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Koo, Sim, and Kang: Risk Factors of Medical Device-Related Pressure Ulcer in Intensive Care Units
Original Article

J Korean Acad Nurs 2019;49(1):36-45.

Published online: 15 January 2019

DOI: https://doi.org/10.4040/jkan.2019.49.1.36

Risk Factors of Medical Device-Related Pressure Ulcer in Intensive Care Units

MiJee Koo1, , YoungA Sim1, InSoon Kang2

1Surgical Intensive Care Unit, Pusan National University Yangsan Hospital, Yangsan

2College of Nursing, Pusan National University, Yangsan, Korea

Address reprint requests to : Koo, MiJee Surgical Intensive Care Unit, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea Tel: +82-55-360-2223 Fax: +82-55-360-1269 E-mail: worldofmiji@hanmail.net

Received 31 July 2018       Revised 20 December 2018       Accepted 24 December 2018

Copyright © 2019 Korean Society of Nursing Science

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The purpose of this study was to identify the characteristics of and risk factors for medical-device-related pressure ulcer (MDRPU) development in intensive care units.

Methods

A prospective cohort study design was used, and the participants were 253 adult patients who had stayed in medical and surgical intensive care units. Data were collected regarding the application of medical devices and MDRPU-related characteristics over a period of six months from June to November, 2017. Data were analyzed using independent t-test, χ 2-test, Fisher's exact test, and binary logistic regression analysis with the SPSS 21.0 program.

Results

Among the 253 participants, MDRPUs occurred in 51 (19.8%) participants. The results of the logistic regression analysis showed that the risk factors for MDRPUs were the use of endotracheal tubes (OR=5.79, 95% CI: 1.66~20.20), having had surgery (OR=2.95, 95% CI: 1.11~7.77), being in a semi-coma/coma (OR=5.79, 95% CI: 1.04~32.05), and sedation (OR=5.54, 95% CI: 1.39~22.19).

Conclusion

On the basis of the study results, it is effectively facilitated by nurses when they care for patients with MDRPUs in intensive care units and the results are expected to be of help in preventive education for MDRPU development as well as preparing the base data for intervention studies.

Keywords: Pressure Ulcer, Intensive Care Units

References

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Table 1.
Comparison of Characteristics between Incidence and Non-Incidence groups of MDRPU (N=253)
Variables Categories Non-incidence (n=202) Incidence (n=51) t or χ2 p
n (%) or M±SD n (%) or M±SD
Gender Male 104 (51.5) 39 (76.5) 10.34 .001
Female 98 (48.5) 12 (23.5)
Age (yr) 63.00±0.99 66.06±12.06 -1.41 .159
Admission route ER 106 (52.5) 25 (49.0) 0.19 .754
Ward 96 (47.5) 26 (51.0)
Diagnostic category Pulmonary 57 (28.2) 13 (25.5) 5.41 .248
Cardiovascular 21 (10.4) 6 (11.8)
Gastrointestinal 28 (13.9) 12 (23.5)
Neurologic 59 (29.2) 16 (31.4)
Sepsis 37 (18.3) 4 (7.8)
Admission after surgery Yes 88 (43.6) 31 (60.8) 4.85 .029
No 114 (56.4) 20 (39.2)
Level of consciousness Alert 61 (30.2) 7 (13.7) 18.80 .001†
Drowsy 70 (34.7) 13 (25.5)
Stupor 17 (8.4) 5 (9.8)
Semicoma/Coma 16 (7.9) 14 (27.5)
Sedation 38 (18.8) 12 (23.5)
Hospital stay before ICU ad mission (day) 5.93±12.83 9.45±14.22 -1.71 .088
ICU stay (day) 13.00±11.98 20.14±11.42 -3.84 <.001
Vasopressors Use 120 (59.4) 41 (80.4) 7.75 .005
Not use 82 (40.6) 10 (19.6)
Day 6.10±6.59 10.17±10.10 -2.95 .004
Sedative drugs Use 103 (51.0) 43 (84.3) 18.53 <.001
Not use 99 (49.0) 8 (15.7)
Day 10.26±9.63 13.35±10.26 -1.73 .085
APACHE II score 16.98±7.82 23.71±9.71 -5.21 <.001
Edema Yes 44 (21.8) 18 (35.3) 4.02 .067
No 158 (78.2) 33 (64.7)
BMI (kg/m2) 23.03±4.82 22.43±3.38 0.84 .404
Albumin (g/dL) 3.31±0.80 2.88±0.64 3.56 <.001
Protein (g/dL) 5.85±1.25 5.28±0.92 3.03 .003
Hematocrit (%) 32.66±7.55 27.97±6.52 4.06 <.001
Hemoglobin (g/dL) 11.23±2.62 9.49±2.30 4.34 <.001
Braden scale (Admission) 12.69±3.19 11.69±2.89 2.04 .042
Braden scale (Discharge) 14.34±3.08 13.33±2.48 2.17 .031

MDRPU=medical devide-related pressure ulcer; ER=emergency room; ICU=intensive care units; APACHE=acute physiology and chronic health evaluation; BMI=body mass index; M=mean; SD=standard deviation.

† Fisher's exact test.

