Device-Related Pressure Injury Risk: Key Insights from the EPUAP 2025 Guidelines

EPUAP 2025 Guidelines: why DRPIs remain a growing clinical challenge

Device-Related Pressure Injuries (DRPIs) continue to pose a significant and evolving challenge in all healthcare settings and is reflected in the European Pressure Ulcer Advisory Panel (EPUAP) 2025 International Guidelines published on 16 September 2025. While much of the existing literature focuses on the acute and critical care settings, there is growing recognition that it’s also highly prevalent in community and care home settings.

EPUAP 2025 definition of Device-Related Pressure Injuries

The EPUAP (2025) guideline defines Device-Related Pressure Injuries as the localised damage to the skin or underlying tissues resulting from sustained mechanical loading exerted by devices applied for diagnostic or therapeutic purposes.

Common medical devices associated with pressure injury risk

These include:

• Oxygen delivery systems
• Catheters
• Splints
• Monitoring equipment

How Device-Related Pressure Injuries differ from traditional pressure ulcers

Unlike conventional pressure injuries over bony prominences, these injuries often mirror the shape or design of the device due to concentrated pressure and shear forces at the skin-device interface (Heywood et al., 2023). Devices can trap heat and moisture, therefore increasing susceptibility to tissue damage.

Recognising mucosal pressure injuries in clinical practice

In addition, mucosal injuries may occur due to devices such as endotracheal tubes and urinary catheters, which are often overlooked in routine assessments. DRPIs differ from traditional pressure injuries, which are more commonly associated with bony prominences, and therefore it is very important that this is recognised in skin and risk assessment and then in any care planning.

Good Practice Statement 

“DRP12: It is good practice to regularly assess for signs of early skin, tissue, and mucus membrane injury by checking underneath and around medical devices and their securements.”  

EPUAP, 2025

Incidence and prevalence of Device-Related Pressure Injuries

The evidence in the literature suggests there is an incidence rate of approximately 19% in adult critical care populations, which aligns with wider systematic reviews evidence reporting incidence and prevalence rates of approximately 10–12% across healthcare environments (Jackson et al, 2019).

Which patients are most at risk of DRPIs? 

Certain groups are particularly vulnerable to DRIPs, including:

• Critically ill adults
• Neonates
• Paediatric patients

Device-Related Pressure Injury risk in paediatric populations

In the paediatric populations, the common anatomical location for DRPIs include the face, head, ears, and areas where respiratory and monitoring devices are usually applied (EPUAP, 2025).  

Challenges of preventing DRPIs in Community and Care Home settings

Patients nursed in their own homes present unique challenges in DRPI prevention due to reduced professional supervision, reliance on informal carers, and environmental constraints. Barriers such as inconsistent advice from professionals, carer fatigue, and limited resources can contribute to inadequate monitoring of devices and skin integrity (Roddis et al., 2023). These findings emphasise the need for age-specific and environment-specific prevention strategies. 

Intrinsic risk factors for Device-Related Pressure Injuries 

Risk factors for DRPIs can be divided into intrinsic and extrinsic elements. Intrinsic factors include:

• Advanced age,
• Co-morbidities such as diabetes
• Peripheral arterial disease
• Impaired sensation
• Poor nutritional status
• Reduced mobility
  
  (Gou et al., 2023). 

Extrinsic risk factors: device fit, duration and monitoring 

Extrinsic factors include:

• The duration of device use
• Poor device fit
• Inadequate monitoring

Good Practice Statement 

“DRP13: It is good practice to reduce and/or redistribute pressure at skin-device interface by:

• Removing the medical devices as soon as medically feasible
• Regularly repositioning the medical device, its securements and/or the individual
• Physically supporting the medical device in order to minimise pressure and shear
• And/or alternating the type of device in use when possible”

EPUAP, 2025 

Prevention of Device-Related Pressure Injuries: key recommendations from EPUAP 2025 

The EPUAP (2025) guideline highlights several key prevention strategies. First, careful selection and fitting of devices are essential. Devices should be selected based on their material properties, design, and ability to conform to the patient’s anatomy to minimise pressure points. Devices should be appropriately sized and designed to minimise pressure and conform to the patient’s anatomy. Secondly, regular monitoring of device placement and skin condition is crucial. Clinicians should frequently reassess device positioning and make adjustments in response to physiological changes such as limb oedema or weight fluctuations. Evidence from nursing literature supports this, indicating that ill-fitting or rigid devices significantly increase the likelihood of tissue damage (Çakar and Karadağ, 2024). 

