How To Remove Tape That Is Stuck To Skin
Combining skill and cognition ensures prophylactic removal.
Takeaways:
- Improve your knowledge on how to remove medical tape or wound dressings
- Discover products and strategies to ease the tape removal experience for your patients
By Ann-Marie Taroc, MSN, RN, CPN
All nurses have struggled with removing pressure sensitive adhesives (PSAs)—medical tape, plastic bandages, wound dressings—from fragile pare, next to healing wounds, or from sites of frequent reapplication. For some patients, removal can cause medical agglutinative–related peel injury (MARSI), which presents every bit persistent erythema, skin stripping, blisters, or bleeding. (See Who's at run a risk for MARSI.) And other patients may feel broken-hearted because of previous experiences with painful PSA removal.
Who's at risk for MARSI?
Patients with delicate or frail skin are at risk for medical agglutinative–removal skin injury (MARSI). These patients volition have a weakened connection between pare layers that may exist injured when pressure-sensitive adhesives are removed. Earlier first removal, consider these patient factors:
• Newborns —The connection between the epidermis and dermis is weaker than in adults.
•Older adults—Equally people age, the skin structure weakens and loosens, resulting in separation of the skin layers upon agglutinative removal.
•Medications—Some drugs, such equally corticosteroids, can cause thinning of the skin, which increases a patient's risk for MARSI and delayed healing.
•Malnutrition and dehydration—Patients who are malnourished or dehydrated may have weakened pare integrity.
Our understanding of PSAs and their removal tin can help prevent harm and patient anxiety. This article will look at the qualities of PSA adhesives and backings, explain the principles of removal, and discuss products that help removal.
PSA adhesives and backing
The skin'southward surface qualities—moisture, hair, oil, and shedding dead cells—make PSA adhesion challenging. PSAs are designed to overcome these challenges, while balancing successful adherence and easy removal. Both the adhesive side of the PSA as well as its backing material play a office in adherence and removal.
Agglutinative
Acrylate, silicone, and hydrocolloid are three unremarkably used adhesives. They each work in different means. (See Comparing adhesives.)
As acrylate adhesive warms, it fills in the peel's rough surfaces. Many medical tapes and some dressings incorporate acrylate with varying levels of adhesion, making some easier to remove than others. Some strongly adhering acrylates place patients at take chances for MARSI.
Silicone adhesives—found in wound dressings and record—adhere to the rough surfaces of the peel at initial application. This low-energy connection separates easily from the skin. Because it hands detaches, silicone PSAs aren't advisable when adhesion is disquisitional, such as when securing an endotracheal tube.
The adhesion of hydrocolloid products increases with time, creating the same level of risk for MARSI as a well-adhered acrylate. Detachment requires a combination of manipulating the PSA bankroll and dissolving the adhesive.
Comparing adhesives
Bankroll
PSA backing materials also bear upon removal. To separate the PSA adhesive from the skin, we take to distort the bankroll by stretching or pulling. The challenge with stretching, however, is our ability to maintain directional command. In the presence of hair, a wound, or a catheter, nosotros don't desire to cause discomfort, distortion, or dislodgment. Consequently, the removal process nosotros select includes assessing both the adhesive and bankroll of the PSA also as the presence of whatever object we don't want to disturb.
Principles of PSA removal
You have ii options for PSA removal: low and slow or distortion. With low and deadening, pull back the PSA at a low horizontal angle, away from the corner or edge, separating it from the skin. Distortion requires stretching the PSA backing to shear the adhesive from the skin. However, PSA removal is more than selecting 1 of two procedures; it requires understanding the core principle of supporting the skin while correctly detaching the production.
Skin is a soft and flexible organ that moves and bends in the direction we pull. Pulling off a PSA at a vertical angle creates the greatest strength, just it may injure pare and distort a healing incision. Consequently, you lot must support the pare with your hands by anchoring the adhesive on the dressing (when stretching) or the newly exposed skin (when peeling back). A low bending of peel requires less strength to separate adhesive from skin, which you attain with either process by keeping the PSA low and close to the surface. The goal is to avoid MARSI past minimizing the amount of force needed for detachment.
Agglutinative-removal products
Silicone-based adhesive-removal products are the all-time choice for aiding PSA removal. They evaporate, go out no residuum on the skin, and are non noted for causing dry pare. If you don't have admission to silicone-based products, other options include water, alcohol, or emollients. Understanding the pros and cons of each will help you lot choose the right solution.
H2o may be hands attainable, but it tin can weaken h2o-permeable PSA backings, separating them from the adhesive but not affecting its connection to the skin, leaving backside a sticky residue. Booze, on its ain or combined with an antiseptic like chlorhexidine, tin solubilize an agglutinative, making it easier to detach. However, alcohol evaporation causes vasoconstriction and dries the skin. In contrast, emollients, such every bit mineral oil or lotions, facilitate separation of adhesive from the pare, causing no impairment. Unfortunately, emollients may separate the adhesive from the backing and leave a glutinous residue.
