Characteristics, risk factors, prevention and nursing measures of medical device-related pressure injuries in critically ill patients: a scoping review.

BACKGROUND: Studies on medical device-related pressure injuries (MDRPIs) in critically ill patients still face some nonnegligible challenges, impeding the development and implementation of evidence-based interventions. OBJECTIVES: The purpose of this review is to investigate MDRPIs in critically ill patients, from the aspects of characteristics, risk factors, prevention and nursing measures, to improve high-quality assessment, treatment, and management of critically ill patients with MDRPIs. METHODS: A systematic literature search was conducted across major electronic databases to identify relevant studies. In addition, the websites and materials from relevant associations, professional organizations, and official departments were also searched for further information. Necessary manual search for references of the retrieved articles was performed to capture potential eligible studies. Two reviewers independently conducted study selection based on the inclusion and exclusion criteria, and then data extraction was carried out by using a pre-designed form. A comprehensive summary of the findings from the final included studies in relation to MDRPIs in critically ill patients was achieved through narrative data synthesis. RESULTS: Eighteen articles were finally included, which were conducted in Brazil, Australia, New Zealand, Turkey, Norway, Jordan, and China, respectively, covering 15,341 critically ill patients. Various medical devices are responsible for MDRPIs in critically ill patients, mainly including endotracheal/orotracheal/nasotracheal intubation tubes. The most commonly affected anatomical locations involving the nose/nasal mucosa, mouth, lips, and ear. The MDRPIs in critically ill patients are caused by the interaction of multiple factors, which can be generally classified into three categories: medical devices, patient-specific factors, and treatment- and care-related factors. Correspondingly, the synthesized preventative and nursing measures were also categorized into the abovementioned three categories. CONCLUSION: MDRPIs exhibit device-dependent injury characteristics, with risk factors involving multi-dimensional interactions among medical devices, patients, and treatment and care procedures. Risk assessment, device optimization, positioning management, and skin care are core interventions for the occurrence of MDRPIs in critically ill patients. In order to provide safe and effective treatment and care services for critically ill patients, the prevention and control of MDRPIs should be guided by existing evidence, integrate innovative technologies and practical wisdom, improve the professional competence of medical staff, and enhance multidisciplinary collaboration.