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

Abstract

PURPOSE:The purpose of this study was to determine the 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. DESIGN: Retrospective, single-center study. SUBJECTS AND SETTING:The sample comprised 1172 consecutive patients who underwent CVAD implantation between February 2018 and February 2019; their mean age was 55.7 years (SD: 13.9). Data were collected at the First Affiliated Hospital of Xi'an Jiaotong University, located in Xi'an, China. METHODS: 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 for 30 minutes 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) and drawing a calibration curve. RESULTS: Among the 1172 patients, 330 (28.2%) had undergone PICC implantation, and 282 (24.1%) experienced 1 or more MARSIs representing an incidence rate of 1.7 events per 1000 CVAD days. Statistical analysis identified previous MARSI history, the need for total parenteral nutrition support, other catheter-related complications, a history of allergy, and PICC implantation as associated with a higher likelihood of developing for MARSI. Based on these factors, we established a nomogram for predicting the risk of developing MARSI in patients with cancer who underwent CVAD implantation. The C-index of the nomogram was 0.96, and the calibration curve of the nomogram showed that the predictive ability of the nomogram was strong. CONCLUSIONS: We evaluated patients with cancer who were undergoing CVAD and identified that previous MARSI history, patients needing total parenteral nutrition support, other catheter-related complications, allergic history, and PICC implantation (compared with ports) were associated with a higher likelihood for developing MARSI. The nomogram we developed showed a good ability for predicting the risk of developing MARSI and may assist nurses to predict MARSI in this population.

Risk factors for medical adhesive-related skin injury at the site of peripherally inserted central venous catheter placement in patients with cancer: a single-centre prospective study from China

“…In 2017, the World Congress of Vascular Access defined central vascular access device (CVAD)-associated skin impairment (CASI) based on the definition of MARSI 2. A study of 1172 patients with cancer and CVAD placement found that 24.1% of CVAD sites had MARSI, and those with peripherally inserted central venous catheters (PICC) placement sites had a higher incidence of MARSI than those with other types of CVADs 3…”

“…2 A study of 1172 patients with cancer and CVAD placement found that 24.1% of CVAD sites had MARSI, and those with peripherally inserted central venous catheters (PICC) placement sites had a higher incidence of MARSI than those with other types of CVADs. 3 PICCs can be left in patient blood vessels for up to a year and are widely used in long-term cancer treatment; however, repeated application and removal of adhesive products during catheter maintenance can increase the risk of MARSI, particularly in patients with cancer…”

“… 2 A study of 1172 patients with cancer and CVAD placement found that 24.1% of CVAD sites had MARSI, and those with peripherally inserted central venous catheters (PICC) placement sites had a higher incidence of MARSI than those with other types of CVADs. 3 …”