Skin tears Skin tears - pg.2 | allnurses

Skin tears - page 3

I need some advice re: skin tears. Occasionaly in the PACU we come across a patient, usually very old and frail with that delicate arm skin that tears from the slightest rub. They come out from O.R... Read More

  1. Visit  steelcityrn profile page
    0
    For almost all skin tears i use aseptic technique and wash with soap /h2o and pat dry. I sometimes need to apply antibiotic ointment, only if site is reddened. Then a telfa and kerlex wrap, paper tape or hyperflex tape to secure. Mepatil dressing is very expensive, and I have only used it or seen it used for chronic blistering skin diseases. Mepatil is only changed once a week, outer dressing with 4x4 and kerlex twice a week, usually
  2. Visit  NRSKarenRN profile page
    0
    In elderly with fragile skin, tear occurs due to "shearing forces" especially those individuals on anticoagulants and steroids.

    Only preventive is applying liberal moisturizing lotion to skin before placed on stretcher/ table. Lifting with a drawsheet, instead of sliding patient helps too but this isn't always practical. On buttocks and arm area, many patients respond well to Vitamin A+D ointment.-- I used it so much you'd think I would have stock in company. :chuckle

    Agree about the tegraderm too.


    Learned something new--Mepitel link:
    http://www.dressings.org/Dressings/mepitel.html
    Last edit by NRSKarenRN on Feb 15, '05
  3. Visit  MikeLPN profile page
    0
    I use our wound cleanser for an initial cleaning and then blot it dry while coaxing the remaining skin edges into approximation using swabs if need be - especially if the skin rolls under. Then I apply steri-strips cut to a decent length and try to match up the edges as best I can applied starting from the center to the edges. Apply a telfa and roll gauze over that and set up a tx to remove that in AM and monitor the steri strips bid til healed.

    I think the most important thing is to get it clean and the edges lined up real close as soon as you can. A skin tear is superficial and the skin is by itself an excellent covering. The steri strips fall off on their own hopefully after holding the edges together for a long time leaving a small scar.

    Our wound care product rep advised us to use tegaderm or opsite or whatever and change every 3-5 d. and I did try that once and it took forever to heal. So I switched back.
    Last edit by MikeLPN on Feb 15, '05
  4. Visit  CoffeeRTC profile page
    0
    Look at your policy first. First off prevention is key.
    Our LTC keeps things cheap and simple. Our policy is to clean with normal saline, apply curagel (cheapes wound gel) apply skin prep to peri wound cover with transparent dressing and change every 3 days.

    If it is a resident that can't tolerate the transparent dressing or it is bleeding and moiste....if clean...we clean with NSS, apply A&D cover with telfa wrap with cling change q day. or if infected looking use triple abt ointment.

    These methods both work well. I like the transparent dressing better..saves time with changes and heals quicker. Also easier to check and see the wound.

    As far as duoderms...if we use them..mostly for prevention, we use the thins..change them every 5 days or prn for dislogment or soilage.
  5. Visit  rln profile page
    0
    Quote from sharann
    I need some advice re: skin tears. Occasionaly in the PACU we come across a patient, usually very old and frail with that delicate arm skin that tears from the slightest rub. They come out from O.R sometimes with a tear that we suspect is r/t the move from the table to the gurney/bed. My co-workers ar crazy about sticking on an "opsite"(clear occlusive IV site size dressings)on them. I belive this will cause more problem when removed(plus it would hurt like heck). I may be wrong, so please educate me
    Cleanse with NS, approximate the edges, then cover with opsite. Leave it there until it falls off. If worried about the opsite being removed when the pt is transferred to another unit, give a good report and that should not happen. Have had good results with this practice.
  6. Visit  Nurse Hatchett profile page
    0
    We have used vaseline guaze, covered with non stick telfa and roll guaze, chg q 3 days on a lady who rec'd humongous skin tears if you looked at her wrong.
    Also bacitracin with non stick telfa and roll guaze works well for us, changed QD or BID
  7. Visit  studious profile page
    0
    Vaseline gauze has it's place but new research suggests that the skin can actually start to granulate throught he holes in the gauze. So I suppose it would be a matter of how long the gauze is in place.
  8. Visit  sharlynn profile page
    0
    [QUOTE=MikeLPN]I use our wound cleanser for an initial cleaning and then blot it dry while coaxing the remaining skin edges into approximation using swabs if need be - especially if the skin rolls under. Then I apply steri-strips cut to a decent length and try to match up the edges as best I can applied starting from the center to the edges. Apply a telfa and roll gauze over that and set up a tx to remove that in AM and monitor the steri strips bid til healed.

    At my facility we find paper tape strips work just as well with no cost to the patient!

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