Article Title:
Incidence and Predictive Model of Medical Adhesive– Related
Skin Injury in Cancer Patients Managed With Central Venous Access Devices
Year Published: July 2023
Please click the link below:
Please follow Journal Rules and Guidelines before posting.
If not automatically directed on the PDF file just click Download PDF file on the Headings tab.
For documents located in SharePoint Site (CA SJ Wound and Ostomy) look for the article and click it to open.
Don't forget to write your name with each posting.
Discuss the sample size used in the study.
ReplyDeleteThis study included 1,268 patients who underwent CVAD implantation, however, 96 patients were excluded due to incomplete data so at the end the study based on 1,172 patients. The average age for the patients was 55 years of age. The size was divided almost equally between males and females, 49.2% males and 50.8% females. All patients had a cancer diagnosis.
Discuss limitation of the article:
Some limitations were the fact that the average age was older in their mid 50's. Patients who are older have more comorbidities and their skin is more delicate when compared to children or younger populations. The same brand of dressing was used for PICC lines and central line dressings so it's harder to generalize the results.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe impairment of skin integrity around vascular access, just like catheter-ralated complications such as thrombosis and infection affects the treatment process and quality of life of patients with cancer.With the use of central venous access device such as implanted port and PICC,medical adhesive related skin injury such as skin stripping , blister ,skin tear and allergic dermatitis are some complications of use of medical adhesive products.
Describe the method used by the author of the study
Electronic records of 1172 consecutive patients who underwent central venous access device (CVAD) implantation between February 2018 and February 2019 were reviewed.Criteria included were those who were older than 18 years, underwent CVAD implantation, survived 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 because the influence of drugs and other interventions on medical adhesive related skin injury (MARSI) were analyzed.Patient;s demographic, clinical data and image data were collected for further analysis
Describe the method used by the author in the study.
ReplyDeleteThey retrospectively reviewed electronic records of 1172 patients over age 18,have a CVAD implanted, survived more than 3 months after CVAD implantation, and had a diagnosis of cancer. In their data collection method, they used a three item severity score to assess the severity of contact dermatitis-erythema, edema, and excoriation. And for skin tears, they used 3 category system to rate the severity of the skin tear. Routine catheter care was PICC line dressing change every 7 days and Port dressing change every 28 days.
Discuss the limitations, of the article.
This study focused on MARSI in a specific population of cancer patients who either had a PICC line or port. the statistical analysis identified 5 risk factors- previous MARSI, need for TPN, other catheter related complications, a history of allergies, and PICC implantation. But in the discussion they also recognized that other risk factors can influence the incidence of MARSI that were not measured. Adults with multiple comorbidities, type of chemo, diabetes, latex sensitivity, various types of medical adhesives, technique for applying and removing adhesive can all influence MARSI incidence.
Article #4- Incidence and Predictive Model of Medical Adhesive-Related Skin Injury in Cancer Patients Managed with Central Venous Access Devices
ReplyDeleteQ5. Discuss the research question or main problem discussed in the study.
The research question was determine the prevalence of medical adhesive-related skin injury (MARSI) at the site of central venous access device implantation (CVAD) in patients with cancer. Literature defines this as skin stripping, tension injury/ blister, skin tear, irritant contact or allergic dermatitis, maceration, and folliculitis. The authors identified the research as a quality improvement project to identify prevalence and risk factors for MARSI. I think the reason for the quality improvement project was that they were seeing an increasing trend of MARSI and they thought it would be good to investigate and see if there were any factors identified to minimize the problem. For me, since I don’t see many central venous access devices it is not as important; however, several characteristics that they were tracking such as BMI, TPN, history of allergies are interesting risk factors that are worth noting.
Q6- Discuss the sample size used in the study.
This research was retrospective review of electronic records of patients who met inclusion criteria, underwent CVAD implantation within a calendar year, was affiliated with a University Hospital in China with a diagnosis of cancer and survived more than 3 months after implantation. The study reviewed 1268 consecutive patient charts, 96 were excluded due to incomplete data leaving 1172 patients in the research study. First of all, that is alot of charts to review and that also means that they averaged at least 3 CVAD’s a day which seems like a lot for one hospital. Does that mean the majority of the oncology population will receive a CVAD if you are being treated at that university in China? I believe that was sufficient size sample to draw some conclusions. Interesting, BMI was tracked but no albumin or prealbumin to infer risk factor. Additionally, the type of malignancy was not indicated in the study.
Discuss the research question or main problem discussed in the study:
ReplyDeleteThe researchers preformed this study to determine rates of medical adhesive-related skin injury occurring at the sites of central venous access devices. A group of 1172 patients undergoing cancer treatments were analyzed. Researchers set out to determine rates of occurrence of such skin injuries and identify risk factors in this patient population.
