Abstract
Aims and objectives
To construct a risk assessment scale for medical adhesive‐related skin injuries (MARSI) at the peripherally inserted central catheter (PICC) insertion site in oncology patients and test its reliability and validity.
Design
The STARD 2015 statement guided this study.
Methods
Literature research and a modified Delphi method were adopted in this study. A total of 31 experts participated in two rounds of consultation to build the assessment scale. A convenient sampling method was used to select 195 oncology patients at the PICC clinic from January to June 2022. Inter‐rater reliability was used to test the reliability of the scale. Validity was evaluated using the content validity index (CVI) and predictive validity.
Results
After the two rounds of consultation, the assessment scale with five dimensions and 13 primary entries and 36 secondary entries was developed, and the expert authority coefficients for both were 0.90. The inter‐rater reliability was 0.968. The CVIs of the items ranged from 0.83 to 1.00. The area under the subject's work characteristic curve was 0.757, and the sensitivity and specificity of the scale were 80.0% and 65.6%, respectively, at a cutoff score of 15.5.
Keywords: Delphi technique, medical adhesive‐related skin injury, oncology, peripherally inserted central catheters, risk assessment
What does this paper contribute to the wider global clinical community?
The risk assessment scale in this study can be used in screening high‐risk patients with MARSI at the PICC sites in oncology patients at an early stage.
The assessment scale can be used as the basis for clinical nurses to take targeted preventive measures, thus reducing the incidence of MARSI in patients.
1. INTRODUCTION
Peripherally inserted central catheters (PICCs) are widely used in chemotherapy for oncology patients (Liao et al., 2019; Santos et al., 2020). However, given that insertion sites need to be maintained using disinfectants and medical adhesives weekly (Ullman et al., 2019), the skin under a dressing becomes sensitive (Zhao, He, Huang, et al., 2018), and is prone to medical adhesive‐related skin injury (MARSI), which is any skin damage associated with the use of medical adhesive products, including film dressings (Fumarola et al., 2020).
Studies have shown that the incidence of MARSI at the PICC insertion sites of oncology patients is 19.70% to 31.50% (Wang et al., 2018; Zhao, He, Huang, et al., 2018; Zhao, He, Wei, & Ying, 2018), which is much higher than that of other types of patients. MARSI leads to pain, increased medical costs, and, in severe cases, infection or even unplanned extubation, thus reducing the life quality of patients (Fumarola et al., 2020; McNichol et al., 2013).
However, this common complication is not fully recognized by healthcare professionals (Barton, 2021). According to guidelines and expert consensus (Broadhurst et al., 2017; Fumarola et al., 2020; Gorski et al., 2021), risk assessment and prevention are key to MARSI management. At present, MARSI risk assessment tools for children (Huang et al., 2019; Vance et al., 2015) and elderly patients (Minematsu et al., 2021) have been developed and widely used, but few risk assessment scales for PICC insertion sites for oncology patients have been established. This study aims to construct a scientific and evidence‐based MARSI risk assessment scale at PICC insertion sites for oncology patients, which will provide a foundation for clinical caregivers to identify patients at risk of MARSI in an early stage and carry out targeted interventions so as to reduce the incidence of MARSI.
2. METHODS
Our research team consisted of six members, including one manager of infusion therapy, three specialist nurses for PICC, and two nursing graduate students. The tasks of the team were: (1) to search literature and construct an initial assessment scale; (2) to screen consulting experts and distribute questionnaires; and (3) to collect and analyse expert feedback.
2.1. Phase 1: Identification of scale items
Primary evaluation entries were developed by conducting a literature search on MARSI risk factors at PICC insertion sites in oncology patients. Seven databases, namely, the Cochrane Library, Web of Science, PubMed, CNKI, Wanfang Data Knowledge Service Platform, VIP, and SinoMed databases were searched using the key words (“PICC” OR “peripherally inserted central catheter”) AND (“Medical Adhesive Related Skin Injury” OR “skin injury” OR “skin impairment” OR “contact dermatitis”). A total of 277 articles were retrieved by October 2021, and 21 articles were finally screened after duplicates and irrelevant ones were removed.
