[2010RN]

I have a question about Tegaderm and Medipore. I am nursing student and have seen a few of my surgical patients get blisters under their tegaderm or medipore dressings. The blisters are always just under the inside perimeter of the dressing. My last patient had a blister that was about 4" long by 1-1/2" deep. One nurse said this happens because the patient is sensitive to the adhesive. Another nurse told me that the blisters are from the OR nurses putting the dressings on too tightly after the surgery thus causing a skin tear. Has anyone seen patients get blisters from their dressing and if so, what is the cause?

[NancyNurse08]

I haven't seen blisters, but I do see redness underneath the dressing occasionally. My understanding is that it's from the adhesive. Using a skin barrier ("lollipop") prior to placing the dressing seems to help.

[TazziRN]

It's not what the second nurse said. I've had a few pts react to both tegaderm and medipore tape, and it's as you described: just under the edge of the dressing. These were pts who were nowhere near the OR when the dressings were applied.

[Dolce]

Originally Posted by TazziRN

It's not what the second nurse said. I've had a few pts react to both tegaderm and medipore tape, and it's as you described: just under the edge of the dressing. These were pts who were nowhere near the OR when the dressings were applied.

I agree. Some patients have sensitive skin and react to the adhesive in the dressings. I have found that, compared to tape or other dressings, tegaderm is the least likely to cause a reaction. But, that is just my own experience.

[suanna]

Post operative tape and tegaderm blisters are caused by the dressing being put on in the OR when the patient & dressings are cold (ORs are chilly) and then, as the patient warms up post-op and has some 3rd spacing of thier IV fluids-thier skin to plumps back up. The skin expands/stretches but the dressing doesn't= blisters. To prevent this always loosen dressings & large tegaderms a couple of hrs post op.

[TazziRN]

Originally Posted by suanna

Post operative tape and tegaderm blisters are caused by the dressing being put on in the OR when the patient & dressings are cold (ORs are chilly) and then, as the patient warms up post-op and has some 3rd spacing of thier IV fluids-thier skin to plumps back up. The skin expands/stretches but the dressing doesn't= blisters. To prevent this always loosen dressings & large tegaderms a couple of hrs post op.

Then how do you explain my home care pts getting them when I am the first person to apply them, and the house is warm? Your explanation makes sense but it not the only one.

[suanna]

Originally Posted by TazziRN

Then how do you explain my home care pts getting them when I am the first person to apply them, and the house is warm? Your explanation makes sense but it not the only one.

Sure, tape and dressings can cause blistering/tape burn on a lot of patients for various reasons-adhesive sensitivity, fragile skin, rough removal but on post-op patients if you don't loosen the dressing almost every patient will get some blistering. The "plumping of the skin" can happen any time your patient gets bigger (fluid retention, drug reaction,fever...not just rewarming) and the dressing dosen't, it's just very common post-op. The cold to warm aspect is just a contributing factor, not the only reason.

[TazziRN]

Okay, makes sense, your post made it sound like it was the only reason.

[2010RN]

Thanks for the replies, I knew that I would find good answers here and if the blisters are preventible, I wanted to know what I could do to help my patients. I have only noticed the blisters on my post-op patients, not on other patients with the same dressings, so Suanna's explanation makes sense to me, and I will try loosening their dressing when I get them post-op. Thanks again!

[P_RN]

You see this a lot under casts and splints too. The skin is taut due to 3rd spacing/edema when the tape or whatever is applied. The tegaderm holds the skin in place "plumply." When the rest of the tissue goes back to normal turgor, it can't under the dressing.

I'm allergic to adhesives but usually just get bright red burned looking areas. I haven't gotten any blisters (yet.)