Skin Integrity Preserved Using a Nurse-Constructed Silicone Adhesive Foley Catheter Securement Device: A Pilot Study

Background: Both critical care and wound nurses frequently note skin breakdown when providing care for patients in the intensive care unit (ICU).  Anasarca can be a temporary effect of multiple fluid boluses. Skin is more prone to skin tears, blistering, and pressure ulcers. Skin breakdown from the use of adhesive-backed catheter securement devices also is a potential untoward outcome. Despite lack of evidence regarding whether catheter securement is beneficial in preventing catheter-associated urinary tract infections (CAUTI), nurses do agree that securement helps prevent the unplanned removal of a Foley catheter. 

Objective:  The objective of this pilot study was to determine whether a nurse-constructed urinary catheter securement device using a silicone adhesive could reduce the complication of blistering and other skin breakdown in a high-risk ICU population with Foley catheters.

Methods: A convenience sample (n=29) of patients in a surgical intensive care unit (SICU) who had a urethral Foley and thigh edema were enrolled in the pilot study. The SICU nurses were instructed on the inclusion/exclusion criteria, process for enrollment, and a checklist to be completed at the end of each shift. Subjects were outfitted with a standard acrylic adhesive catheter securement device on one thigh and the nurse-constructed device on the contralateral thigh.

Results: Data was analyzed. The study results demonstrated a significant incidence of skin breakdown using the standard commercially available acrylic adhesive-based securement and no breakdown visible to the eye with the nurse-constructed silicone-based securement. There was no statistical difference in the sex of those with skin breakdown from the standard catheter securement. Edema status was found to be a significant factor. The study findings suggest that further work in developing a Foley anchor using silicone adhesive may positively impact the incidence of skin breakdown associated with the adhesive material currently used for most adhesive anchor devices.