The MARSI risk factors at PICC insertion sites of oncology patients reported in the literature were sorted and summarized. On this basis, team members conducted interviews with clinically experienced specialist nurses. Finally, the first assessment scale, including five dimensions, 21 primary items and 30 secondary items, was formed.
2.2. Phase 2: Delphi expert consultation
2.2.1. Develop expert consultation questionnaire
The questionnaire consisted of three parts: (1) introduction, which explained the background, purpose, method and significance of the study, and requirements for filling in the questionnaire; (2) the assessment scale items; experts rated the importance of each item by using a five‐point Likert scale, and scores of one to five indicated unimportant, less important, general, more important, and important, respectively; “Modification opinion” column was set next to each item, where experts can make suggestions for modification, deletion, and addition of items; and (3) the investigation of the basic situation of the experts, including the expert's personal basic information, familiarity with the content of the study and the self‐judgement based on practical experience, theoretical analysis, reference materials, and intuitive selection.
2.3. Implementation of expert consultation
Purposive sampling was used to recruit experts from Grade A tertiary hospitals in six provinces of Shanxi, Inner Mongolia, Tianjin, Shandong, Zhejiang, and Guangxi. There is no consensus on the sample size of expert consultation, but in general, the number of experts is 10–50. According to research, more than 30 experts have little impact on the accuracy of the inquiry results (Lancaster et al., 2023). Therefore, considering the actual recovery rate, 32 experts are recruited. These experts were specialist nurses who were engaged in infusion therapy or wound care, had clinical experience of 10 years or more, and had a bachelor's degree and intermediate professional qualifications or above. All experts were voluntarily and actively involved in this study.
From November to December 2021, after obtaining the consent of experts, the research team conducted consultations by sending e‐mails or in person. When expert opinions converged, consultation was ended. The mean importance score of items >3.5 and a coefficient of variation <0.25 was considered to be deleted, and entries were deleted, added, or modified in combination with expert opinions and panel discussion results. Two rounds of consultation were conducted.
2.4. Weight and assignment of the items
According to the mean importance score of the second round of experts, the analytic hierarchy process (AHP) was used to construct the judgement matrix and calculate the weight coefficient. The combined weight of the secondary items was calculated by the principle of probability method (Tian et al., 2014). The combined weights were multiplied by 100 and rounded to an integer, which was the assignment of the secondary entries.
2.5. Phase 3: Validity and reliability testing
2.5.1. Patient selection
Using the convenient sampling method, 195 oncology patients who underwent PICC maintenance at the outpatient of a Grade A tertiary hospital in Shanxi Province, China, from January to July 2022 were selected. Inclusion criteria were: (1) oncology patients aged 18 or older; (2) PICC was inserted by specialist nurses at the PICC outpatient in our hospital; and (3) must regularly come to our hospital for maintenance. Patients who had serious mental illnesses or cognitive impairments and cases with incomplete data collection were excluded. All patients and their families were aware of and voluntarily participated in this study. This study was approved by the Ethics Committee REDACTED.
2.6. Diagnosis of MARSI
MARSI is defined as an erythema with or without other skin abnormalities (such as blisters, erosions, or tears) that form after at least 30 min of the removal of the medical dressing. Common types include mechanical injury (skin stripping, skin tear, and tension blister), contact dermatitis, folliculitis, and maceration (Fumarola et al., 2020).
2.7. Data collection and analysis
Informed written consent was obtained from each participant before the investigation. A demographic data form and MARSI risk assessment scale at PICC inserted sites for oncology patients were used for data collection. Patients' gender, age, education level, diagnosis, and related information about PICC were recorded in the demographic data form.
Before catheter maintenance, use the risk assessment scale to evaluate the patient and record the score. Judge whether the patient has MARSI during maintenance. Patients were followed up until MARSI or an unplanned extubation occurred.