To ensure successful use of agglutinative-removal products, follow production instructions. For case, an adhesive-removal product made with an odorless mineral spirit tin can effectively dissolve the adhesive for hurting- and injury-free removal. However, if you don't follow the production instructions to wash off any remaining product with soap and h2o, the patient's skin may dry out and scissure.
Removal products aren't appropriate in all cases. For case, they may be contraindicated in the presence of dermal glue or in close proximity to an incision.
Case report:
Depression and irksome prevents injury
Joe Roberts, a sixty-yr-erstwhile human with type 2 diabetes, is gear up for discharge from the hospital. His nurse, Alice, must showtime discontinue his peripheral intravenous (PIV) catheter. Mr. Roberts is eager to go out and asks Alice to bustle.
Alice notes that the cannula is well secured with a transparent polyurethane dressing. Mr. Roberts' pare is dry and loose. During shift handoff, Alice learned that Mr. Roberts has peripheral neuropathy. She understands that removal of the PIV will crave knowledge and skill to prevent MARSI.
As with removal of any PSA, the start edge is the most challenging. Alice chooses to use an adhesive-removal product. Because transparent polyurethane dressings are water-resistant, Alice applies the removal product liberally, gently detaching a corner of the dressing from the skin. When she has the edge of the dressing in her mitt, she pulls information technology back low and dull. This technique gives Alice greater command and allows her to go on applying agglutinative remover, while supporting Mr. Roberts' skin. She removes the dressing from the edges toward the catheter, working with the direction of hair growth.
When Mr. Roberts grows impatient with the slow progress, Alice takes the opportunity for patient education, explaining that her arroyo to removing the PSA will prevent a skin wound that may be tedious to heal because of his diabetes.
Example study:
Alleviating patient anxiety
Nine-twelvemonth-erstwhile Emily Gray arrives in the emergency department for evaluation of a head laceration. Earlier assessment can begin, David, the emergency department nurse, must remove a big plastic bandage from Emily'south brow. Emily fearfully anticipates its removal.David recognizes that the acrylate adhesive foam-backed bandage, placed an hour ago, may not accept adhered well to the skin. However, he realizes that sharing this logic may do nothing to convalesce Emily'south anxiety.To make sure removal of the bandage goes equally smoothly as possible, David decides to use a removal assist. He chooses lotion because he doesn't have access to products specifically designed for adhesive removal. With patience and slow removal, he eases the bandage off. David and so cleanses the peel to remove any remaining balm. This hurting-free bandage removal may assist Emily feel less anxious about like situations in the future.
Combine knowledge and skill
PSA removal is a combination of skill and knowledge. No single solution fits every patient or care environment, and so understanding the qualities of various PSAs, the principles of removal, and the pros and cons of removal products helps ensure safe removal.
Ann-Marie Taroc is a staff nurse at Seattle Children'south Hospital in Seattle, Washington.
Selected references
Czech Z, Kowalczyk A, Swiderska J. Pressure level-sensitive adhesives for medical applications. In Akyar I, ed. Wide Spectra of Quality Control. Rijeka, Croatia: InTech; 2011; 309-32.
Denyer J. Reducing pain during the removal of agglutinative and adherent products. Br J Nurs. 2011;twenty(15):S28, S30-5.
Konya C, Sanada H, Sugama J, et al. Pare injuries caused past medical adhesive tape in older people and associated factors. J Clin Nurs. 2010;xix(9-10):1236-42.
Matsumura H, Ahmatjan N, Ida Y, Imai R, Wanatabe Thou. A model for quantitative evaluation of peel damage at adhesive wound dressing removal. Int Wound J. 2013;ten(3):291-iv.
Matsumura H, Imai R, Ahmatjan N, et al. Removal of adhesive wound dressing and its effects on the stratum corneum of the skin: Comparison of eight unlike adhesive wound dressings. Int Wound J. 2014;11(1):50-iv.
McLafferty Eastward. (2012). The integumentary system: Anatomy, physiology and function of skin. Nurs Stand up. 2012;27(3):35-42.
McNichol 50, Lund C, Rosen T, Grey M. Medical adhesives and patient safety: Country of the scientific discipline: Consensus statements for the cess, prevention, and treatment of agglutinative-related pare injuries. J Wound Ostomy Continence Nurs. 2013;40(4):365-eighty.
Reevell Yard, Anders T, Morgan T. Improving patients' feel of dressing removal in practice. J Community Nurs. 2016;30(v):44-9.
Salmanoğlu M, Önem Y. Diabetic foot: Even the most innocent may turn into a threat. Euro J Gen Med. 2014;11(ii):117-8.
Taroc A. Staying out of sticky situations: How to choose the right tape for your patient. Wound Care Counselor. 2015;iv(6):21-half dozen.
van Schaik R, Rövekamp MH. Fact or myth? Pain reduction in solvent-assisted removal of adhesive tape. J Wound Care. 2011;twenty(eight):380-3.
A guide for adhesive removal: Principles, practice, and products
Source: https://www.myamericannurse.com/adhesive-removal/
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