between February 2018 and February 2019 were reviewed, participants consist of those who were older than 18yrs of age with obtained informed consent, underwent CVAD implantation, survived for more than 3 months after CVAD implantation,
    2.Describe the method used by the author of the study
    Demographic and pertinent clinical data were collected from patient records.
    Trained nurses examined and assessed participants’ skin that had been exposed to medical adhesive after the removal of the previous dressing during the CVAD maintenance process. Routine maintenance,
    including dressing changes and catheter care, Routine dressing changes were
    performed every 7 days for peripherally inserted central venous catheters (PICCs) or 28 days for ports except in patients with existing skin injuries. All were followed up for 1 year Photographs of skin lesions were obtained for quality improvement and evaluation of treatment, Skin injuries related to use of medical adhesives and persisting for more than for 30 minutes with help of TIS score were classified MARSI.

    ReplyDelete
  25. 1. Discuss the sample size used in the study.
    The sample size used consisted of 1172 consecutive patients who underwent CVAD implantation at the First Affiliated Hospital of Xi’an Jiaotong University. The sample size data collected was done between February 2018 and February 2019 with the participants mean age of 55.7 years old.

    2. Discuss the limitations of the article
    Some limitations of this study included a limited sample size (quantity and sample size was only collected from one location), and the same medical dressings were used for patients who received PICC and other types of CAVD, and the likelihood of MARSI occurrences based on port selection was difficult to identify.

    ReplyDelete
  26. 1. Discuss the sample size utilized in the study.
    The research was carried out at the First Affiliated Hospital of Xi-an Jiaotong University in Xi’an, China. The study involved a comprehensive examination of electronic medical records pertaining to 1172 consecutive patients who had undergone CVAD implantation over a one-year period, from February 2018 to February 2019. The study’s participants included individuals who were 18 years of age, provided informed consent, had undergone CVAD implantation, and had survived for a minimum of three months following the CVAD procedure.
    2. Describe the approach employed by the study’s author.
    The study’s methodology involved the collection of demographic and relevant clinical data directly from patient records. To evaluate the impact of medical adhesives on patients’ skin, trained nurses conducted assessments on the skin areas exposed to these adhesives during CVAD maintenance procedures. Routine maintenance practices, such as dressing changes and catheter care, were implemented as per established protocols. Dressing changes occurred at regular intervals, with a frequency of every seven days for PICCs and every 28 days for ports, unless patients had pre-existing skin injuries. The study followed up with participants for a duration of one-year, documenting skin lesions through photographs to facilitate quality improvement and treatment evaluations. Skin injuries attributed to the use of medical adhesives, persisting for more than 30 minutes as indicate by the TIS score, were categorized as MARSI.

    ReplyDelete
  27. 1. Describe the method used by the author of the study
    Demographic and pertinent clinical data were collected. Trained nurses examined and assessed participant's skin that had been exposed to medical adhesive after the removal of the previous dressing during the CVAD maintenance process. Routine maintenance including dressing changes and catheter care, was performed every 7 days for PICC's or 28 days for ports except with patients with existing skin injuries.

    2.Discuss the sample size used in the study.
    1172 patients underwent CVAD implantation between February 2018 and February 2019. Inclusion criteria were those who were older than 18 years, underwent CVAD implantation, survived for more than 3 months after CVAD implantation and had a diagnosis of cancer. Patients who did not survived atleast 3 months after the CVAD implantation were excluded.

    ReplyDelete
  28. 1. Discuss the sample size used in the study:
    The sample size consisted of 1,172 patients who underwent CVAD implantation between February 2018 and February 2019 at First Affiliated Hospital of Xi'an Jiaotong University located in Xi'an, China.
    According to the study, the average age of the patient was 55 years old.

    2. Discuss the limitations of the article: limited sample size, design flaws, and/or author
    The main limitation to this study is applying its results to practice in the United States since it took place in another country. If the study took place in the United States, it would have a better representation of this patient population and the current practices for these patients. However, since this study took place in China, they may have very different practices or products that they use.

    ReplyDelete
  29. 1. How does this research article compare to our practice, policy and/or procedure?

    This article discusses prevalence of medical adhesive-related skin injuries with CVAD in patients with cancer in a hospital setting over 1 year. In this article's study - the hospital’s practice included changing central line dressings every 7 days and ports every 28 days. One difference I was able to note is that with our policy, we change the dressings every 7 days – regardless of if it is a PICC or Portacath. This may make a difference in the result.


    2. Describe the method used by the author of the study

    This author used clinical as well as demographic data from patients’ records obtained between February 2018 and February 2019. They excluded patients who already had preexisting skin injuries as well as those who didn’t survive after 3 months. They included those diagnosed with cancer that had survived passed the 3 months after CVAD insertion.

    ReplyDelete
  30. 1. Discuss the sample size used in the study:
    The sample size was 1172 patients who underwent CVAD implantation from Feb 2018 and Feb 2019. The age was a mean of 55.7 and the data was collected from a hospital in Xian, China

    2. Describe the method used by the author of the study
    Demographic data was collected from patient records with routine dressing changes performed every 7 days except for those with existing skin injuries. Skin injuries related to those used with medical adhesive persisting for more than 30 min was was classified as MARSI.

    ReplyDelete
  31. Describe the sample size in the study.
    In this study 1172 patients was used, that had placed central venous access divice. The study was done from 2018-2019 and excluded patients 18 and younger.
    Describe the method used by the author of the study.
    The method was retrospective, single center study. Data was collected from patients records. Dressing changes were preformed every 7 days for PICC lines or 28 days for ports. Skin injuries related to those used and medical adhesive persisting for more than 30 min was classified as MARSI.

    ReplyDelete