To evaluate inter‐rater reliability, MRASI risk assessment was performed on 30 patients by two nurses at the same time, and the correlation between the two scores was calculated. Six experts in infusion therapy were invited to rate the relevance of each item and the study content using a four‐point Likert scale. Item content validity (I‐CVI), unanimous content validity (SCVI/UA), and average content validity (SCVI/Ave) were used in evaluating the content validity of the scale. Prediction validity was determined by plotting the receiver operator characteristic (ROC) curve and calculating the area under the curve (AUC). Then, levels were categorized as high, medium, or low risk by the quartile method.
2.8. Data analysis
SPSS 26.0 software (IBM, New York, USA) was used for data analysis. Frequencies and percentages were calculated for categorical variables, whereas means and standard deviations were obtained for continuous variables. The data was double‐checked. p values <0.05 were considered statistically significant.
The expert authority coefficient (Cr) is the mean of the expert judgement coefficient (Ca) and familiarity (Cs). The concentration of expert opinion was determined by calculating the expert coordination coefficient (Kendall's W), the mean importance score, and the coefficient of variation (CV).
3. RESULTS
3.1. Characteristics of experts
Thirty‐one experts, from 19 Grade A tertiary hospitals in six provinces in China participated in the two rounds of consultation, and all the experts were women. Table 1 shows the characteristics of the experts.
TABLE 1.
Characteristics of the experts (n = 31).
| Demographic category | n | % |
|---|---|---|
| Age, years | ||
| <40 | 8 | 25.81 |
| 40–50 | 14 | 45.16 |
| >50 | 9 | 29.03 |
| Education | ||
| Undergraduate | 29 | 93.55 |
| Master and above | 2 | 6.45 |
| Professional qualifications | ||
| Intermediate | 10 | 32.26 |
| Deputy senior | 16 | 51.61 |
| Senior | 5 | 16.13 |
| Position | ||
| Head of the nursing department | 3 | 9.68 |
| Head nurse | 19 | 61.29 |
| Nurse | 9 | 29.03 |
| Current professional field | ||
| Infusion therapy | 28 | 90.32 |
| Wound care | 3 | 9.68 |
| Professional, years | ||
| 10–20 | 10 | 32.26 |
| 20–30 | 12 | 38.71 |
| >30 | 9 | 29.03 |
3.2. Positivity and authoritative coefficients of experts
A total of 32 experts were invited to participate in the study, and 31 completed the data collection. The recovery rate was 96.88% and 100%. Seven (23.33%) experts in the first round proposed 26 amendments, and two (6.67%) in the second round provided two suggestions. These actions indicated the relatively high enthusiasm of the experts. Ca of the two rounds was 0.93, Cs was 0.87, and Cr was 0.90, higher than 0.7, showing the authority degree of experts was high (Wu et al., 2021).
3.3. Degree of concentration of expert opinions
In the first round of consultation, the mean importance score was 3.13–4.94, the CV was 0.051–0.410, and the Kendall's W was 0.279–0.515. In the second round, the average importance score was 3.58–4.97, the CV was 0.036–0.250, and the Kendall's W was 0.243–0.428. The difference was statistically significant (p < 0.001), which showed that the expert opinions tended to be in agreement after two rounds of consultation.