Discuss the limitations of this article:
The research participants included in the study were patients undergoing cancer treatment. The patients had central line devices for various reasons including TPN, antibiotics and chemo. The study doesn't clearly define or provide a correlation between type of infusion and potential MARSI. Moreover, the type of cancer, stage, and chemo cycle, length of treatment, etc. is not included in the study.
Karen Caneday, RN, 6NE
Discuss the research question or main problem discussed in the study:
ReplyDeleteThe authors of the article were looking to find out if there was a way to predict MARSI (medical adhesive-related skin injury) in patients with a PICC or a port by identifying risk factors. They looked at 1172 patients with recently placed PICC or ports. They determined the following risk factors: presence of cancer, diabetes, history of positive skin scratch tests, use of TPN, and whether they had a PICC or port. From this data, they were able to create a nomogram which can help healthcare workers predict the risk of MARSI.
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital:
ReplyDeleteThe nomogram that they authors developed would be a useful tool for nurses providing care to patients with PICC or port, particularly during dressing changes. If we could predict ahead of time which patients were likely to develop MARSI, we could use products and techniques that would better prevent the injury. It would require that nurses be educated in using the nomogram, and MARSI prevention and treatment.
How does this research article compare to our practice, policy and/or procedure?
ReplyDelete-Our ICU often receives Patients with acutely ill underlying end-stage cancer and our huge attention goes to infection related to CVADs maintaining CLABSI team to make a round for assessing and dressing change for CVADs regularly, but a little attention to Medical adhesive-related skin injury (MARSI) as this article mentions. I believe our CLABSI team doesn't get routine opportunities for education/training for MARSI currently to learn the MARSI definition, classification standards using like a Three-Item Severity score for the severity of irritant contact dermatitis or the Skin Tear Audit Research classification instrument for skin tear severity. Thus, our focus on catheter-related complications is predominant, while our attention on a complication of use of medical adhesive products is very limited.
What are the advantages and disadvantages to the proposed recommendations in the article?
-The first advantage is to catch and intervene earlier for MARSI using a nomogram scoring the 5 risk factors for probability of MARSI, which is introduced at this article for example. This results in improving Patient's treatment process and quality of life with Patients with cancer. The secondary advantage is to empower CLABSI team adding the knowledge for MARSI by having an opportunity of routine education/training. CLABSI team will evolve to assess/intervene earlier for infection and medical product related skin injuries. They can lead the colleague nurses sharing their knowledge.
-Disadvantage would be resist toward a cultural change and possible burden for Wound care nurses. It could be a cultural change that adding assessment/intervention for MARSI to CLABSI team including bedside nurses. Like introduction of AirTap in ICU, we need a good plan for the transition for MARSI. I think we should conduct a study first to see prevalence for MARSI to find out how many incidence we actually have for the skin injuries to raise everyone's attention. We need educational and training opportunities for MARSI, which could be a burden to Wound Care Nurses. If we prove prevention for MARSI can improve length of hospital stay, Hospital may increase budget to hire one more Wound Care Nurse, which I hope.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe main research question or problem discussed in the study is to investigate the prevalence and risk factors associated with medical adhesive-related skin injury (MARSI) in cancer patients who have central venous access devices (CVADs). The study aims to understand how common MARSI is in this specific patient population and to identify the factors that contribute to an increased risk of developing these skin injuries. Additionally, the study seeks to develop a predictive tool (a nomogram) that can help clinicians anticipate which patients are most likely to experience MARSI, thereby enabling more targeted preventive measures.
Describe the method used by the author of the study
The study conducted was a retrospective, single-center analysis focused on 1,172 cancer patients who underwent central venous access device (CVAD) implantation at the First Affiliated Hospital of Xi’an Jiaotong University between February 2018 and February 2019. The researchers collected data on patient demographics, clinical characteristics, and specifics related to the CVADs, including the type used, the occurrence of medical adhesive-related skin injury (MARSI), and other related complications. MARSI incidents were identified through routine clinical monitoring, particularly around the CVAD implantation site.
In order to identify potential risk factors associated with MARSI, the study first utilized univariate analysis and then applied multivariate logistic regression to determine independent risk factors. Based on these findings, the researchers developed a predictive nomogram to estimate the likelihood of MARSI in individual patients, with the accuracy of the nomogram evaluated using the concordance index (C-index). This approach provided a comprehensive understanding of MARSI prevalence and the key risk factors involved, contributing to the development of a useful clinical tool for predicting MARSI risk.
Discuss the research question or main problem discussed in the study?
