Incidence of medical adhesive-related skin injury: a reduction by changing posture.

OBJECTIVE: Medical adhesive-related skin injuries (MARSI), defined as skin damage associated with the use of medical adhesive products or devices, are a common and under-reported condition that compromises skin integrity. The prevention and management of MARSI that can occur around the needle insertion site of a chest wall implantable port in hospitalised patients with a tumour remain challenging issues. The aim of this study was to explore whether the incidence of MARSI could be reduced by changing the body position during dressing changes. METHOD: Participants were recruited between May 2019 and November 2020 in the oncology department of a tertiary hospital. Patients were randomly assigned to Group AB (supine followed by semi-recumbent position) and Group BA (semi-recumbent followed by supine position) with a standard intervening recovery interval of 21-28 days. Assessments for typical MARSI included itching, the combination of erythema and oedema, and blisters in the port area, and were graded according to the level of severity. RESULTS: The itch intensity was significantly lower in phase B (semi-recumbent) compared to phase A (supine) (2.35±1.985 versus 5.31±1.332, respectively; p<0.01). Similarly, the severity of erythema and oedema was less severe when comparing phase B to phase A: grade 0 (64.9% versus 10.5%, respectively); grade 1 (28.1% versus 19.3%, respectively); grade 2 (3.5% versus 7.0%, respectively); grade 3 (1.8% versus 45.6%, respectively); and grade 4 (1.8% versus 17.5%, respectively) (Z=5.703; p<0.01). Blisters were found far less frequently in phase B than phase A (1.8% versus 56.1%, respectively; p<0.01). CONCLUSION: The study provided statistically significant evidence that patients in a semi-recumbent position receiving dressing at a chest wall implantable port had fewer and less severe injection site MARSI than when in a supine position. DECLARATION OF INTEREST: The authors have no conflicts of interest to declare.

Evaluation of EMLA cream for relieving pain during needle insertion on totally implantable venous access device.

PURPOSE:: Needle insertion is a routine procedure performed on cancer patients with totally implantable venous access device. Although this procedure is painful for most of the patients, it is regularly performed without topical application of local anesthetics. In our study, we assess the degree of pain associated with different duration times of EMLA cream. METHODS:: A total of 361 cancer patients with totally implantable venous access devices were randomly divided into three groups: group 1-placebo, group 2-30 min after application of EMLA, and group 3-60 min after application of EMLA. In this double-blinded prospective study, the efficacy of EMLA cream was compared with a placebo cream by comparing the degree of pain experienced by the patient who was evaluated during and after needle insertion on a numeric rating scale. RESULTS:: The mean ± standard deviation of pain experienced by the patients was significantly (p < 0.05) lower in group C (0.69 ± 0.98) than groups B (1.11 ± 1.14) and A (1.91 ± 1.40). No significant (p > 0.05) difference was found in mean scores from inexperienced and experienced procedures of needle insertions among three groups. Comparing male patients, the female patients in group 1 and group 2 had lower numeric rating scale (1.59 ± 0.94, 1.39 ± 1.35; p < 0.01). CONCLUSION:: The present results review that the application of EMLA cream for 30 min is suitable, acceptable, and convenient in cancer patients with totally implantable venous access device undergoing needle insertion.