CC BY
15Cellular Therapy and Transplantation (CTT). Vol. 12, No. 1, 2023 doi: 10.18620/ctt-1866-8836-2023-12-1-46-50 Submitted: 18 January 2023, accepted: 03 March 2023
Silicone medical adhesive removal for central venous catheter care optimization in patients with hematological diseases
Tamara A. Gogoleva, Maxim A. Kucher, Maxim P. Bogomolnyi
RM Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantology, Pavlov University, St. Petersburg, Russia
Tamara A. Gogoleva, RM Gorbacheva Research Institute Phone: +7 (911) 934-04-15
of Pediatric Oncology, Hematology and Transplantology, E-mail: tamaragogoleva@icloud.com
Pavlov University, 6-8 L Tolstoy St, 197022, St. Petersburg, Russia
Citation: Gogoleva TA, Kucher MA, Bogomolnyi MP. Silicone medical adhesive removal for central venous catheter care optimization in patients with hematological diseases. Cell Ther Transplant 2023; 12(1): 46-50.
Summary
Regular manipulations with central venous catheters (CVC) are associated with the risk of medical adhesive-related skin injury (MARSI) and infectious complications. Traditionally, alcohol-containing anti-adhesives are used to remove film dressings, but they may cause skin toxic effects. Meanwhile, the silicone-based anti-ad-hesives are successfully used in clinical practice, especially in abdominal surgery. In 2021-2022, hematopoietic stem cell transplantation (HSCT) recipients (n=46) with haematology diseases participated in comparative study. The control group (n=26) consisted of patients who used alcohol-containing solution (Ekobriz, Mir Dezinfektsii, Russia) for CVC care, and the comparison group (n=20) was treated with silicone-based spray (Niltac, Convatec,
England). A decreased frequency of skin irritation was revealed in the CVC dressing area with silicone-based spray, i.e., 5% versus 30.8% with alcohol-based solution (p=0.03). There were no differences in the frequency of febrile neutropenia, i.e., 70% vs 84.6% (p=0.4); inflammation at CVC entry site, 20% vs 34.6% (p=0.45); sepsis incidence, 35% vs 53.8% (p=0.33), respectively. None of the patients had skin allergy when using Niltac spray. Thus, in a representative group of HSCT patients, the sil-icone-containing spray proved to be safe and effective in order to reduce the incidence of CVC skin irritation.
Keywords
Central venous catheter, film dressing, silicone medical anti-adhesive.
Introduction
Installation of a central venous access is mandatory for patient's intensive care with haematological diseases and malignancies, which allows the administration of intravenous forms of cy-tostatic drugs, immunosuppressive agents, antibiotics, blood components, parenteral nutrition and other drugs and solutions for supportive therapy. A central venous catheter (CVC) requires daily monitoring and nurse care, including dressing changes, which can lead to the development of so-called, medical adhesive-related skin injury (MARSI), with typical manifestations in the form of painful irritation and epidermis damage [1, 2]. Subsequently, these changes can become a provoking factor, both skin local infection and life-threatening catheter-associated bloodstream infections [3] (Fig. 1).
Another skin-damaging factor is the toxicity of cytostatic agents used, e.g., during the conditioning treatment before hematopoietic stem cell transplantation (HSCT), including alkylating agents (cyclophosphamide, busulfan, melphalan), antimetabolites (cytarabine, fludarabine, clofarabine) and topoisomerase II inhibitors (daunorubicin, mitoxantrone, etoposide) [4].
Additional predisposing negative conditions are the patient's age (newborns and elderly persons), previous radiation therapy, malnutrition, dehydration, concomitant dermato-logical, and a number of somatic diseases, such as diabetes mellitus and renal failure [5]. In the context of HSCT, the presence of hemorrhagic syndrome against the background of thrombocytopenia and coagulopathy, acute skin graft-ver-sus-host disease (GVHD) are of particular importance [6].
Figure 1. Skin changes at the central venous catheter injection site: A, thrombocytopenia-associated petechiae; B, allergic dermatitis at the site of film dressing; C local infection (photographs by Gogoleva T.A., 2022)
According to the updated guidelines, MARSI prophylaxis should include the selection of an appropriate dressing type, depending on the initial patient's characteristics and current skin state as well as prevention of bacterial contamination and minimization of skin contact [5].
One of the promising areas in the nursing care upon removal of adhesive dressings is the use of medical alcohol- and silicone-containing anti-adhesives to reduce the risk of skin irritation, as well as alleviation of pain, which is especially important in pediatrics. The latter has a higher efficiency potential due to more gentle skin interaction effect. E.g., in abdominal surgery, the use of medical adhesives based on liquid silicones in the intestinal stoma care has reduced the incidence of skin irritations and local infections [7, 8]. So far, despite the development of skin care products and related consumables in various medical specialties, no data has been reported concerning the use of different anti-glues in CVC care. Our aim was to compare the safety and efficacy of a medical silicone-containing anti-adhesive and an iso-propanol-based solution in CVC operation procedures in patients with haematology diseases.
