MEDICAL ADHESIVE- RELATE SKIN INJURY (MARSI): TREATMENT AND PREVENTION IN PREMATURE INFANT JUDUL MATER! Update on MARS! Management in neonates: Evidence Based Practice Approach . mn Defi Efendi eo ‘4 26 NOV 2022MARSI: Consensus Definition * Medical adhesive: medical adhesive is a product used to approxi- ECR ek Coe Ue err Ut NC ee ae a Ceili gee coe ele) Ronn ane Be Wate eit ecm MT Ne Mele een) which erythema and/or other man- ifestation of cutaneous Elec ia a SC eee MC ACE Aro eR ee mele ley Celi Ut Ie-T+ Choe© Introduction * Kulit merupakan struktur yang kompleks dan dinamis * Kulit memiliki fungsi barrier terhadap organisme dan lingkungan + Kulit neonatus terutama prematur merupakan kelompok rentan terhadap kejadian kerusakan/cidera kulit * Memahami perkembangan kulit bayi penting untuk mengetahui bagaimana perawatan yang tepat * Slides ini berfokus pada lingkup cidera kulit akibat penggunaan bahan perekat medis@ Anatomi dan fisiologi Oranges, et. Al (2015) * Bayi aterm akan memulai pematangan struktur kulitnya segera setelah lahir hingga satu tahun awal kehidupan. Sedangkan pada bayi prematur akan dimulai dari 2-3 minggu setalah lahir * Saat dalam kandungan, perkembangan barrier semakin meningkat seiring dengan bertambahnya usia gestasi, dan lengkap pada minggu 34. sovaness nwo Cte, VOLE 4 Nac 8 90 10:a89scure 2040682Rep, Se @ynatomi kulit eamesome site] Deinis Macher Mandan (206) Neon fr Sh Dever race Frc Neto fn Maing Reviews 630) 3-86 TEWL *PMA terhadap TEWL ee aa Furction . Newésar & ofr Mein Reviews i weanteeTable 1, Structural and functicnal differences between infant and adalt skin intant ‘ak seirerce Srutwalaeraneas eect b, Epler thickness Thinner Thicker ’ EVM Cimeliie No significant diferences e pada bayi lebih gens i= fre . elanle) 2 Dormoep dermal junction Flat LUndutering a Upide Loss. ‘More ¥ ‘Melanin Loss More Q Fn ona diteroncos Pea a aay Sweat Less More ne GIS CIe ea Wate comer Hig Lower ae Natural meisturding factor — Lower Higher 2 cxncenation oH Higher lower La TEWL Lower Higher a Higher lower s Ko signifleant dferencos@ Dampak Perawatan dan Kematangan Kulit a (Oeetced Stratum Comeum Lipid yore ctrateaRelease coating for unwind Backing (nonwoven backing shown h Primer for optimal bonding between backing and adhesive Adhesive“Teason nur Fister pao ct Hepes ees cane she icra et its fh oer an ae ese ‘abou ean, morpnate bere tp erdecema rg cppecon. © 1 mc na wasan oun o ‘ins jrverdnrat moses ta ayes es Narheeceny esata area } ‘Skin ear—Wour case yr.no tafe sing ‘geo 3a er opr a we”@ Neonatal Skin Condition Score Diyaess Lenora, ao sim of ey shan 2 = dey shin, sible sealing 3 = very aby skin, cracking fines erties 1 = oo eicence of axythemna 2 = visible erythema < 50% of body surice 3 = vile erythema > 50% of body sutace Breakdonmvexecriaion ‘=e evident 3 semensive Poor ane = wore a, oste 1. (a) wy aay eon coon Se 20 3, Seotar|Zooa 6. Voni77/onaaa sues ioa (Dryness: 2-= dry skin. wl scaling rythema: 5 = vishle erythema >50% body su Breakiowne 5 = exensie Dryness: t= normal, no sgn of dry sar fythema: 2 ville erythems <50% bo Breakdown: 3 = extensive FIGURE 1 Scoring of three infants using the Dryness: 2 dry shin, visible scaling erythema: {= no evidence erythema reakdown: 1 nane eventAssociation between the occurence of a MARSI and independent ‘atiables, considering only individuals that used adhesive tapes PALO MSILCO) ee eaucen! ~ Net Si Cote Si ooo: a ‘Type of tape fs Ps ts ‘ _ eee “apron im ee ‘ As ec rae oon coms sve er ‘ ‘Length of hospital stay in days” 0948 ‘Weight at birth in grams? 