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Medical Device-Related Pressure Injuries in Infants and Children
Judith J Stellar1, Natalie R Hasbani, Lindyce A Kulik
1Judith J. Stellar, MSN, CRNP, PPCNP-BC, CWOCN, Department of Nursing and General Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Natalie R. Hasbani, MPH, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts. Lindyce A. Kulik, PhD, RN, CWON, Cardiovascular Nursing Patient Services, Boston Children's Hospital, Boston, Massachusetts. Stacey S. Shelley, RN, DNP, Intermountain Healthcare, Salt Lake City, Utah. Sandy Quigley, RN, MSN, CPNP, CWOCN, Department of Nursing and Patient Care Services, Boston Children's Hospital, Boston, Massachusetts. David Wypij, PhD, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. Martha A. Q. Curley, PhD, RN, FAAN, Department of Family and Community Health, School of Nursing, and Department of Anesthesia and Critical Care, Perelman School of Medicine, University of Pennsylvania and the Research Institute, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
Medical devices frequently cause pressure injuries in hospitalized children, especially younger ones. Respiratory devices were the most common culprits, and many devices lacked preventive interventions.
Area of Science:
- Pediatric Nursing
- Medical Device Safety
- Patient Injury Prevention
Background:
- Medical device-related pressure injuries (MDRPIs) are a concern in hospitalized pediatric patients.
- Understanding the incidence and risk factors for MDRPIs in this population is crucial for developing effective prevention strategies.
Purpose of the Study:
- To describe the occurrence, characteristics, and risk factors of medical device-related pressure injuries (MDRPIs) in hospitalized pediatric patients.
Main Methods:
- A prospective, descriptive study was conducted in 8 US pediatric hospitals.
- 625 pediatric patients (preterm to 21 years) with medical devices and on bed rest were assessed.
- Two blinded nursing teams evaluated device-related pressure injuries, risk factors, and interventions over 4 weeks or until discharge.
Main Results:
- Of 625 patients, 7% developed MDRPIs, with two-thirds being younger than 8 years.
- Respiratory devices were the most frequent cause of MDRPIs, followed by immobilizers and gastric tubes.
- Factors like intensive care unit stay, neuromuscular blockade, and inotropic medications increased MDRPI risk; Braden QD scores predicted development.
Conclusions:
- Medical devices are prevalent in hospitalized children and pose a significant risk for pressure injuries.
- Targeted preventive interventions are needed, especially for high-risk devices and patient populations.
- The Braden QD scale is a valuable tool for predicting MDRPI development in pediatric patients.
Purpose:
The purpose of this study was to describe medical device-related pressure injuries (MDRPIs) in hospitalized pediatric patients.
Design:
A prospective, descriptive study.
Sample/Subjects And Setting:
The sample comprised 625 patients cared for in 8 US pediatric hospitals. Participants were aged preterm to 21 years, on bed rest for at least 24 hours, and had a medical device in place.
Methods:
Two nursing teams, blinded to the other's assessments, worked in tandem to assess pressure injury risk, type of medical devices in use, and preventive interventions for each medical device. They also identified the presence, location, and stage of MDRPI. Subjects were observed up to 8 times over 4 weeks, or until discharge, whichever occurred first.
Results:
Of 625 enrolled patients, 42 (7%) developed 1 or more MDRPIs. Two-thirds of patients with MDRPIs were younger than 8 years. Patients experiencing MDRPIs had higher acuity scores on hospital admission, were more frequently cognitively and/or functionally impaired, or were extreme in body mass index. Respiratory devices caused the most injuries (6.19/1000 device-days), followed by immobilizers (2.40/1000 device-days), gastric tubes (2.24/1000 device-days), and external monitoring devices (1.77/1000 device-days). Of the 6336 devices in place, 36% did not have an MDRPI preventive intervention in place. Clinical variables contributing to MDRPI development included intensive care unit care (odds ratio [OR] 8.9, 95% confidence interval [CI] 1.9-43.6), use of neuromuscular blockade (OR 3.7, 95% CI 1.7-7.8), and inotropic/vasopressor medications (OR 2.7, 95% CI 1.7-4.3). Multivariable analysis indicated that Braden QD scores alone predicted MDRPI development.
Conclusion:
Medical devices are common in hospitalized infants and children and these medical devices place patients at risk for MDRPI.
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