Patients and methods
Our study included a total number of 46 adult patients (1866 years, median - 44 years), mainly, with acute leukemia (n=31), multiple myeloma (n=6) and other haematology diseases (n=6), treated with autologous and allogeneic HSCT at the RM Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantation over 2021-2022. In all patients, prior to the conditioning treatment, a double or triple lumen CVC (BBraun, Germany) was installed via Seldinger method and under ultrasound guidance. Initially, a self-adhesive film dressing with 2% chlorhexidine gluconate antiseptic (3M TegadermTM CHG, USA) was used; later on, Cosmopor® E (Hartmann, Germany). According to the manufacturer's instructions, the Tegaderm™ CHG patch was changed every 6 days or more often depending on clinical needs, Cosmopor® E - daily. The CVC injection site was treated with a 3% hydrogen peroxide solution and a 0.05%
chlorhexidine bigluconate solution using sterile instrument and consumables.
Depending on the bandage removal, the patients were divided into two groups: the control group (n=26) was treated with isopropanol-based skin antiseptic solution (Ekobriz, Mir Dezinfektsii, Russia), and the comparison group (n=20), with the use of silicone-based anti-glue spray (Niltac, Conva-tec, England). Upon treatment at the inpatient department, the incidence of skin irritation, CVC injection site inflammation, febrile neutropenia, development of catheter-associated bloodstream infections, and sepsis were documented. Statistical significance was evaluated by the Chi-square test.
Results
The frequency of skin irritation cases at the adhesive bandage site was lower in the Niltac spray group, compared with the control group - 5% and 30.8%, respectively, p=0.03 (Fig. 2).
Chi-Square p-value=0.03 100%n 5.0%
30.8%
80%-
60%- _
Response
95.0% 0
20%-
o%-l-■-■-
Niltac Control
Figure 2. The frequency of skin irritation at the central venous catheter dressing area when using Niltac spray and Ecobriz solution (control group)
There were no differences in the incidence of infectious complications: febrile neutropenia - 70% and 84.6% (p=0.4); CVC injection site inflammation - 20% and 34.6% (p=0.45); sepsis, 35% and 53.8% (p=0.33), respectively. None of the patients experienced skin allergic reactions when using Niltac Spray.
Discussion
In recent years, different trends have been noted in CVC medical care at the haematology departments and HSCT centers. On the one hand, its quality has improved due to the use of more effective antiseptics, the expansion of film dressing's variety that require less frequent replacement due to the opportunity of visual control and their supplementation with antibacterial components, as well as advances in the skin GVHD prophylaxis protocols. At the same time, permanent training is a necessary condition for high skills of the nursing staff, in view of new emerging skincare products.
On the other hand, the leading problem is the control over poly- and pan-resistant bacterial infections, which, in combination with CVC skin area damage, may increase the risk of infectious complications. Also, during HSCT, there is a long list of drugs, which can negatively affect the skin integrity due to their direct damaging effect manifesting as toxic dermatitis and skin allergy. Under these conditions, MARSI prophylaxis is of particular clinical importance.
Alcohol-based solutions used in general practice are capable of dissolving some components of the adhesive bandage [9]. Moreover, due to the alcohol evaporation from the skin
surface, vasoconstriction occurs, and the skin becomes dry and cracks [10]. In addition, alcohol can be absorbed from the skin, disturb its water balance, and cause burning and irritation [11]. These side effects created the prerequisites for the development and use of alternative, non-toxic agents for the skin care, including silicone-containing ones, primarily in abdominal surgery. For example, according to an international multicenter study, Brava protective seal (Coloplast, Denmark) anti-glue was found to be highly effective in removing dressings and reducing the risk of their peeling off during subsequent application [12].
In our study, the already known data on effectiveness of sili-cone-containing anti-adhesives were confirmed and, for the first time, their allergic and infectious safety was demonstrated in the patients with immunodeficiency and throm-bocytopenia. The absence of statistical differences when comparing the incidence of CVC injection site inflammation and sepsis in this cohort of patients seems to be associated with a small sample of observed patients, and the observed cases of febrile neutropenia are explained by the fact that this complication has other pathogenesis.
Our preliminary experience also shows that the use of novel silicone-containing patches may be also effective in skin restoration after severe irritation damage of epidermis (Fig. 3).
Conclusion
In the patients with haematological disorders treated with HSCT, silicone-based anti-adhesives are safe and significantly reduce the incidence of skin irritation.
Figure 3. Skin irritation and epidermis damage treatment via WinnerPlastTM silicone coated patch (Winner-MED, Russia): A, before treatment; B, 3 days after the initiated application (photographs by Gogoleva T.A., 2022)
Acknowledgments
The authors would like to thank Yulia Yu. Vlasova and Mikhail M. Kanunnikov from Department of Bone Marrow Transplantation for adults, RM Gorbacheva Research Institute, Pavlov University for their help in organizing the study and manuscript preparation.
Conflict of interest
None declared.
