We’re used to thinking of medical devices as our loyal sidekicks in healing our patients. Indeed they are; the medical technology around today saves and improves lives that would have been quickly lost 100 years ago.
At the same time, reveals Prof. Janet Cuddigan of the University of Nebraska, those same beneficial, life-saving medical devices also have the potential to harm patients: one-third of facility-acquired pressure injuries in adults are caused by medical devices. The overwhelming majority of pressure injuries in children are caused by medical devices.
Medical device related pressure injuries are not a different classification of pressure injury; they are classified according to the standard pressure injury staging criteria based on depth: Stage One through Stage Four. Since their cause is different, however, when it comes to prevention and treatment, you need to go beyond the standard best practices for standard pressure injuries.
One of the most critical factors in preventing medical device related pressure injuries is your own powers of observation. Having your eyes open and knowing what to watch out for will be key in your ability to help and protect your patients.
What to Watch For
Make sure the device fits the patient well initially, but don’t assume that just because it fit perfectly at the beginning that it still fits perfectly, hours or days later. Swelling limbs can cause an initially well-fitting medical device to suddenly become tight and pressurized. Check periodically to ensure that the device is not too tight – especially if signs of edema are seen in other areas of the body.
Too tight a fit – whether from the outset or edema-induced – causes pressure to be applied to the skin. But too loose a fit is also an issue. Loose medical devices tend to slide and chafe, causing friction and shear: prime conditions for the creation of pressure injuries.
If a device can’t move and flex with the patient, it’s much more likely to cause injury. Select flexible devices whenever possible, and keep an observant eye on rigid devices when you need to use them.
If the device is in a location where moisture tends to collect under the device, the chances of pressure injuries increase. Make it a priority to keep the skin under medical devices clean and dry. Change dressings that tend to absorb moisture on a routine basis.
Critical care devices
The sheer number of devices and technology in critical care units raises the chances of medical device related pressure injuries significantly. If you work with patients in a critical care unit, make an extra effort to stay on top of all devices and their locations on the body. This includes tubing, which can get entrapped in folds of skin and cause injury.
Devices without dressing
Whenever possible, place prophylactic dressing between the skin and the medical device. Try not to use adhesive backed dressing, since when removed, may tear at the top layer of skin.
10 years ago, the approach of the medical community was that pressure injuries were caused by ischemia. Pressure obstructed blood flow, and when blood flow was obstructed for too long – on the order of hours – cell and tissue death resulted. Today, the research community has discovered that the main way that pressure causes cell death is not indirectly via ischemia, but directly via cell deformation. Pressure squashes the cell structure, and within a short time – tens of minutes! – cells lose their viability and die.
A medical device forgotten in a patient’s bed – a catheter, an ECG electrode – can become wedged under a patient and morph into a pressure injury in under an hour. After removing a medical device from a patient – especially one with sensory impairment or communication issues – make extra sure that you’ve taken it with you and not accidentally left it behind.
In addition to keeping your eyes open for medical device situations that cry out, “Check on me!”, make sure you keep an eye out in lower-risk situations. The areas underneath all medical devices must be examined twice daily, even in healthy patients. For patients with edema, more frequent checks are in order. If the patient complains of discomfort, itching or pressure under the device, check immediately for redness, swelling or moisture.
Recent years have brought more awareness to the issues presented by medical devices – and how to retain the benefits while preventing the harm. If you stay aware of the issues, and keenly aware of what’s going on with your patients, medical devices will remain your lifesaving, loyal sidekick in healing.