ReplyDeleteIn the retrospective study, it discusses creating a predictive model for medical adhesive related skin injury (MARSI) with patients that manage central venous access devices. It brings up the first concerns involving central lines are always about catheter related complication such as thrombosis and infection. However, there is a high risk for impaired skin integrity with the central lines as well. The research is to determine similar skin issues with patients having central lines to uncover if there a common factor using three-item sensitivity which assess the severity of irritant contact dermatitis and skin tear audit research classification instrument which calculates skin tear severity.
How does this research article compare to our practice, policy and/or procedure?
In the study, the method they used to collect data involved routine dressing changes that were done every 7 days for PICCs and every 28 days for ports. In all forms of central lines, they used the same medical dressings. In our hospital policy, it states to change all central venous access devices, including ports, every 7 days and when soiled. In the study, trained nurses in advanced wound specialist training programs would assess the skin on the central line dressing. In our practice, the nurse accessing and changing the central line dressings are assessing the skin and consulting wound care if needed.
Discuss the research question or main problem discussed in the study?
ReplyDeleteImpaired skin integrity can be caused by a number of factors including poor circulation, edema and medical adhesives. Poor circulation can cause skin damage due to a number of vascular conditions including PVD, stasis ulcers and vascular skin and skin complications from vascular access devices. Skin impairment can occur around vascular access devices due to a number of factors including MARSI, catheter insertion, dressing disruption and irritation of the VAD site during maintenance procedure can cause skin damage
Describe the method used by the author of the study
ReplyDeleteThe methods used for this study 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 related to use of medical adhesives persisting for more than 30mins were classified 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)a calibration curve
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe prevalence of medical adhesive–related skin injury (MARSI) at the
site of central venous access device (CVAD) implantation in patients with cancer, identify risk factors associated with MARSI in
patients with cancer, and create a nomogram for predicting risk of MARSI
Medical adhesive–related skin injury (MARSI) is a potential
complication of use of medical adhesive products; common
manifestations include skin stripping, tension injury/blister,
skin tear, irritant contact or allergic dermatitis, maceration, and
folliculitis.
It entails skin impairment can occur around vascular access devices due to a number of factors including MARSI, catheter insertion, dressing disruption and irritation of the VAD site during maintenance procedure can cause skin damage.
DeleteIt discusses creating a predictive model for medical adhesive related skin injury (MARSI) with patients that manage central venous access devices.
Describe the method used by the author of the study:
ReplyDeleteDemographic and pertinent clinical data were collected from patient records.
The sample comprised 1172 consecutive patients who underwent CVAD implantation between
February 2018 and February 2019; their mean age was 55.7 years.
Trained nurses who had attended an advanced wound specialist training program, 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, was performed
every 7 days for PICCs or 28 days for ports except in patients
with existing skin injuries.
The design use in the study is retrospective single study center. It is a type of longitudinal study in which researchers look back to a certain point to analyze a particular group of subjects who have already experienced an outcome of interest. A total of 1172 patient who underwent CAVD implantations between February 2018 and February 2019 were included in the study. The inclusion criteria were older than 18 years, CAD implantation, survive for more than three months after CAD implantation and had a diagnosis of cancer. After obtaining consent, data were collected and analyzed. In conclusion, a MARSI rate of 1.7 events out of 1000 CAVD days was observed.
Delete1. Discuss the research question or main problem discussed in the study?
ReplyDeleteThe main problem that is discussed in this study is that medical adhesive-related skin injury (MARSI) is a potential complication when using medical adhesive products. The purpose of the study was to evaluate the prevalence of MARSI at the site of central venous access devices (CVAD) in patients who have cancer as well as to identify risk factors for MARSI. When using medical adhesive products there are common complications such as skin stripping, tension injury, skin tears, contact dermatitis, maceration, and folliculitis. It specifically looks at cancer patients because they commonly use CVADs for long term intravenous access.
2. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
One of the biggest limitations of the article is that it does not specify which device, CVAD, PICC, Port-A-Caths, etc., was most or least likely to cause MARSI since the same medical dressings were used for all types of access ports. Another limitation of this study is that since it is only looking at two variables, a bivariate study. In real life there are many factors that may be at play, therefore a multivariate analysis may be more beneficial to understand how various factors influence each other. The study is overall limited since it simplifies relationships between variables.
1. Discuss the research question or main problem discussed in the study?
ReplyDeleteThe research question in the study is to find out the occurence of medical adhesive-related skin injury (MARSI) at the site of central venous access devices (CVAD) in cancer patients. The study also aims to find out what the causes and risk factors are in getting a MARSI. In the study, the researchers find that there are five risk factors that put cancer patients with CVAD at risk for getting a MARSI: (1) previous MARSI history, (2) use of TPN, (3) other catheter-related complications, (4) a history of allergy, and (5) PICC implantation. An incidence rate of 1.7 events per 1000 CVAD days was found after collecting and reviewing the data.
2. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
I think the limitations of the study were the sample size of the participants. They used a very specific patient population, cancer patients that have CVADs, and were only studying at one hospital. Although they were still able to study 1172 patients, I think that this limited sample size compared to the general population of patients that may get MARSIs is too small to generalize a conclusion for all patients that have CVADs and MARSIs. There are many patients that have CVADs that are not oncology patients and they are also at risk for MARSIs. Also, since they only studied patients at one hospital, we can only base the findings on the policies and procedures and equipments at that hospital. Other hospitals might have different procedures and equipment that could make patients more at risk or less at risk for MARSI development.
Sabrina Ittidecharchoti, RN, 6NE
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe main problem in this study is medical adhesive-related skin injury (MARSI), which can cause skin breakdown, injury/blister, maceration, and dermatitis. Other catheter associated complications have been highlighted such as infection or thrombosis, however skin integrity related to catheters have been overlooked. This is an issue because it also affects quality of life especially in patients with cancer.
Describe the method used by the author of the study
The author reviewed electronic records of 1172 patient who received central venous access device (CVAD) implantation from February 2018 – February 2019. The study was done at a university hospital in China. The criteria were people of 18 years and older, under going CVAD implantation, and had cancer. Those that did not survive 3 months after implantation were not included in the study because the author wanted to analyze the effect of drugs and other interventions on MARSI occurrences.
1. Discuss the sample size used in the study.
ReplyDeleteThe study consisted of 1172 Cancer patients who underwent CVAD implantation between February 2018 and February 2019 in China. 49% were males and 51% were females. Majority of the patients were receiving chemotherapy, some were receiving TPN. The majority of patients (63%) had irritant contact dermatitis from the adhesive.
2. Discuss the research method used? Why or why not?
The article discusses using a retrospective study of medical records of cancer patients who were managed with central venous access devices (CVADs). Data is collected from past patient records, focusing on cases where medical adhesive-related skin injuries (MARSI) were observed. This would help to identify occurrences of MARSI and help direct subsequent investigations.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
ReplyDeleteThe article did not include the possibility of using disinfectant as a cause of skin irritation/injury at the site of CVAD and not the adhesive. Also, the article did not determine the uniformity and make up of the material of the dressing that was used for the study. History of allergy (to adhesive) as a risk factor for higher incidence of MARSI poses a question "should patients with history of allergy be excluded from the study?" the article did not specify if history of allergy means allergy to adhesive or others during demographic data collection.
Discuss the research question or main problem discussed in the study?
The study aims to determine the prevalence of MARSI at the site of CVAD implantations in patients with cancer by identifying the risk factors associated with MARSI in cancer patients and predicting the risk of developing MARSI. The study shows that out of 1172 patients with cancer, 282 patients developed MARSI. It determined the risk factors for higher incidence of MARSI are patients with MARSI history,
use of TPN, other catheter related complications, history of allergy and PICC implantation. With the created nomogram, a higher score predicts more probability of suffering MARSI
1. Describe the method used by the author of the study:
ReplyDeleteThis was a retrospective study whereby demographic, clinical and image data of patients who underwent CVAD implantation was analyzed. Skin surveillance of the area exposed to medical adhesives was by performed by nurses during weekly PICC dressing changes and catheter care, 28 days for ports, except for patients with existing skin injuries, and patients were monitored for up to a year. Skin lesions recognized as medical adhesive-related skin injury (MARSI) were photographed. Subsequent data was then used to establish a nomogram for predicting MARSI in at-risk patients.
2. Discuss the sample size used in the study:
In Xi'an, China at First Affiliated Hospital of Xi'an Jiaotong University, 1172 consecutive patients undergoing CVAD implantation from 02/2018-02/2019 were studied. Included were those who were over 18 years old, who had survived more than 3 months after the procedure and were diagnosed with cancer. Those who died less than 3 months after implantation were not included because the authors wanted to account for drugs and other interventions as a factor in developing MARSI.
1. How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteIn our hospital it is policy to use some type of skin prep to create a literal film the adhesive can bind to and keep the skin intact and safe. When dressings are changed then alcohol can be used to remove the dressing if the skin is not compromised and / or saline. CVADs are every 7 days and PRN. If gauze dressings are used, then every 48 hours. The article states 7 days for PICCs and 28 days for ports (not compromised). Their nurses were given additional training on MARSI, but exact details were omitted. PICC dressings seem to be the same. Their port dressing changes are more lenient in terms of frequency.
2. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
One limitation they discussed was that the dressings were all the same. Proper sizing, stabilizers, skin prep, frequency of changes, etc. can all potentially contribute to skin compromise. The details of the dressings were not, well, detailed. The article findings were from 2018-2019 before COVID. I feel policies have changed since COVID. Even our own policies had RNs using bio-patches on dressings. Without these details it is hard to compare what exactly could have had an impact on the results.
(1) What are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteAdvantages: Development of a predictive nomogram: The study created a nomogram to predict the risk of medical adhesive-related skin injury (MARSI) in cancer patients with central venous access devices (CVADs). This tool could help clinicians identify high-risk patients and take preventive measures.
Identification of specific risk factors: The study identified five key factors associated with increased MARSI risk: previous MARSI history, use of total parenteral nutrition (TPN), other catheter-related complications, history of allergy, and use of peripherally inserted central catheters (PICCs). This knowledge can guide targeted interventions.
Quantification of MARSI incidence: The study found a MARSI incidence rate of 1.7 events per 1000 CVAD days, providing a baseline for future comparisons and quality improvement efforts.
Disadvantages: Limited generalizability: The study was conducted at a single center and focused only on cancer patients with CVADs, which may limit the applicability of findings to other patient populations or healthcare settings.
Potential for type 2 error: The study used bivariate analysis to identify risk factors, which may increase the risk of type 2 errors compared to multivariate analysis.
Lack of differentiation between dressing types: The study used the same medical dressings for all CVAD types, making it difficult to assess the impact of different dressing materials on MARSI risk.
(2) Discuss the research question or main problem discussed in the study?
The main research question or problem discussed in this study focuses on medical adhesive-related skin injury (MARSI) in cancer patients who have central venous access devices (CVADs) implanted. Specifically, the study aims to address several key aspects of this issue:
Prevalence of MARSI: The researchers sought to determine the prevalence of MARSI at the site of CVAD implantation in cancer patients. This was an important starting point to understand the scale of the problem.
Risk Factors: The study aimed to identify risk factors associated with MARSI in cancer patients with CVADs. Understanding these risk factors is crucial for developing preventive strategies and identifying high-risk patients.
Predictive Model: A major goal of the study was to create a nomogram for predicting the risk of MARSI in this patient population. This tool could potentially help healthcare providers assess individual patient risk and tailor interventions accordingly.
The researchers recognized that while catheter-related complications such as thrombosis and infection have been well-studied, the issue of impaired skin integrity around vascular access sites has received less attention. This is despite the fact that such skin injuries can significantly affect the treatment process and quality of life for cancer patients.
By addressing these research questions, the study aimed to fill a gap in the existing knowledge about MARSI in cancer patients with CVADs. The ultimate goal was to provide insights and tools that could help improve patient care and outcomes by better predicting and potentially preventing MARSI in this vulnerable population.
1. Discuss sample size used in the study.
ReplyDeleteThe researchers used the data of 1172 patients who received CVAD implantation with the average age of the participants being 55.7 years old. However, they started with 1268 patients and had to exclude 96 due to incomplete data. With a sample size of over 1000 participants, this seems like a large enough number to create the nomograh they wanted. The results section mentioned that a majority (921) of patients were receiving chemotherapy at the time of hospital admission. I wish they had elaborated more on that, for example, including data on the effects of chemotherapy on skin integrity in general. Or if another group wanted to expand on this issue, create a study of skin integrity with two populations, those who are getting chemotherapy vs those who are not.
2. Discuss the research question or main problem discussed in the study.
The main problem discussed in this study was the prevalence of MARSI, especially in the cancer effected population. This study aimed to created a nomograph to predict MARSI so that nurses could use this tool to identify if their patients are vulnerable. Given that cancer patients often need long term infusions, chemotherapy, or TPN via a central line and that cancer treatment often leads to skin integrity issues, the study focused on this population. The study also acknowledged that while issues like CLABSI and thrombosis have received a lot of attention, skin related issues related to CVADs have less research.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe research question discussed in this study was to determine the prevalence of medical adhesive-relate skin injury (MARSI) at the implantation site of the central venous access device (CVAD) in patients with cancer to identify risk factors for MARSI and create a nomogram for predicting MARSI risk in this patient population. The researchers were able to identify five associated factors increasing the risk of these patients developing MARSI, which were previous MARSI history, TPN use, other catheter related complications (i.e. CLABSI), allergic history, & PICC implantation (in comparison to ports). By determining and presenting these five factors within this population, the nurses in this area could collaborate to develop initiatives to prevent these factors from arising and keeping their patients safe and healthy.
Discuss the sample size used in the study.
