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Study design: Secondary analysis of MDRPI data from the Braden QD study1 an IRB-approved, multicenter, prospective cohort study. Inclusion criteria were hospitalized patients, preterm to 21 years, on bedrest for at least 24H with a medical device in place. Two nursing teams, blinded to each other’s assessment, worked in tandem to score pressure injury risk and evaluate medical devices in place. Observations occurred 8 times over a maximum of 4 weeks or until discharge.
Results: A total of 625 subjects were enrolled of which 14 (2%) developed immobility-related HAPI and 42 (7%) developed MDRPI. Children 1 month to 8 years developed most MDRPI (49%). Half of those with MDRPI were cardiovascular patients. Functional impairment (Pediatric Overall Performance Category>1), requiring ICU support, and being malnourished (overweight or underweight according to CDC defined body mass index standard scores) were significantly associated with MDRPI (p<0.05 for all variables). The most common medical devices on study day 1 were vascular devices (27%), followed by external monitoring (26%), securement/supportive (8%) and respiratory devices (8%). About 65% of medical devices identified on day 1 were noted to have at least one prevention practice in place. Respiratory devices had the highest rate of MDRPI development (6.19 per 1000 device-days), followed by immobilizers, GI tubes/drains, and external monitoring devices.
Conclusion: MDRPI constitutes the majority of HAPI in the pediatric population. Pressure injury risk assessments should therefore include medical device-related risk. In addition, details of MDRPI such as device type, and location and stage of MDRPI should be monitored in order to design targeted interventions for device-specific injury prevention.