How can our facility systematically address medical device-related pressure injuries?
Medical device-related pressure injuries (MDRPIs) are not uncommon in the post-acute and long-term care setting, especially with an increase in more medically complex patients. A proactive, vigilant approach to the assessment and prevention of these pressure injuries can reduce the incidence of MDRPIs.
They are typically associated with medical devices commonly seen in the post-acute setting — namely, feeding tubes such as percutaneous endoscopic gastrostomy (PEG) tubes, supplemental oxygen therapy tubing such as nasal cannulas or positive airway pressure devices like continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) devices, foley urinary catheters, or orthopedic splints and casts. MDRPIs typically present as pressure injuries that mirror the size and shape of medical devices in place. These MDRPIs can, for the most part, be anticipated, given device use in patients who are already compromised by advanced age, decreased sensation, a decrease in tissue tolerance to pressure, altered nutritional status and immobility.
A proactive approach can be implemented to ensure best outcomes. For example, patients who require supplemental oxygen by nasal cannula should have foam covers added to plastic tubing to reduce pressure over the external ear.
Patients with a PEG tube should have protective gauze placed beneath the flange of the tube between the device and the skin to minimize direct pressure and absorb excessive moisture. Urinary catheters should be secured to the thigh with an elastic band and not left to lie beneath the resident’s thigh.
Regular inspection of the skin underlying any medical device should be part of the routine nursing care of all patients and can minimize MDRPIs.