Development and Preliminary Validation of a Central Venous Access Device-Associated Skin Impairment Classification Tool Using Modified Delphi and Clinimetric Methods.

The tool was developed and preliminarily tested by the same seven expert nurses, so raters already understood the wording and categories. Reliability was tested only on 38 clinical photographs, not in real clinical practice with live patient assessment. The photographs came from cancer patients in acute-care hospitals, so results may not apply to other settings or patients without cancer. No photographs included darker skin tones, and no neonatal or younger paediatric cases were tested. The tool does not give an overall CASI severity score; severity ratings apply only to pressure injuries and skin tears. Allergic dermatitis had the lowest agreement, and the panel noted that photographs could not capture palpation, culture results or patient symptoms.

The authors declared no conflicts of interest. The study was funded by the National Health and Medical Research Council.

Do not assume this tool has been shown to work in routine nursing assessment. It was tested only by seven expert nurses rating 38 photographs, not in real clinical practice, and it lacked images from darker skin tones and neonates.