3.4. Item modifications
After the first round of consultation, three first‐level entries were deleted, one was added, and two were adjusted. Moreover, six secondary entries were removed, seven were added, and two were adjusted. (1) “Gender”, “Female”, “Insomnia”, and “Rarely wet skin” met the screening criteria, and were deleted after team discussion. Experts pointed out that “Summer” was repeated with “Wet skin”, and “Mild edema” had little effect on skin injury, so they were removed. Chemotherapy drugs all increase the risk of skin damage, therefore, “Oxaliplatin” and “Arsenic trioxide” were removed. (2) Combined with expert opinions and literature research, added entries included the first‐level entry “Mental state”, and the second‐level entries “Negative emotions”, “Digestive system oncology”, “Autoimmune diseases”, “Renal insufficiency”, “Nonsteroidal Anti‐inflammatory Drugs”, “Immunosuppressant”, and “Chemotherapy cycle ≥ four times”. (3) Entries were also adjusted according to experts who suggested that disease‐related entries be integrated into one dimension, so the “Disease factors” dimension was added. The second‐level item “≥one month” was amended to “<three months”, “three—six months” and “>six months”, and “Radiotherapy” was changed to “Chemoradiotherapy”. After the revision and adjustment of the entries, the second round of the expert consultation questionnaire was formed, including five dimensions, 16 primary entries, and 41 secondary entries.
In the second round of consultation, experts pointed out that it was difficult to calculate dehydration and that the assessment of wet skin was subjective. Dehydration was judged based on dehydration symptoms after team discussion and literature review, and was included in the “Nutritional status” entry. Place a 20 × 20 double‐layered paper towel at the skin of the catheter insertion side, mild humidity was less than half area of sweat‐impregnated paper towels, and more than half was severe moisture (Wei et al., 2016).
The final evaluation scale included five dimensions, 13 primary entries, and 36 secondary entries (Table 2).
TABLE 2.
Weight and assignment of MARSI risk assessment entries for PICC insertion sites in oncology patients.
| Entries (weight) | Importance score () | Coefficient of variation | Portfolio weight | Assignment (score) | I‐CVI | ||
|---|---|---|---|---|---|---|---|
| Patient general condition | I‐1 age (0.212) | II‐1 50–65 years old (0.250) | 4.16 ± 0.86 | 0.207 | 0.001 | 1 | 1.00 |
| (0.092) | II‐2 ≥ 65 years old (0.750) | 4.45 ± 0.81 | 0.182 | 0.015 | 2 | 1.00 | |
| I‐2 Past medical history (0.212) | II‐3 History of skin allergies (including allergies to disinfectants and dressings) (0.614) | 4.97 ± 0.18 | 0.036 | 0.012 | 1 | 1.00 | |
| II‐4 History of drug allergy (0.117) | 4.23 ± 0.92 | 0.217 | 0.002 | 1 | 1.00 | ||
| II‐5 History of MARSI (0.268) | 4.65 ± 0.76 | 0.162 | 0.005 | 1 | 1.00 | ||
| I‐3 Nutritional status (0.511) | II‐6 Body mass index (BMI) <18.5 (0.110) | 4.16 ± 0.90 | 0.216 | 0.005 | 1 | 1.00 | |
