MEDICAL ADHESIVE RELATED SKIN INJURIES (MARSI)
There is no doubt that innovative adhesives have spurred advancements in wound care over the years. Intricate border designs and strong adhesive components allow devices to be secured and wounds to be dressed. But as these medical adhesives grew stronger, human skin remained the same, creating a problem for people with poor skin integrity. In this article, I take a look at Medical Adhesive Related Skin Injuries (MARSI) and ways that the medical community is solving this new problem.
While we do know a lot about it, it’s important to note that the pathophysiology of MARSI is not entirely understood. Generally speaking, “skin injury results when the skin adhesive attachment is stronger than skin cell-to-skin cell attachment”.(1) There are seven different kinds of adhesive related skin injuries with the most common being contact dermatitis, skin stripping, tension injuries/blisters, and skin tears. As you can see in the picture on the right, gaps exist between the flat acrylate adhesives and the skin’s irregular surface. The adhesive warms and fills these gaps, increasing the strength of the bond. Even when there is no visible harm, varying layers of skin cells are removed with every adhesive removal and repeated application and removal can compromise vulnerable skin. The deformation and breathability of adhesives are both elements that can impact MARSI as well. With silicone based adhesives, these gaps are filled in by the softer silicone upon application.
The most common medical grade adhesives are synthetic rubber, acrylate, and soft silicone, each with their own advantages and disadvantages. Silicone has good initial tack that remains consistent with low skin trauma on removal, but its peel adhesion is very poor compared to synthetic rubber. Acrylate can be tuned up and down, but over time can become overly adhered and cause irritation. We’ve all removed that adhesive that left a ‘gunky’ residue from over adhesion. Other important adhesive characteristics are sterilization compatibility, repositionability, and breathability.(2)
Turning to the other side of the bandage, the type of backing on the tape further impacts the characteristics mentioned above. These backings can be films, non-woven, and woven, each with their own subsets of material options. Of those materials, the backings can be composed of polyurethane, polyester, polyethylene, cellulose, cotton, and/or foam. This may feel like overkill, but when you think about how unique wounds can be, it makes sense that bandages come with lots of options; it also makes you thankful for wound care nurses! This variety of options allows clinicians to select the proper bandage based specifically on the individual patients needs such as, conformability, elongation, tear-ability, and fluid resistance. Securing a complex medical device is impossible without the right dressing, even for the most skilled clinicians.
Despite all of these adhesive options, MARSI persists. In one study of older individuals admitted to a long-term care facility, the cumulative incidence of skin injury caused by adhesive tape was reported to be 15.5% (incident density 38 per 1000 person-days).(3) With neonates, use of adhesives was found to be the primary cause of skin breakdown in the NICU.(4) When it comes to skin tears, medical adhesives were found to be the third most common cited cause of skin tears, behind hospital beds and patient transfers.(5)
With the vast array of medical adhesive combinations at our disposal, experts agree that the challenge at hand is two fold: educating healthcare providers and giving them access to all necessary adhesive options. As healthcare providers, we must remain educated on ways to assess, prevent, and treat MARSI. The hospitals we work for must be proactive in providing the proper adhesive options for our patients. Softer silicone adhesives have been gaining popularity in the marketplace due to their gentle application and removal. New topical skin solutions, some previously used to secure surgical staples, are being tested as catheter stabilization options and showing unique characteristics. But regardless of which adhesive you prefer, one thing is certain; innovation within adhesives and catheter securements must continue if we are to address the IV complications that persist in our clinical settings.
3. Konya C, Sanada H, Sugama J, et al. Skin injuries caused by medical adhesive tape in older people and associated factors. J Clin Nurs. 2010;19(9/10):1236-1242.
4. Lund CL, Osborne JW, Kuller J, Lane AT, Lott JW, Raines DA. Neonatal skin care: clinical outcomes of the AWHONN/NANN evidence-based clinical practice guideline. J Obstet Gynecol Neonatal Nurs. 2001;30(1):41-51
5. Pennsylvania Patient Safety Reporting System. Skin tears: the clinical challenge. PA-PSRS Patient Safety Advisory. 2006;3(3):1-7