What is MARSI?
MARSI stands for Medical Adhesive-Related Skin Injuries – damage caused to your skin by medical adhesives, such as stoma appliances, bandages and medical tape. Everyone knows that removing plasters can be painful, especially if you have an area of skin which is sore (or hairy!). In basic terms, MARSI is similar to this but on a more severe level.
In medical terms, a MARSI is when the adhesive appliance removes superficial layers of skin cells, causing injury and pain and resulting in a loss of skin integrity. This is referred to as ‘skin stripping’. These layers of skin cells are part of the stratum corneum, the outermost layers of skin. Injury can also occur where the top layer of skin is separated from the epidermis, and this causes a deeper skin injury.
What are the affects of MARSI?
The skin’s main function is to act as a physical barrier against the external environment and prevent harmful substances and infections from entering the body. In addition, the skin acts as a moisture barrier, preventing excessive fluid gain or loss from the body.
With repeated use of medical adhesives, the skin may feel irritated or painful, and appear red or bleed. When the skin integrity is compromised, it takes longer to heal and is more susceptible to infection causing further damage that may require treatment.
Also, when the skin is damaged, it cannot adequately manage water balance. Trans epidermal water loss (TEWL) can occur, leading to a moist or wet area on the skin surface. Increased moisture can prevent the next adhesive appliance from attaching effectively which increases the possibility of leakage from an appliance such as a stoma, entering a cycle of further damage.
This can have a psychological impact due to pain, discomfort and stress.
Find out more from the British Journal of Nursing
How does MARSI affect stoma patients?
MARSI is a common issue with stoma patients because stoma appliances must have an effective adhesive to ensure that the flange and stoma bag stay in position. In addition, ostomates change their stoma appliances regularly, so the application and removal of the medical adhesive are regularly repeated. If this is not done with care, it can cause skin damage.
If the skin becomes moist or irritated, the adhesion of the stoma bag is more likely to be compromised, leading to increased chances of faeces or urine from the stoma leaking and coming into contact with the skin. This in turn causes more irritation and possibly infection, creating a cycle of skin damage.
This can be a prevalent stoma problem if you have a particularly active stoma, requiring frequent bag changes.
How to prevent MARSI
Your peristomal skin must be kept as intact and healthy as possible to prevent infections and pain, so remove your stoma appliances with care. This is particularly important if you have fragile skin – for example if you are elderly. Remember, the healthier the skin, the less likely you are to experience leaks and the easier your stoma will be to manage. Read more: Peristomal skin protection
Do not apply cream to the skin around the stoma as this can affect the adhesion of your stoma bag and cause further irritation.
Many products are suitable for ostomates to use to prevent MARSI, including:
- Medical adhesive remover spray or wipes
- Stoma barrier film spray or wipes
- Stoma seals
Let’s explore each of these in more detail.
Medical adhesive remover
Take care when removing your appliances, ensuring you do not remove them too quickly or harshly. To help with this, use medical adhesive remover spray or wipes for bag changes. These products are designed to allow you to remove the appliance easily with minimum force, plus they soothe the skin to keep it healthy.
Medical adhesive remover wipes are particularly helpful if you have a build-up of adhesive residue on your skin from adhesive appliances, seals or stoma paste. They can gently clean the residue off without harsh scrubbing, protecting the skin from damage. These are also handy to have in your bag or car to use whilst out and about because they come individually packaged.
If you use a lot of medical adhesive remover, a bigger spray may be more convenient for you, and more cost-effective for the NHS (and better for the environment because less packaging is needed).
Speak to your doctor or stoma nurse about medical adhesive remover as they can prescribe them for you. You can also request free samples to try out the products.
Stoma barrier films
If you have damaged skin around your stoma, your doctor may suggest you use a protective barrier film. These come in the form of stoma barrier sprays and stoma barrier wipes. This provides a ‘second skin’ to prevent peristomal skin from coming into contact with stoma output and to protect it from the effects of repeated medical adhesive removal. They also enhance adhesion to prevent leakage, allow your skin to heal properly and enable your stoma bag to last longer – overall, making life with a stoma much easier.
Stoma seals
Stoma seals can also help as a long-term solution. They are ring barriers which protect your skin against stoma output. These are particularly helpful for difficult-to-manage stomas, such as high-output, retracted or non-centred stomas. Ostoform’s FLOWASSIST is non-absorbent and has a funnel to direct output away from the skin and into the stoma bag. Speak to your stoma nurse to find out if this could be a suitable solution for you.
Conclusion
Stoma skin irritation is common but you don’t have to suffer. Speak to your stoma nurse or doctor if you are having problems with the skin around your stoma and they will help you.
If you are a medical professional and are interested in finding out more about StoCare products, please email info@rhodespharma.co.uk.
This information is for guidance and does not replace advice given by your healthcare professional.
