What is MARSI?
Medical adhesive-related skin injury (MARSI) occurs when medical adhesives remove superficial layers of skin, resulting in variable levels of skin damage, such as skin-stripping, tension blisters, skin tears, contact dermatitis1.
MASRI can occur to any group of patients in any setting and is often under-recognised as a skin issue – possibly because it is so common.
How does MARSI occur?
The skin has three layers:
- Deeper hypodermis
When a medical adhesive device is placed onto the skin, it adheres to it to keep it in place. However, when removed, it can cause stripping of the superficial top skin layers, affecting the skin integrity.
When this reaction lasts for longer than 30 minutes after the adhesive, this is categorised as MARSI2.
Devices commonly used in practice that can cause MARSI are:
- Stoma bags
- Catheter securing items
- Films to secure infusion lines
There are various compositions of medical adhesives to consider. Traditional materials such as acrylates, which some people have an allergy to, can cause contact dermatitis. Silicone adhesives may be gentler to the skin but may not always reach the optimal adhesion required.
Who is at risk?
We can break down the risk factors for MARSI into intrinsic and extrinsic factors:
- Elderly patients – as we age, skin becomes more fragile, loses elasticity and is more susceptible to skin tears.
- Premature infants / neonates
Underlying medical conditions (i.e. diabetes, infection, renal insufficiency, immunosuppression, venous insufficiency, peristomal varices)
Impaired sensory perception
Dermatologic conditions (i.e., eczema, dermatitis, epidermolysis bullosa, chronic wounds with high exudate)
Living with a stoma appliance
Patients at end of life
Skin cleansing using soaps, harsh cleansers non-PH balanced.
Dry skin not moisturised.
Moisture-associated skin damage (MASD)
Impaired mobility – self or shared care and difficulty changing adhesive devices.
Medications changing skin structure, i.e. anti-inflammatory agents, anticoagulants, chemotherapy, long-term corticosteroid use.
Repeated use of harsh adhesives
If a patient has one or more of these risk factors and a medical adhesive is being used, care planning needs to be put in place to reduce the risk of MARSI by using a medical adhesive remover such as Lifteez.
Prevention and minimising risk of MARSI
Preventative care requires a risk assessment of the probable cause and effects of harm or a poor-quality outcome to the patient. We often associate prevention with pressure ulceration, but all skin-related injuries need to be avoided where possible. Following these steps will help you to prevent the risk:
- Check whether the skin needs shaving.
- Check that the skin is clean and dry.
- Prepare the skin with a barrier product such as the Medi Derma-S barrier film and cream.
Choosing the right medical adhesive
- Think about adhesive selection and adhesion level, along with the ingredients of the backing or adhesive and what level of adhesion they apply.
- Education on prevention is essential to staff. In addition, open-ended education on new products, prevention, and treatment is a critical part of a skin prevention and treatment program.
- Remove the device gently, slowly, and evenly, keep it low to the skin surface easing outwards and hair growth direction.
- Do not change dressings too frequently as this can cause unnecessary trauma to the skin; consider absorbency of the dressing type and longer wear time.
- Consider using a specialised medical adhesive remover to reduce unwarranted trauma, such as Lifteez Medical Adhesive Remover, which can help prevent MARSI by dissolving the adhesive on devices.
Two products that can make a difference.
Supporting skin preparation:
The Medi Derma-S barrier range has been reported to possess durability and effectiveness due to a protective effect that prevents the removal of the stratum corneum3 and avoids periwound breakdown4. In addition, the barrier film is silicone-based and uses ingredients that have stability, low toxicity, and low flammability.
Supporting dressing or device removal:
Lifteez Medical Adhesive Remover can help prevent MARSI by dissolving the adhesive on dressings, surgical tapes, stoma or ostomy pouches and tube securement devices. In addition, it supports the fast and painless removal of adhesive-based products.
MARSI compromises patient safety and well-being and increases clinician time and healthcare costs. With good education for staff and patients, supported using appropriate products, we can prevent MARSI together.
- Jones L., Bell, D., Hodgson C. et al (2018). Case study series: Lifteez aerosol and wipes for the prevention and management of MARSI. Wounds UK 14(5): 118-123
- McNichol L, 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. J Wound Ostomy Continence Nurse 40(4): 365-80
- Dykes P, Goodwin R, Rosslee V. Pilot study into the efficacy of film barrier skin care products. Wounds UK. 2012;8(4)
- Bianchi J, Beldon P, Callaghan R, Stephen-Haynes J. Barrier Products: effective use of a barrier cream and film. Wounds UK. 2013;9(1):82–88
McNichol L, 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. J Wound Ostomy Continence Nurse 40(4): 365-80