MARSI

MARSI

1. Erythema or other cutaneous abnormality persisting 30 minutes or more after adhesive dressing removal.

   • erythema, blistering, vesicles, bulla, erosion, tear
   • Intrinsic risk factors
     • Age extremes
     • Skin changes
     • Dehydration, poor nutrition, reduced sensation, altered mobility, cognitive impairment
   • Extrinsic risk factors
     • mechanical trauma
     • soap
     • dry skin
     • immobility
     • Environmental factors- furniture

2. Irritant Contact Dermatitis

   • Exposure
     • alcohol
     • bleach
     • solvents
     • deodorants
     • soaps
     • cosmetics
   • Erythema/edema; vesicles
   • TEWL normalizes in 6-12 days

3. Allergic Contact Dermatitis

   • Immune-mediated
   • Antigen-specific
     • rash, erythema, macules, papules, vesicles, wheals
   • mirrors placement of allergen
   • Patch testing

4. Maceration

   • Overhydration of the skin
   • Wrinkling of skin surface and change in skin color
     • white/grayish

5. Mechanical Trauma

   • Skin-stripping
   • Degree of delamination
     • adhesive type
     • peel force
     • angle and removal speed
   • Deeper stripping-skin tear
     • Type 1
       • Linear skin tear: full thickness
       • Flap type: partial thickness that can be fully approximated
         • Treatment
           • appoximate tissue flap
           • skin barrier film
           • minimaze dressing removal
           • non-adherent dressing or low adhesive and high MVTR
           • place arrow on dressing for removal direction
           • avoid adhesives
           • avoid transparent adhesives, hydrocolloids, closure strips
     • Type 2
       • Skin tear with partial thickness lostt
       • Scant tissue loss
       • Mod to large tissue loss
     • Type 3
       • Skin tear with complete tissue loss
       • Partial thickness, loss of epidermal flap
   • moist/glistening surface

6. Tension Blisters

   • Stretching and strapping
   • Shear force lifting the epidermis
   • Unroofed with removal

7. Folliculitis

   • Inflammed hair follicles
     • Pustules

8. Prevention

   • Remove excess hair
   • Clean with no-rinse pH balanced product without a moisturizer or petrolatum
   • Alcohol free liquid barrier
   • Correct application: apply without tension or stretch, firm application to fit contours.
   • Correct removal: push/pull method, low and slow, horizontal, adhesive removers, stretch and release with transparent films

9. Alternatives

   • tubular elastic net
   • elastic tubular bandage
   • Coban
   • conforming gauze wrap
   • Abdiminal dressing holders