Medical device-related pressure injury (MDRPI) is a distinct subset of pressure injury that occurs when a diagnostic or therapeutic device exerts sustained pressure or shear at the skin-device interface, often over bony prominences or along lines, tubing, masks, and collars. The result can be tissue ischemia, inflammation, and ulceration that mirrors the device’s shape and contact points.^1,2 MDRPI is frequently underrecognized because devices are essential to care and because skin under or adjacent to the device is not always inspected as reliably as conventional risk areas. As device use expands across acute and post‑acute settings, from noninvasive ventilation to monitoring leads, awareness and prevention are now core competencies for wound care teams across the continuum. Foundational overviews and meta‑analyses emphasize both the clinical significance and the need for standardized prevention approaches.^1,2

Incidence estimates vary widely by device type, population, and care environment, reflecting discrepancy in definitions, surveillance, and risk profiles. Meta‑analytic work underscores the idea that MDRPI is common, particularly in critical care settings and among patients requiring respiratory support or hemodynamic monitoring, but rates differ substantially across studies and settings.^1,3 Regardless of the precise rate in a given unit, the clinical and operational consequences, including pain, infection risk, treatment delays, extended length of stay, and additional costs, are relatively consistent. A shared challenge is that device necessity competes with offloading opportunities, and the tight tolerances needed for device performance (eg, mask seal, cervical immobilization) can amplify pressure and shear.²

MDRPI risk is multifactorial and includes patient, device, and care‑process contributors. Patient‑level factors associated with MDRPI include immobility, altered perfusion or hemodynamics, edema, compromised sensation or consciousness, fever, moisture, and poor nutritional status; lower skin tolerance from age‑related changes or comorbidities can also magnify these risks.^2,4 Device‑level risks include rigid materials, rough or narrow edges, inadequate padding, incorrect sizing, high strap or securement tension, and prolonged uninterrupted wear time.⁴ Care‑process risks span inconsistent skin inspection, lack of device‑specific risk screening, poorly timed repositioning relative to device checks, and delayed escalation when early skin changes are noted.^2,4,5 In the ICU, the combination of vasopressors, sedation, respiratory devices, and limited repositioning time windows can compound vulnerability.⁴

Because MDRPI arises at predictable device-skin interfaces, prevention hinges on structured care protocols that integrates device fit, microclimate management, and timely offloading into routine workflows. Systematic reviews of interventional strategies describe bundles that pair device‑specific risk assessment with frequent targeted skin checks, use of prophylactic dressings at high‑risk contact points, strap or fixation retensioning, scheduled device repositioning or offloading, moisture and heat control, and early device removal when no longer clinically necessary.^6,7 Protocols also embed interprofessional roles (eg, respiratory therapy adjusting mask fit, nursing monitoring skin and microclimate, physical therapy supporting positioning, physicians reevaluating device indications) to ensure that prevention does not depend on a single discipline.^6,5

Skin inspection must literally reach under and around devices. When visualization is limited, as in the case of immobilization devices, documented checks of adjacent areas and consideration of temporary “device holidays” guided by the care team can still reduce cumulative load.^2,5 In addition, fit testing should not be considered a one‑time event: changes in edema, weight, or sedation can convert a previously safe interface into a hazardous one. Securement should minimize shear and “tourniquet effect,” using anchoring points that distribute load more broadly; switching to softer, wider ties or fixation, and avoiding excessive strap tension when a good seal is already achieved, are practical adjustments.^2,5

Prophylactic dressings are frequently included in strategic bundles. Reviews note that silicone‑bordered foam and similar low‑friction, low‑shear dressings can reduce contact stress at masks, tubing, and collar edges, especially when combined with fit optimization and moisture control.^6,7 Dressings are not substitutes for offloading, however, and must be applied in ways that do not impede device function. Microclimate also matters; trapped heat and humidity under devices degrade skin tolerance, and strategies such as moisture‑wicking interfaces, periodic drying, and timely replacement of damp materials can help address these issues to mitigate addition MDRPI risk.^2,5,7

Education, audit, and feedback sustain prevention efforts over time. MDRPI‑specific training, including using device photos, pressure maps, and case reviews, builds shared mental models so that early detection can trigger action rather than watchful waiting. Evidence from protocol implementation studies suggests that standardized bundles are associated with reductions in MDRPI, though heterogeneity in study design and outcome definitions warrants cautious interpretation and ongoing quality improvement.^6,7

Across the continuum, the same principles apply: in the emergency department, prevent damage during the high‑throughput, high‑device‑intensity window; in the ICU, pair device checks with sedation or ventilator bundles; on wards and in long‑term or home settings, protect skin from oxygen cannulae, feeding tubes, catheters, and compression interfaces that may persist for weeks. Documentation should identify the device, location, earliest observed changes, and actions taken; consistent nomenclature improves surveillance and handoffs.^2,5 Ultimately, MDRPI prevention is the sum of small, reliable practices—seeing under devices, fitting them thoughtfully, protecting microclimate, and offloading whenever safely possible—delivered by teams working from shared protocols and data.^2,5-7

References
1. Jackson D, Sarki AM, Betteridge R, Brooke J. Medical device-related pressure ulcers: A systematic review and meta-analysis. Int J Nurs Stud. 2019;92:109-120. doi:10.1016/j.ijnurstu.2019.02.006

2. Pittman J, Gillespie C. Medical Device-Related Pressure Injuries. Crit Care Nurs Clin North Am. 2020;32(4):533-542. doi:10.1016/j.cnc.2020.08.004

3. Zhang N, Li Y, Li X, et al. Incidence of medical device-related pressure injuries: a meta-analysis. Eur J Med Res. 2024;29(1):425. doi:10.1186/s40001-024-01986-2

4. Gou L, Zhang Z, A Y. Risk factors for medical device-related pressure injury in ICU patients: A systematic review and meta-analysis. PLoS One. 2023;18(6):e0287326. doi:10.1371/journal.pone.0287326

5. Çakar V, Karadağ A. Best Practices in Medical Device‑Related Pressure Injuries. J Educ Res Nurs. 2024;21(4):350‑356.

6. Lee H, Choi S. Protocols and their effects for medical device-related pressure injury prevention among critically ill patients: a systematic review. BMC Nurs. 2024;23(1):403. doi:10.1186/s12912-024-02080-y

7. Lyu Y, Huang YL, Li ZY, Lin F. Interventions and strategies to prevent medical device-related pressure injury in adult patients: A systematic review. J Clin Nurs. 2023;32(19-20):6863-6878. doi:10.1111/jocn.16790