References
1. Namazova-Baranova LS, Torshkhoeva RM, Belyaeva IA, Pilgui EI, Kharitonova NA, Rychkova LV, et al. Skincare of a newborn baby. / Scientifically-based methodological recommendations. First edition. - 2016. - 66 p. (In Russian).
2. Barton A. Prevention of medical adhesive-related skin injury (MARSI) during vascular access. Br J Nurs. 2021; 27(30, Suppl 2): 1-8. doi: 10.12968/bjon.2021.30.Sup2.1
3. Fumarola S, Allaway R, Callaghan R, Collier M, Downie F, Geraghty J, et al. Overlooked and underestimated: medical adhesive-related skin injuries. J Wound Care. 2020; 29 (Suppl 3c):1-24. doi: 10.12968/jowc.2020.29.Sup3c.S1
4. Reyes-Habito CM, Roh EK. Cutaneous reactions to chemotherapeutic drugs and targeted therapies for cancer: Part I. Conventional chemotherapeutic drugs. / J Am Acad Dermatol. 2014; 71(2): 203 - E1-203.e12; quiz 215-6. doi: 10.1016/j.jaad.2014.04.014
5. McNichol L, Lund C, Rosen T, Gray M. Medical ad-hesives and patient safety: state of the science: consensus statements for the assessment, prevention, and treatment of adhesive-related skin injuries. J Wound Ostomy Continence Nurs. 2013. 40(4): 365-380; quiz E1-2. doi: 10.1097/ W0N.0b013e3182995516
6. Neumann J. Nursing challenges caring for bone marrow transplantation patients with graft versus host disease. Hematol Oncol Stem Cell Ther. 2017. 10(4): 192-194. doi: 10.1016/j.hemonc.2017.06.001
7. Burch J. Peristomal skin care and the use of accessories to promote skin health. Br J Nurs. 2011; 20(7): 4-8. doi: 10.12968/bjon.2011.20.Sup3.S4
8. Swift T, Westgate G, Van Onselen J, Lee S. Developments in silicone technology for use in stoma care. Br J Nurs. 2020; 29(6): 6-15. doi: 10.12968/bjon.2020.29.6.S6
9. Berry J, Black P, Smith R, Stuchfield B. Assessing the value of silicone and hydrocolloid products in stoma care. Br J Nurs. 2007; 16(13): 778-782. doi: 10.12968/bjon.2007.16.13.24243
10. Cutting KF. Impact of adhesive surgical tape and wound dressing on the skin, with reference to skin stripping. J Wound Care. 2008; 17(4): 157-162. doi: 10.12968/ jowc.2008.17.4.28836
11. Mather C, Denyer J. Removing dressings in epidermolysis bullosa. Nurs Times. 2008; 104(14): 46-48.
12. Tielemans C, Probert R, Forest-Lalande L, Hansen AS, Aggerholm S, Ajslev TA. Evaluation of a new ostomy mould-able seal: an international product evaluation. Br J Nurs. 2016 ; 25(22): S16-S22. doi: 10.12968/bjon.2016.25.22.S16
Роль антиклея на основе жидкого силикона в улучшении качества ухода за центральным венозным катетером у больных с гематологическими заболеваниями
Тамара А. Гоголева, Максим А. Кучер, Максим П. Богомольный
НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой, Первый Санкт-Петербургский государственный медицинский университет им. акад. И. П. Павлова, Санкт-Петербург, Россия
Резюме
Эксплуатация центрального венозного катетера (ЦВК) сопряжена с риском развития адгезивно-вызванного повреждения кожи и инфекционных осложнений. Традиционно используемый, для снятия пластырных повязок, спиртосодержащий антиклей обладает рядом кожных токсичных эффектов. В то время как антиклей на основе силикона успешно применяется в клинической практике, особенно в абдоминальной хирургии. В 2021-2022 году в сравнительное исследование включено 46 реципиентов трансплантации гемопоэтических стволовых клеток (ТГСК) с онкогематологическими заболеваниями. Контрольную группу (п=26) составили больные, у которых для удаления пластыря ЦВК использовали спиртовой раствор Экобриз (Мир Дезинфекции, Россия), группу сравнения (п=20) - силиконсодер-жащий спрей №кас (Сопуа1ес, Англия). Выявлено снижение частоты раздражения кожи в области повязки ЦВК с силиконовым спреем - 5% против 30,8%
с алкогольсодержащим раствором (р=0,03). Не было различий в частоте фебрильной нейтропении - 70% и 84,6% (р=0,4); воспаления места вкола ЦВК - 20% и 34,6% (р=0,45); сепсиса - 35% и 53,8 (р=0,33), соответственно. Ни у одного пациента не зафиксировано кожных аллергических реакций при использовании спрея №Кас. Таким образом, в данной группе пациентов онкогематологического профиля, получающих лечение методом ТГСК, использование силиконсо-держащего антиклея безопасно при эксплуатации повязок ЦВК и позволяет снизить частоту возникновения раздражения кожи.
Ключевые слова
Центральный венозный катетер, повязки, силикон-содержащий антиклей.