0.063, ‘Weight at birth im grams" O84 Gestacional age in days? 0.183FAKTOR RISIKO — ati et | ft REN NangnORAGR @ WiLey Medical adhesive-related skin injuries in the neonatology pa aa eA hospital Ee f Length of hospital stay in days <0.001 Weight at birth in grams 0.556 , Gestacional age in days 0.028 totus nian erthimananoningasucitonPREVENTION (Online Concensus) ORIGINAL ARTICLE Skincare practices in extremely premature infants: A survey of tertiary neonatal intensive care units from Australia and New Zealand Umesh Mishra"? Prangv Jani®,"* Rajesh Maheshwar’@ Dharmesh Shah,'* Daphne D'Crw," Archana Priyadarsh , Claire Galea ©,*" Krista Lowe, James Marceau’ and Audrey Wright?Silicone tape versus micropore tape to prevent Say medical adhesive-related skin injuries: systematic review and meta-analvsis Fita de silicone versus fra microporosa para Tansee trates nen_ tenner ng —_—_gsrms sg prevencdv de lesdo cuidnea relacionada aa.» a won em == médicos: reviséo sistematicaemetandlise : + | 1 = nave Soares Santas, Ane Cuno sete also Micels de Sous Manica iegnefaeines (a | Jd We da son lular de Owera§ Dor anette o3e27 0 ssgporipey |e od mene a ma wane ee ‘heath erinaenaanngApplication of a Pectin Barrier for Medical Adhesive Skin Injury (Epidermal Stripping) in a Premature Infant JWOCN® mer * The use of this pectin barrier proved to-be a suitable surface to secure the temperature probe and avoid further medical adhesive-related skin injury. dor oor ANCOOODDMONEECIE aaPreventing MARSI in PICC scionaccnasiren Oa wiey Intervention efficacy of MARSI nursing management on skin injury at peripherally inserted central catheter insertion site on oncological patients ‘Yizm20 | Liogling Blan | Tinna Yang f symm) Cau mim soa 3am Ee Foo) 3G) su aa) a) “ho, Y am Lng 2 iene ay af MAR nrg management ony atprpher ered cat ‘Gteterverionste mexougcalpeens somal Wd 0 101503 2._ Risk Prevention -> Bundle 3. Risk Management > TriningTranslating Evidence Into Practice (2020) = z@ Kesimpulan * Kulit pada bayi masih dalam proses perkembangan dan pematangan yang ditandai dengan tingginya TEWL, pH kulit, hidrasi kulit, dan perbedaan mikrobiom kulit * Kulit bayi lebih rapuh, cidera, robek, kehilangan suhu. Struktur kulit bayi juga membuat lebih mudah cidera akibat kontak dengan bahan kimia, dan suhu, dan lebih permeable yang menyebabkan lebih mudah infeksi. * Perawata kulit khusus diperlukan untuk menjaga keutuhan kulit pada bayi baru lahir.8 Pustaka Advances in Neonatal Care: December 2016 - Volume 16 - Issue 6 - p 449-454 doi: 10.1097 / ANC.0000000000000333 Lund, H.S., Osborne, JW. (2003). Validity and Reliability of the Neonatal Skin Condition Score. JOGNN. 33, 320-327; 2004. Di |0.1177/0884217504265174 M. Visscher, V. Narendran (2014), Neonatal Infant Skin: Development, Structure and Function Newborn & Infant Nursing Reviews 14 (2014) 135-141 McNicole, Lund, C., Rosen, T., & Gray, M. (2013) Medical Adhesives and Patient Safety: State of the Science Consensus Statements for the Assessment, Prevention, and Treatment of Adhesive- Related Skin Injuries. ournal of Wound, Ostomy and Continence Nursing, 2013;40(4):365-380. DOI: 10.1097/WON.0b013e3182995516. Zhao, ¥,, Bian, L., & Yang, J. (2021). Intervention efficacy of MARSI nursing management on skin injury at peripherally inserted central catheter insertion site on oncological patients. Int. Journal of Wound. DOI: 10.1111/iwj-13805