The sample size of this study was 1268 diagnosed cancer patients who had undergone CVAD implantation between February 2018 to February 2019 to receive chemotherapy, TPN, or long-term antibiotics of which 96 were excluded, due to incomplete data and analysis, for the grand total of 1172 patients. The median age of these patients was 55.7 years with 49.2% being males & 50.8% being females. They also took into account that 52 of these patients had a history of allergies based on positive dermatographia testing as well as 259 of these patients who had a history of MARSI.
Discuss the research question or main problem discussed in the study?
ReplyDeleteSkin integrity around vascular access such as thrombosis and infection will affects the treatment process and quality of life of patients especially patient with cancer with the use of central venous access device such as implanted port and PICC, medical adhesive related skin injury such as skin stripping , blister ,skin tear and allergic dermatitis are some complications of use of medical adhesive products.
2. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
Five risk factors were found to be significant on bivariate analysis. They were previous 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. Based on these factors, we created a nomogram using the RMS package for predicting the probability of MARSI in patients who received CVAD implantation. The predicted probability of MARSI was obtained by summing the scores of the 5 factors from the nomogram. The C-index of the nomogram was 0.96, suggesting that the accuracy of the nomogram was good. We performed internal verification of the nomogram via drawing validation curve. The predicted risk of the CVAD associated MARSI corresponded closely with actual MARSI occurrence and was within a 10% margin of error, indicating a good nomogram predictive ability
Describe the method used by the author of the study
ReplyDeleteMethod used by the author of the study is retrospective and demographic and pertinent clinical data and electronic records of 1172 consecutive patients who underwent CVAD implantation between February 2018 and February 2019 with regards to Medical adhesive related injury (MARSI) the potential complication of use of medical adhesive products, common manifestation includes skin tripping, tension injury/blister, skin tear, allergic dermatitis, maceration and folliculitis. Other complication that was discussed was catheter related complication such as thrombosis and infection.
Discuss the sample size used in the study.
The study consist of 1172 patients who underwent CVAd implantation between February 2018 to February 2019 with their mean age 55.7 years of age male 49.2 % and females. 50.8%. Fifty two 4.4% had a history of allergies. Majority of the patients were receiving chemotherapy at the time of hospital admission and remaining is receiving TPN or long term antibiotic treatment. Among the 1172 patients 1 or more MARSI representing an incidence rate of 1.7 events per 1000 CVAD days
Discuss the research question or main problem discussed in the study?
ReplyDeleteSkin integrity around vascular access such as thrombosis and infection will affects the treatment process and quality of life of patients especially patient with cancer with the use of central venous access device such as implanted port and PICC, medical adhesive related skin injury such as skin stripping , blister ,skin tear and allergic dermatitis are some complications of use of medical adhesive products. Medical adhesive–related skin injury (MARSI) is a potential
complication of use of medical adhesive products; common
manifestations include skin stripping, tension injury/blister,
skin tear, irritant contact or allergic dermatitis, maceration, and
folliculitis. The purpose of this study, performed as part of a quality improvement initiative, was to determine the prevalence of MARSI at the site of CVAD implantation in patients with cancer, to identify risk factors for MARSI, and create a nomogram for predicting MARSI risk in this patient
population
2. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
Five risk factors were found to be significant on bivariate analysis. They were previous 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. Based on these factors, we created a nomogram using the RMS package for predicting the probability of MARSI in patients who received CVAD implantation. The predicted probability of MARSI was obtained by summing the scores of the 5 factors from the nomogram. The C-index of the nomogram was 0.96, suggesting that the accuracy of the nomogram was good. We performed internal verification of the nomogram via drawing validation curve. The predicted risk of the CVAD associated MARSI corresponded closely with actual MARSI occurrence and was within a 10% margin of error, indicating a good nomogram predictive ability
1. Discuss the research question or main problem discussed in the study?
ReplyDeleteThe main research question of this study focuses on understanding the prevalence of medical adhesive-related skin injury (MARSI) at the sites where central venous access devices (CVADs) are implanted in cancer patients. It aims to identify specific risk factors that contribute to MARSI and to create a nomogram that can help predict the likelihood of these injuries occurring. This is particularly important because MARSI can complicate treatment regimens and impact patient comfort and recovery. By shedding light on these issues, the study seeks to improve care practices for patients requiring CVADs, ultimately enhancing their overall health outcomes.