| II‐7 BMI ≥28 (0.072) | 4.03 ± 1.14 | 0.187 | 0.003 | 1 | 0.83 | ||
| II‐8 Albumin <35 mg/dL (0.369) | 4.58 ± 0.56 | 0.123 | 0.017 | 2 | 1.00 | ||
| II‐9 Anaemia (0.185) | 4.39 ± 0.76 | 0.173 | 0.009 | 1 | 0.83 | ||
| II‐10 Dehydration a (0.264) | 4.45 ± 0.72 | 0.162 | 0.012 | 1 | 1.00 | ||
| I‐4 Mental state (0.066) | II‐11 Negative emotions (1.000) | 3.58 ± 1.39 | 0.237 | 0.006 | 1 | 0.83 | |
| Disease factors | I‐5 Basic illness | II‐12 Diabetes (0.177) | 4.58 ± 0.67 | 0.147 | 0.024 | 2 | 1.00 |
| (0.184) | (0.750) | II‐13 Skin disease b (0.507) | 4.94 ± 0.25 | 0.051 | 0.070 | 7 | 1.00 |
| II‐14 Autoimmune diseases (0.250) | 4.65 ± 0.80 | 0.172 | 0.035 | 4 | 1.00 | ||
| II‐15 Renal insufficiency (0.065) | 4.03 ± 0.98 | 0.187 | 0.009 | 1 | 1.00 | ||
| I‐6 oncology type | II‐16 Blood system (0.594) | 4.16 ± 1.07 | 0.207 | 0.027 | 3 | 1.00 | |
| (0.250) | II‐17 Reproductive system (0.157) | 3.71 ± 1.13 | 0.222 | 0.007 | 1 | 0.83 | |
| II‐18 Digestive system (0.249) | 3.81 ± 0.98 | 0.219 | 0.011 | 1 | 0.83 | ||
| Skin condition | I‐7 Oedema (0.528) | II‐19 Moderate oedema c (0.250) | 4.61 ± 0.50 | 0.107 | 0.055 | 6 | 1.00 |
| (0.418) | II‐20 Severe oedema d (0.750) | 4.90 ± 0.40 | 0.081 | 0.166 | 17 | 1.00 | |
| I‐8 Dry skin (0.140) | II‐21 Localized skin exfoliation (0.117) | 4.13 ± 0.89 | 0.214 | 0.007 | 1 | 0.83 | |
| II‐22 Extensive skin exfoliation (0.268) | 4.55 ± 0.62 | 0.137 | 0.016 | 2 | 1.00 | ||
| II‐23 Cracked skin (0.614) | 4.81 ± 0.48 | 0.099 | 0.036 | 4 | 1.00 | ||
| I‐9 Wet skin (0.333) | II‐24 Mild moisture e (0.25) | 4.52 ± 0.57 | 0.126 | 0.035 | 4 | 1.00 | |
| II‐25 Severe moisture e (0.75) | 4.90 ± 0.30 | 0.061 | 0.104 | 10 | 1.00 | ||
| Therapeutic factors (0.184) | I‐10 Treatment mode (0.333) | II‐26 Chemoradiotherapy (0.333) | 4.29 ± 0.94 | 0.219 | 0.020 | 2 | 1.00 |
| II‐27 Chemotherapy cycle ≥ four times (0.667) | 4.52 ± 0.63 | 0.138 | 0.041 | 4 | 1.00 | ||
| I‐11 Drug factors | II‐28 Chemotherapy drugs (0.365) | 4.61 ± 0.62 | 0.133 | 0.045 | 5 | 1.00 | |
| (0.667) | II‐29 Targeted drugs (0.059) | 3.97 ± 1.11 | 0.248 | 0.007 | 1 | 1.00 | |
| II‐30 Anticoagulant drugs (0.084) | 4.00 ± 1.16 | 0.250 | 0.010 | 1 | 1.00 | ||
| II‐31 Corticosteroids (0.174) | 4.26 ± 0.73 | 0.171 | 0.021 | 2 | 1.00 | ||
| II‐32 Nonsteroidal Anti‐inflammatory Drugs (0.084) | 4.00 ± 0.93 | 0.233 | 0.010 | 1 | 1.00 | ||
| II‐33 Immunosuppressant (0.235) | 4.42 ± 0.67 | 0.152 | 0.029 | 3 | 1.00 | ||
| Catheter insertion factors | I‐12 Number of punctures (0.250) | II‐34 ≥ two times (1.000) | 4.32 ± 1.19 | 0.234 | 0.030 | 3 | 1.00 |
| (0.121) | I‐13 Days with tube | II‐35 three—six months (0.250) | 4.29 ± 0.82 | 0.192 | 0.023 | 2 | 1.00 |
| (0.750) | II‐36 > six months (0.750) | 4.74 ± 0.51 | 0.108 | 0.068 | 7 | 1.00 | |
Manifested as dry mouth, loose skin, thick and dry body secretions, little or no urine and dark urine, headache, dizziness, etc.
Including eczema, dermatitis, psoriasis, and epidermolysis bullosa.
Refers to oedema in the loose tissues of the whole body, obvious or deep tissue depression may appear after acupressure, and the recovery is slow.
