Effectiveness of care bundle in preventing medical adhesive-related skin injury due to central venous catheter fixation in children

Objective: This study aimed to evaluate the effectiveness of a care bundle in preventing medical adhesive-related skin injury (MARSI) due to central venous catheter (CVC) fixation in pediatric patients. Methods: This quasi-experimental study included 91 children hospitalized in a pediatric cardiovascular surgery intensive care unit (Standart care = 45, Secure bundle = 46). Data were collected using the Patient Identification Form, Braden QD Scale, Skin Observation Form, and the SECURE Care Bundle Evaluation Checklist. In the standard care group, central venous catheter dressing was performed according to the clinic's routine practice without any changes. The SECURE Care Bundle, which includes skin assessment, appropriate adhesive selection, correct application technique, use of a silicone-based adhesive remover, and documentation of MARSI, was implemented in the secure care bundle group. Results: The standart care and secure bundle groups had similar descriptive and clinical characteristics (p > 0.05). The incidence of MARSI was significantly lower in the secure bundle group (n=7, %15,2) compared to the standart care group (28, %62,2) (p < 0.01). In addition, for children who developed MARSI, the time to onset was significantly longer in the secure bundle group (Secure bundle=9,71±5,31 day; Standart care=1,89±1,23 day) (p < 0.01). Multivariable analysis showed that the risk of developing MARSI was approximately 12 times higher in children without the care bundle (OR=11.8; p=0.001). Conclusion: The care bundle developed to prevent MARSI due to CVC fixation was found to be effective in reducing the incidence and delaying the onset of skin injuries in children. Integration of the SECURE Care Bundle into routine nursing care in pediatric intensive care units is recommended as an effective strategy for MARSI prevention.