LESÃO POR PRESSÃO RELACIONADA A DISPOSITIVO MÉDICO EMPACIENTES CRÍTICOS: INCIDÊNCIA E FATORES DE RISCO

Abstract

Introduction: Medical devices are part of the daily nursing practice, particularly in the care of critically ill patients. Patients in the Intensive Care Units (ICUs) often have reduced mobility and various deficits that contribute to the development of Medical Device-Related Pressure Injuries (MDRPI). The nursing team plays a crucial role in the prevention of these injuries. Objective: To determine the incidence and risk factors associated with MDRPI in critically ill patients. Method: A prospective cohort study was conducted in the adult ICU of a large hospital. Data collection occurred from October 2023 to January 2024. The monitored devices included: orotracheal tube, pulse oximeter, nasoenteral catheter, tracheostomy catheter, nasogastric catheter, mechanical restraint, indwelling urinary catheter, non-invasive ventilation mask, intermittent pneumatic compressor, central venous catheter, arterial catheter, and peripheral venous catheter. The skin in contact with these medical devices was examined daily by trained researchers. qualitative variables were subjected to descriptive analysis through absolute and relative frequency distributions and quantitative variables were analyzed through descriptive statistics for measures of central tendency and dispersion. The Mann-Whitney test and Chi-squared test were employed to identify statistical differences and the incidence of MDRPI and associated risk factors. The study received ethical approval under Opinion n. 6.423.233. Results: The sample consisted of 88 patients. A total of 911 patient-days and 4,753 device-days were analyzed. The incidence of MDRPI was 33%. It was found that patients who underwent mechanical ventilation (RR: 7.46), presented pulmonary dysfunction (RR: 3.97), fever (RR: 3.48), used anticoagulants (RR: 3.45), sedatives (RR: 9.26), and had lower Glasgow or Braden scores were at greater risk of developing MDRPI. Patients admitted for surgical reasons exhibited a lower risk of developing MDRPI (RR: 0.23). The orotracheal tube was associated with the highest rate of MDRPI, with stage 2 injuries, mucosal injuries, and non-stageable injuries predominantly occurring in the lip/commissure region. Conclusion: Proper fixation of devices along with regular changes of fixation are measures that may reduce the likelihood of injury development. Intensive care nurses should understand these factors to implement preventive care measures against these injuries.