2. Discuss the sample size used in the study
In terms of sample size, the study included 1,172 consecutive patients who received CVAD implantation over a one-year timeframe, with a mean age of 55.7 years. This significant number of participants provides a robust foundation for analyzing the prevalence and associated risk factors for MARSI in this population. Among these patients, 330 had peripherally inserted central venous catheters (PICCs), and 282 experienced MARSI, which translates to an incidence rate of 1.7 events per 1,000 CVAD days. The large sample size not only enhances the validity of the findings but also supports the development of a nomogram with a high concordance index of 0.96, indicating its strong predictive capability. This tool could be invaluable for nursing practice, enabling us to anticipate and mitigate the risk of MARSI in our patients, thereby improving their care and outcomes.
Describe the method used by the author in the study.
ReplyDeleteThe researchers conducted a retrospective analysis of electronic medical records for 1,172 patients aged 18 and older who had a central venous access device (CVAD) placed, survived for more than three months post-implantation, and were diagnosed with cancer. To collect data, they employed a three-item severity score to evaluate contact dermatitis, assessing erythema, edema, and excoriation. For skin tears, they implemented a three-category system to determine severity. Routine care for the catheters included changing the dressing on peripherally inserted central catheters (PICCs) every seven days and on ports every 28 days.
Discuss the limitations of this article
This research examined the incidence of medical adhesive-related skin injury (MARSI) among cancer patients using either a peripherally inserted central catheter (PICC) or a port. The statistical analysis identified five key risk factors: a history of MARSI, the need for total parenteral nutrition (TPN), complications related to catheters, previous allergies, and the implantation of PICC lines. However, the authors acknowledged that there are additional risk factors affecting MARSI incidence that were not included in their analysis. For instance, adults with multiple comorbid conditions, the type of chemotherapy received, diabetes, sensitivity to latex, the use of different medical adhesives, and the techniques used for applying and removing adhesives can all impact the likelihood of developing MARSI.
Impaired skin integrity around vascular access devices has received little attention. Medical adhesive products used to secure central venous access devices (CVADs), such as intravenous ports and peripherally inserted central venous catheters (PICCs) can potentially lead to medical adhesive-related skin injury (MARSI). Injuries related to MARSI include skin stripping, tension injury, blistering, skin tear, irritant contact, dermatitis, maceration, and folliculitis.
ReplyDeleteThis is a retrospective study performed as a quality improvement initiative to determine the frequency of MARSI at the site of CVAD implantation in cancer patients in order to identify risk factors for MARSI and for predicting these risks. This study was done at the First Affiliated Hospital of Xi’an Jiaotong University, in Xi’an, China. Electronic records were retrospectively of 1172 consecutive patients who underwent CVAD implantations between February 2018 and February 2019. All patient were older than 18 years old, had cancer, had a CVAD implantation, and survived more the 3 months post CVAD implantation. Data collection included age, sex, chemotherapy strategy, types of adhesive dressings, preliminary diagnosis / cancer type, history of allergies, and details regarding the type of CAVD.
The published study goes into detail about how the data was collected and the software used to analyze the collected data. Almost one-quarter of the patients, (24.1%), experienced a MARSI event, which represented 1.71 per events per 1000 catheter days. With the majority of those patients having contact dermatitis. Blisters and skin tears were the remaining primary complications. Five risk factors were found to be significant. They were; previous MARSI history, use of TPN, other catheter related complications, history of allergies, and PICC implantation. The study resulted in the development of a nomogram for predicting MARSI that may help nurses predict the MARSI risk in this patient population. However, the study also admitted to some shortcomings, and stated that additional research is needed to develop broader models. I agree that the study needs additional research to factors in additional variables.
As a Cardiac Cath Lab nurse, we routinely deal with the insertion of central line catheters. Most are short term, but there are occasions when we leave a variety of catheters in the patient, and then transport them to the ICU or 3 North. Meticulous care is always taken to properly secure the catheters, and to apply the proper dressings in accordance to hospital policy and best practices. During my 30 years as a nurse, I only had one incident of a grade 1 skin tear. It happened while removing one of the defibrillation patches from my patient once he had been transported to 3 North. Also, the Cath Lab experienced only one serious infection following a permanent pacemaker insertion. Proper wound closure was performed and an appropriate dressing was applied to the surgical site. Follow-up investigation revealed the patient was non-compliant and picked at his wound. So, I guess what I am trying to saying is that, despite following proper protocol, sometimes things just go wrong.
How does this research article compare to our practice, policy and/or procedure?
