Effectiveness of the SECURE care bundle in preventing medical adhesive-related skin injuries in children with central venous catheters
INTENSIVE AND CRITICAL CARE NURSING, vol.98, 2027 (SCI-Expanded, SSCI, Scopus)
- Publication Type: Article / Article
- Volume: 98
- Publication Date: 2027
- Doi Number: 10.1016/j.iccn.2026.104542
- Journal Name: INTENSIVE AND CRITICAL CARE NURSING
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI), Scopus, CINAHL, EMBASE, MEDLINE, Psycinfo, Social Science Premium Collection (ProQuest), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest), Sociology Database (ProQuest)
- Istanbul University Affiliated: Yes
Abstract
Background Medical adhesive-related skin injuries (MARSI) are common but often underrecognized and preventable complications in paediatric intensive care, particularly associated with central venous catheters (CVCs). Objectives This study aimed to evaluate the effectiveness of the SECURE Care Bundle in preventing CVC fixation-related MARSI and its time to onset in children. Methods A quasi-experimental pretest-posttest design was conducted in a Paediatric Cardiac Intensive Care Unit. A total of 91 patients were enrolled (45 pre-intervention and 46 intervention groups). Data were collected using a descriptive information form, Braden QD Scale, skin observation form, and SECURE Care Bundle Checklist. The intervention group received the SECURE Care Bundle, comprising structured skin assessment, secure fixation, use of a silicone-based adhesive remover, proper removal techniques, and MARSI evaluation. The pre-intervention group received standard care according to the clinic's routine CVC protocol. MARSI incidence and time to onset were compared between groups. Results MARSI incidence was significantly lower in the intervention group compared to the pre-intervention group (15.2% vs. 62.2%, p < 0.001). Mean time to MARSI onset was significantly longer in the intervention group (9.7 +/- 5.3 vs. 1.9 +/- 1.2 days, p < 0.001). Multivariable analysis showed that the risk of developing MARSI was approximately 12 times higher in the pre-intervention group (OR = 11.8; p = 0.001). Conclusions The SECURE Care Bundle significantly reduced MARSI incidence and delayed time to onset in children with CVCs. Implications for clinical practice The SECURE care bundle reduces the incidence of MARSI and delays its onset by standardizing catheter securement and protecting skin integrity, demonstrating significant clinical potential in paediatric intensive care settings.