Effectiveness of the SECURE care bundle in preventing medical adhesive-related skin injuries in children with central venous catheters

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.