Refers to the severe oedema of the whole body tissue, and the tight shiny skin on the lower part of the body.
Place a 20 × 20 double‐layered paper towel at the skin of the catheter insertion side; mild humidity is less than half the area of sweat‐impregnated paper towels, and more than half is severe moisture.
3.5. Characteristics of participants in the testing study
A total of 195 oncology patients with PICC were included in testing study. Among them, 70 (35.9%) were males and 125 (64.1%) were females; their age was 19–85 (53.44 ± 14.37) years old. 100 (51.3%) with education level of junior high school and below, and 95 (48.7%) with high school and above. A total of 94 (48.2%) participants had reproductive system oncology, 43 (22.1%) had blood system, and 27 (13.8%) had digestive system. Most of the participants (98%) used single‐chamber PICC.
3.6. Reliability and validity of the assessment scale
The inter‐rater correlation coefficient of the scale was 0.968 (p < 0.001), indicating very satisfactory inter‐rater consistency.
The I‐CVI ranged from 0.83 to 1.00; the SCVI/UA was 0.83; and the SCVI/Ave was 0.97 (Table 2).
MARSI occurred in 35 of 195 patients, with a percentage of 17.9%. Among them, there were four patients with mechanical injuries(two had tension blisters and two had skin stripping), one had maceration, and 30 had contact dermatitis. The ROC curve was drawn (Figure 1), and the area under the ROC curve was 0.757 (95% confidence interval: 0.688–0.826). The difference was statistically significant (p < 0.001), indicating that the predictive validity of this scale was good. The sensitivity and specificity of the scale were 80.0% and 65.6%, respectively, at a cut‐off score of 15.5. According to the quartile method, a score of 13–15 was classified as low risk, 16–22 was medium risk, and 23 or higher was high risk.
FIGURE 1.
Subject work characteristic (ROC) curve of the scale.
According to the risk level, the patients in the group without MARSI and the group with MARSI were divided into risk grades. The results of MARSI risk levels between the two groups were statistically different (p < 0.001) (Table 3).
TABLE 3.
Comparison of MARSI risk levels between two groups of patients [n (%)].
| Risk level | MARSI group | Without MARSI group | χ 2 | p |
|---|---|---|---|---|
| No risk | 0 (0.00) | 74 (46.25) | 30.311 | <0.001 |
| Low risk | 7 (20.00) | 31 (19.38) | ||
| Medium risk | 19 (54.29) | 36 (22.50) | ||
| High risk | 9 (25.71) | 19 (11.88) |
4. DISCUSSION
The construction of MARSI risk assessment scale at the PICC insertion sites in oncology patients is scientific and reliable. According to the results of a literature review and expert consultation, we formulated the MARSI risk assessment scale, which ensures the scientific nature of the items. Experts from multiple provinces were selected for this consultation, and sample representation was good. All the experts had a bachelor's degree or above, 66.67% of them had a professional qualification of deputy high or above, and all of them were specialist nurses in infusion therapy or wound care. Thus, the experts had considerable knowledge in the field, and their opinions were representative. The experts were highly motivated, authoritative, and consistent in their opinions; thus, the consultation results were reliable. In addition, the weight of each item was calculated with AHP, which is more scientific and objective.
The reliability and validity of MARSI risk assessment scale are good. Reliability is an indicator to evaluate the consistency, reliability, and stability of an instrument (He et al., 2021). The inter‐rater correlation coefficient of the MARSI risk assessment scale was 0.968, indicating high consistency of assessments among different raters. Validity refers to the ability of a measurement tool to accurately measure the real situation of things (He et al., 2021). In this study, content validity and predictive validity were selected for validity testing. The I‐CVI scores were 0.83–1.00, S‐CVI/UA and S‐CVI/Ave scores were 0.83 and 0.97, respectively, and thus the content validity was good (Lee & Cha, 2021) and the contents of the scale items reflected the risk factors of MARSI at PICC sites in tumour patients. The area under the ROC curve of the MARSI risk assessment scale was 0.757, indicating that the scale had moderate value in predicting MARSI‐risk patients (Ueno et al., 2021). The optimal cut‐off value was 15.5 points, and a sensitivity of 80.0% and specificity of 65.6% were obtained, indicating that the scale had a good effect in predicting MARSI. Therefore, this scale can be used in screening high‐risk patients for MARSI at a PICC site before catheterization.
