Effect of evidence-based skin care and hydrocolloid dressing in the prevention of nasogastric-related pressure injury: A randomized controlled trial

Nasogastric (NG) tube-related pressure injuries are local tissue damage to the nasal mucosa, nasal skin, and/or subcutaneous tissue or under the tube fixation material due to pressure generated by the NG tube. The aim of this study was to determine the effect of evidence-based skin care and hydrocolloid dressing in preventing NG tube-related pressure injuries in critically ill patients. This prospective parallel, three-arm (hydrocolloid, evidence-based skin care, control) randomized controlled trial was conducted in the Anesthesiology and Reanimation Intensive Care Unit (ICU) of Necmettin Erbakan University Meram Medical Faculty Hospital. The study included 102 patients over the age of 18 years who were admitted to the ICU between September 2020 and June 2022 and underwent NG tube placement. 34 patients were assigned to each arm by randomization. Data collecting researcher and patients were blinded to group assignment. Ethics committee and institutional permissions were obtained before the study. After the NG tube was inserted a translucent hydrocolloid dressing was applied into the nasal mucosa and nasal wing of the patients in the hydrocolloid dressing arm and the tube was fixed with this dressing. Then, once a day, the hydrocolloid dressing was removed to assess the underlying skin and mucosa, the nasal skin and surrounding skin were cleaned, dried, and a new hydrocolloid dressing was applied. In the skin care arm, evidence-based skin care interventions included in the guidelines were applied twice daily. Descriptive statistics, Chi-Square tests, Independent Sample t test, Mann-Whitney U test, One-Way Analysis of Variance, Kruskal-Wallis test and regression analysis were used in data analysis. NG tube-related pressure injury occurred in 97.1% of patients in the control arm and 94.1% in the skin care arm, whereas no pressure injury occurred in any patient in the hydrocolloid dressing arm (p<0.001). Compared with the control arm, hydrocolloid dressing application had an effect of 97% in preventing NG tube-related pressure injury, and 94% compared with skin care application. The rate of stage 1 pressure injury was higher in the skin care arm and stage 2 pressure injury in the control arm, and the time to pressure injury was significantly shorter in the control arm (p<0.005). Results of multivariate penalized logistic regression analysis showed that not applying hydrocolloid dressing increased the risk of NG tube-related pressure injury 20.3-fold (p<0.001), whereas the risk decreased by 18% (p=0.038) when the ventilation time increased by one unit. In conclusion, the study's results showed that while skin care measures did not have the same impact, hydrocolloid dressing was effective in preventing pressure injuries caused by NG tubes. The development of protocols for the application of hydrocolloid dressing in the prevention of NG tube-related pressure injuries, education of healthcare personnel, and new research on the efficiency of skin care t interventions are all advised in light of these results. Keywords: Hydrocolloid dressing, Nasogastric tube, Pressure injury, Skin care.