ReplyDelete- Our dressing change policy seems to be similar to the one outlined in the article. We also change CVAD dressings every 7 days, however the research does not state other changing times such as when the dressing is soiled. It is also unclear if the dressings used on the CVAD is the same as over the ort or if they use a different type of dressing. The article does briefly state that all dressings used were the same however that could have been made more clear.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
Limitiations of the article include: It does not give detail as to complications of lines, cleaning techniques used and frequency of prn dressing changes, among other things. There can be so many issues with CVADs and their dressings, and patients can require very frequent dressing changes (daily, QOD, BID) based on their needs. This would be a huge factor as to the incidence of skin issues under the dressing and therefore does not accurately reflect the total amount of dressing changes but instead uses the q7day dressing change policy as a broad category for how often the dressings were changed. Overall looking at the broader picture of how likely a patient is to develop skin issues underneath a long term dressing, the research does provide good information over a broad group. However this research does not provide useful information on how to improve and reduce incidences that are found within its own results because of a lack of focused evaluation.
1. Discuss the sample size used in the study.
ReplyDeleteThe sample size used in this study included 1,172 consecutive patients who had a central venous access device implanted. This included 577 males and 595 females with a combined mean age of 55.7 and a mean BMI of 22.3. 259 of the patients had a history of MARSI. The catheters were being used for such treatments as chemotherapy (78.6%), TPN (19.9%) and Others (1.5%). Of these total patients, 52 participants had prior allergies, while 913 participants did not.
2. What are the advantages and disadvantages to the proposed recommendations in the article?
Based off the data collected, the researchers have proposed multiple recommendations on the prevention and management of these medical adhesive related skin injuries. Some of the advantages of the given recommendations include improved risk assessment and better personalized care for every individual. This also includes better education for healthcare professionals thus leading to a better understanding and treatment of such issues. Some of the disadvantages of the proposed recommendations include barriers like the increased time and resources it would take to provide adequate care, which lack of funding and resources makes it very difficult to achieve. Another issue due to this is increased time and workloads on these healthcare professionals due to lack of resources.
Discuss the research question or main problem discussed in the study.
ReplyDeleteThe study aimed to assess the prevalence of medical adhesive-related skin injury (MARSI) at the sites of central venous access device (CVAD) implantation in cancer patients. MARSI encompasses various skin conditions, including skin stripping, tension injuries or blisters, skin tears, irritant contact dermatitis, allergic reactions, maceration, and folliculitis. The authors framed their research as a quality improvement initiative to identify both the prevalence of MARSI and its associated risk factors. This project was likely prompted by a noted increase in MARSI cases, leading the authors to explore potential contributing factors to help mitigate the issue. While I personally encounter few CVADs, the characteristics being monitored, such as BMI, total parenteral nutrition (TPN) usage, and allergy history, are intriguing risk factors that merit attention.
Discuss the sample size used in the study
This study involved a retrospective analysis of electronic medical records from patients who met specific criteria: they had undergone central venous access device (CVAD) implantation within a year at a university hospital in China, were diagnosed with cancer, and survived for more than three months post-implantation. Out of 1,268 patient charts reviewed, 96 were excluded due to incomplete information, resulting in a final sample of 1,172 patients. This represents a substantial volume of records to analyze, suggesting the hospital averaged at least three CVADs per day—an impressive statistic. This raises questions about whether most oncology patients at this university hospital are likely to receive a CVAD during their treatment. The sample size appears adequate for drawing meaningful conclusions. Interestingly, while body mass index (BMI) was monitored, there was no assessment of albumin or prealbumin levels, which could have provided additional insights into risk factors. Furthermore, the study did not specify the types of malignancies involved.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
ReplyDeleteSome of the flaws included the medical dressings that were used. The same medical dressings were used for patients who had a PICC and other types of CVAD and the likelihood of MARSI occurrences was based on the port were difficult to find. No details the the complications of lines, frequency of dressing changes, and cleaning technique were mentioned. There also needed to be additional research to develop broader models for finding MARSI risks.
Describe the method used by the author of the study
1172 consecutive patients who underwent CVAD implantation from February 2018 through February 2019 were used from a hospital located in Xi'an, China. People 18 years older who survived for more than 3 months had a diagnosis of cancer. Those who did not survive for more than three months after CVAD implantation were excluded due to the analysis of the influence of drugs on MARSI occurrence.
Discuss the sample size used in the study: The study comprised of 1172 consecutive patients who had CVAD implants between February of 2018 and February of 2019.
ReplyDeleteDescribe the method used by the author of the study:
Electronic records of patients who underwent central venous access device (CVAD) implantation between February 2018 and February 2019 were reviewed.Criteria included were those who were older than 18 years, underwent CVAD implantation, survived 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 because the influence of drugs and other interventions on medical adhesive related skin injury (MARSI) were analyzed.
Tanya Matiossian
The study setting was the First Affiliated Hospital of Xi’an Jiaotong University, located in Xi’an, China.
DeleteThe study completed a bivariate analysis in a group of 1172 patients undergoing treatment of cancer including implantation of a CVAD and found a MARSI incidence rate of 1.7 events per 1000 CVAD days.