The MARSI risk assessment scale can be implied in a clinical situation. The MARSI risk assessment scale consisted of 5 dimensions (patient general conditions, disease factors, skin conditions, treatment factors, and catheterization factors), 13 primary items, and 36 secondary items. These items were relatively comprehensive and fully reflected the high‐risk factors for MARSI at PICC sites in oncology patients (Yue et al., 2022). Most items, such as age, past medical history, basic illness, and oncology type, were objective items, and information was obtained by checking medical records. Items, such as dry skin, wet skin, and oedema, were relatively subjective, but all of them were evaluated by widely used criteria. Therefore, the scale is convenient for nurses to make accurate assessments with less time.
This assessment scale is designed to evaluate the patient's general condition, medical history, treatment, and other hard‐to‐change factors before catheterization, and determine the risk level according to the evaluation score, so as to take targeted preventive measures in the whole process of catheterization and maintenance according to the risk level to reduce the incidence of MARSI. Therefore, the evaluation scale does not include variable factors such as type of dressing, disinfectant, and fixed device, which are included in the next preventive measures, and the nurses can choose the appropriate type according to the patient's situation. This is different from previous studies (Yue et al., 2022).
There were several limitations to our study. First, the experts were all women, and there may be gender bias. Second, this study constructed the risk assessment scale but has not yet formulated the corresponding risk classification prevention measures for the risk level. Third, the participants recruited for psychometric testing were from one hospital, and this method may reduce the generalizability of the findings. Therefore, large‐scale validation studies in different geographical areas of China are recommended. Our subsequent research is to construct a risk grading prevention programme based on the risk assessment scale and apply it to clinical practice to evaluate the effectiveness of the MARSI risk assessment scale and a risk grading prevention programme.
5. CONCLUSIONS
In this study, the MARSI risk assessment scale at the PICC‐inserted sites in oncology patients was developed and validated through systematic literature research, expert consultation, and reliability and validity testing. The items on the scale are clear and manoeuvrable. It can be used in screening high‐risk patients with MARSI at the PICC sites in oncology patients at an early stage.
AUTHOR CONTRIBUTIONS
All authors contributed to the study conception and design. Among them, Huijiao Zhang and Yuling Li are the main authors. Literature review and expert consultation were performed by Huijiao Zhang and Yuling Li. Data collection and analysis were performed by Shuqing Zhang, Xiaoya Hou and Lina Feng. The first draft of the manuscript was written by Huijiao Zhang and Yuling Li, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
FUNDING INFORMATION
No funding was received to assist with the preparation of this manuscript.
CONFLICT OF INTEREST STATEMENT
The authors have no competing interests to declare that are relevant to the content of this article.
ETHICS STATEMENT
Approval was obtained from the Ethics Committee of First Hospital of Shanxi Medical University (number: [2022](K087)). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.
CONSENT TO PARTICIPATE
Informed consent was obtained from all individual participants included in the study.
ACKNOWLEDGEMENTS
We thank all the consulting experts who participated in this study for their great support.
Li, Y. , Zhang, H. , Zhang, S. , Hou, X. , & Feng, L. (2023). Development and validation of medical adhesive‐related skin injury risk assessment scale at peripherally inserted central catheter insertion site in oncology patients. Nursing Open, 10, 5244–5251. 10.1002/nop2.1762
Yuling Li and Huijiao Zhang are the first co‐authors.
Contributor Information
Yuling Li, Email: liyuling5646@163.com.
Huijiao Zhang, Email: huijiaoz996@163.com.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.