Table 2.
Pressure Ulcer Stages Incidence Site of MDRPU† (N=51)
Pressure ulcer Total Mouth Nose Ears Fingers Legs Back of neck
stages n (%)
  Stage I 8 (15.7) 2 (9.5) 1 (12.5) 2 (28.6) 3 (75.0) 0 (0.0) 0 (0.0)
  Stage II 28 (54.9) 17 (80.9) 3 (37.5) 0 (0.0) 1 (25.0) 5 (55.6) 2 (100.0)
  Stage III 2 (3.9) 1 (4.8) 1 (12.5) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)
  DTI 11 (21.6) 1 (4.8) 3 (37.5) 4 (57.1) 0 (0.0) 3 (33.3) 0 (0.0)
  Unstageable 2 (3.9) 0 (0.0) 0 (0.0) 1 (14.3) 0 (0.0) 1 (11.1) 0 (0.0)
  Total 51 (100.0) 21 (100.0) 8 (100.0) 7 (100.0) 4 (100.0) 9 (100.0) 2 (100.0)

MDRPU=medical devide-related pressure ulcer; DTI=deep tissue injury.

† Incidence rate by site of MDRPU (%): mouth (41.2), nose (15.7), ears (13.7), fingers (7.8), legs (17.7), back of neck (3.9).

Table 3.
Medical Device Related Characteristics between Incidence and Non-Incidence Group of MDRPU (N=253)
Medical device Non-incidence (n=202) Incidence (n=51) χ2 or t p
n (%) M±SD n (%) M±SD
  Endotracheal tube Yes 105 (52.0) 45 (88.2) 22.17 <.001
No 97 (48.0) 6 (11.8)
Day 7.55±4.67 11.09±7.21 -3.58 <.001
  Tracheal tube Yes 57 (28.2) 26 (51.0) 9.57 .002
No 145 (71.8) 25 (49.0)
Day 16.21±13.44 13.81±9.60 0.82 .415
  Arterial catheter Yes 172 (85.1) 50 (98.0) 6.29 .012
No 30 (14.9) 1 (2.0)
Day 12.34±10.96 19.30±11.65 -3.90 <.001
  Central catheter Yes 150 (74.3) 49 (96.1) 11.55 .001
No 52 (25.7) 2 (3.9)
Day 13.41±12.61 18.59±11.64 -2.65 .012
  Foley catheter Yes 191 (94.6) 51 (100.0) 2.90 .088
No 11 (5.4) 0 (0.0)
Day 13.04±12.15 19.06±10.98 -3.21 .002
  Nasal cannula Yes 125 (61.9) 19 (37.3) 10.01 .002
No 77 (38.1) 32 (62.7)
Day 5.16±4.33 8.26±9.05 -2.44 .016
  Oxygen probe Yes 202 (100.0) 51 (100.0) - >.999
No 0 (0.0) 0 (0.0)
Day 12.77±11.84 20.12±11.39 -3.99 <.001
  IPC/stocking Yes 127 (62.9) 44 (86.3) 10.18 .001
No 75 (37.1) 7 (13.7)
Day 14.03±13.01 19.61±11.99 -2.50 .013
  Nasogastric tube Yes 130 (64.4) 42 (82.4) 6.06 .014
No 72 (35.6) 9 (17.6)
Day 14.85±12.63 18.55±11.45 -1.69 .093
  Restraints Yes 105 (52.0) 43 (84.3) 17.54 <.001
No 97 (48.0) 8 (15.7)
Day 11.75±10.72 12.42±8.94 -0.36 .720

MDRPU=medical devide-related pressure ulcer; IPC=intermittent pneumatic compression device.

Table 4.
Risk Factors for MDRPU in ICU (N=253)
Variables Reference B SE p OR 95% CI
95% Lower % CI Upper
Gender Female 1.01 0.48 .098 1.69 1.07 7.07
Admission after surgery No 1.08 0.50 .029 2.95 1.11 7.77
Semicoma/Coma Alert, Drowsy, Stupor 1.76 0.87 .045 5.79 1.04 32.05
Sedation Alert, Drowsy, Stupor 1.71 0.71 .016 5.54 1.39 22.19
ICU stay (day) 0.02 0.02 .400 1.02 0.98 1.06
Vasopressor No -0.84 0.67 .214 0.43 0.12 1.62
Sedative drugs No -0.23 0.69 .741 0.79 0.20 3.11
APACHE II score 0.02 0.03 .586 1.02 0.96 1.07
Albumin (g/dL) -0.21 0.43 .631 0.82 0.35 1.88
Protein (g/dL) 0.14 0.25 .588 1.15 0.70 1.88
Hematocrit (%) 0.02 0.15 .873 1.02 0.77 1.37
Hemoglobin (g/dL) -0.46 0.44 .291 0.63 0.27 1.48
Braden scale (admission) 0.14 0.11 .198 1.15 0.93 1.43
Braden scale (discharge) 0.14 0.10 .166 1.15 0.94 1.40
Endotracheal tube No 1.76 0.64 .006 5.79 1.66 20.20
Tracheal tube No 0.75 0.69 .277 2.11 0.55 8.07
Arterial catheter No 0.55 1.45 .706 1.73 0.10 29.65
Central catheter No -0.68 1.06 .522 0.51 0.06 4.07
Foley catheter No -19.26 826.05 .998 0.00 0.00 -
Nasal cannula No 0.75 0.64 .260 1.76 1.65 20.19
Oxygen probe No - - - - - -
IPC/stocking No -0.57 0.60 .348 0.57 0.17 1.85
Nasogastric tube No 0.11 0.66 .865 1.12 0.31 4.07
Restraints No -0.44 0.57 .445 0.65 0.21 1.98
R2=0.47, Hosmer & Lemeshow test χ2=3.26, p=.917

MDRPU=medical devide-related pressure ulcer; ICU=intensive care units; SE=standard error; OR=Odds ratio; CI=Confidence interval; APACHE=acute physiology and chronic health evaluation; IPC=intermittent pneumatic compression device.

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