Medical devices injure babies’ skin, mucosa
Medical devices often cause skin and mucosal lesions in infants admitted to the neonatal intensive care unit (NICU), according to a new study.
“It was shown the majority of participants had skin lesions associated with medical devices and the number of medical devices used, and the age of the newborns were predictors for this occurrence,” said researchers.
In the 85 included newborns (mean age, 3.46 days; 61.2 percent male), majority (72.9 percent; n=62) experienced skin or mucosal lesions caused by using medical devices over a mean monitoring duration of 14.94 days. The mean number of lesions per newborn was 2.62, and 32 participants (37.6 percent) presented with 1–3 lesions. [J Clin Nurs 2019;doi:10.1111/jocn.14998]
The mean number of devices used per infant during the study period was 4.67. All patients required the use of orogastric tubes and pulse oximeters. Orotracheal tubes, used in 62.4 percent (n=53), were the third most common device utilized.
Majority (89.4 percent; n=76) of the patients similarly used materials to help protect the skin or mucosa against possible injuries from medical devices. Of these, microporous adhesive tapes (82.4 percent; n=70) and hydrocolloid plaques (51.8 percent; n=44) were the most frequently used.
Four types of skin and mucosal lesions were observed: excoriation (64.7 percent; n=55), pressure injury (28.2 percent; n=24), burn (2.4 percent; n=2) and blister (1.2 percent; n=1).
Multiple linear regression analysis was then performed to identify significant risk factors. The number of medical devices used emerged as a significant and positive predictor of skin and mucosal lesions (β, 0.471; p=0.001), while age was inversely associated with lesion development (β, –0.205; p=0.033).
“A large number of skin lesions in newborns are associated with the procedures performed during hospitalization and the medical devices used,” said researchers.
“It’s important that nurses know both physical and biological newborn characteristics and identify the risk of injury to promoting high-quality and humanized care, soothing the complications caused by the lesions, the length of hospitalization, the mortality rate, the hospital expenses and the physical discomfort [caused by] the lesions,” they added.
In the present study, participants were enrolled from the NICU and lesions were evaluated according to the Neonatal Skin Condition Score. Medical devices included probes, cannulas, drains, nasal masks and prongs, catheters, electrodes, and pulse oximeters. Babies were evaluated daily until discharge from the NICU.
Important limitations of the study included the small sample size and the performance of skin evaluation at only one time of the day, said researchers. Despite these, they “hope that these findings may support the implementation of injury prevention measures associated with the use of medical devices in the newborns, contributing to a safe and quality care for this population.”