Incorporating device checks into routine skin assessment

 The monitoring of medical devices should be part of all routine skin inspection. Areas underneath and around devices must be examined systematically to ensure early identification of tissue damage. Evidence demonstrates that failure to assess these areas can result in delayed detection and poorer outcomes. 

Organisational strategies to prevent Device-Related Pressure Injuries

Organisational factors also play an important role in DRPI prevention. The availability of appropriately sized devices, staff training, and guidelines linked to evidence-based practice are essential components of effective prevention strategies (Çakar and Karadağ, 2024).

The role of staff training and clinical guidelines in DRPI prevention

Guidelines and timely care planning have been associated with reduced incidence and improved patient outcomes, reflecting the importance of system-level support (Goswami et al., 2024).

Reducing Device-Related Pressure Injuries: a call for proactive prevention 

In conclusion, Device-Related Pressure Injuries are a significant patient safety issue requiring targeted prevention strategies. The EPUAP (2025) guideline provides a comprehensive framework that emphasises individualised care, proper device management, and multidisciplinary collaboration. When supported by current research evidence, these principles can lead to improved patient outcomes and a reduction in DRPI incidence across healthcare settings.

Please cite as: OSKA Care Ltd. (June 2026). Device-Related Pressure Injury Risk: Key Insights from the EPUAP 2025 Guidelines. Havant, Portsmouth: OSKA Care Ltd. 

References 

Anwar, D. and Naidoo, V. (2026) The Silent Threat: Incidence and Prevalence of medical device-related pressure injuries in critical care units. A Systematic Review. Journal of Intensive Care Medicine. https://doi.org/10.1177/08850666261426336

Çakar, E. and Karadağ, A. (2024) Best practices in medical device-related pressure injuries. Journal of Education and Research in Nursing, 21(4), pp. 350–356. DOI: 10.14744/jern.2024.79158

Goswami, A. et al. (2024) Medical device-related pressure injury and associated factors among ICU patients admitted in Intensive Care Units a tertiary care teaching hospital. Library Progress International, Vol.44, No.4, P.1149-1155. https://bpasjournals.com/library-science/index.php/journal/article/view/3881/3600

Gou, L. Zhang, Z. and Yongde, A. (2023) Risk factors for medical device-related pressure injury in ICU patients, A systematic review and meta-analysis. PLOS One. Available at https://doi.org/10.1371/journal.pone.0287326

Heywood, N. et al. (2023) The prevention of medical-device related pressure ulcers in a critical care unit. Wounds UK, Vol 18 | No 2 | 2022. Available at chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://wounds-uk.com/wp-content/uploads/2023/02/69a877bf2a0f57536859dc9afb8d8845.pdf

Jackson, D. et al. (2019). Medical device-related pressure ulcers: a systematic review and meta-analysis. International Journal of Nursing Studies, 92, pp. 109–120. Available at https://www.sciencedirect.com/science/article/abs/pii/S0020748919300379?via%3Dihub

Roddis,J. et al., (2024). Barriers and facilitators to pressure ulcer prevention behaviors by older people living in their own homes and their lay carers: a qualitative study. BMJ Open, DOI:10.1136/bmjopen-2023-080398

European Pressure Ulcer Advisory Panel (EPUAP), National Pressure Injury Advisory Panel (NPIAP) and Pan Pacific Pressure Injury Alliance (2025). Device-related pressure injuries guideline https://www.internationalguideline.com/the-international-guideline