Skin tears

  1. 0 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
  2. Enjoy this?

    Join thousands and get our weekly Nursing Insights newsletter with the hottest discussions, articles, and toons.

  3. Visit  sharann profile page

    About sharann

    From 'california'; 46 Years Old; Joined Feb '01; Posts: 1,842; Likes: 206.

    20 Comments so far...

  4. Visit  Traveler profile page
    0
    How about Neosporin, Telfa, and wrap with stretch gauze? You're right, removing the opsite could cause another tear.
  5. Visit  Fiona59 profile page
    0
    I've only ever seen our "opsite" type product used to cover a blood blister on the elderly. The skin tear one is a biggie in LTC. Usually its cleanse, a non adhesive type (right now I'm thinking Mepitel, but I know its not that one),dressing with kling to hold it secure. When they're on Coumadin, it can take forever to stop the bleeding and get rid of the dressing. One gentleman, took 8 weeks before we could d/c the dressings.
  6. Visit  kids profile page
    0
    Oclusive dressings for skin tears are the standing order at the LTCs/SNFs in my area.

    The wound needs to be cleaned, aproximated, covered with the occlusive dressing and left alone. Only change the dressing when it comes loose on its own. I've seen the same dressings left in place for as long as 2 weeks.
    Blood trapped under the dressing can make it difficult to visulize the wound and turn green as it (the blood) breaks down so it is important to observe the skin surrounding skin for infection.

    In my experience skin tears heal faster and with less scaring in the moist environment of an occlusive dressing as opposed to dry dressings.
    Another reason I prefer occlusive dressings to dry is that in skin tears that have a flap the occlusive dressing will often get the flap to reattach where with a dry dressing the skin will die and slough leaving a larger wound bed to heal.
  7. Visit  letina profile page
    0
    We have seen optimum results from Mepitel, secured with an absorbent secondary dressing and slinky bandage. It can be left insitu for up to 7/10 days. Tip : moisten your gloves with sterile water or saline before handling the Mepitel, this will prevent it from sticking to your gloves when handling
  8. Visit  suzanne4 profile page
    0
    Opsite works fine over skin tears, but it should be left in place until it comes off, not removed by nursing. Have seen very good results with it. As stated above, it is best to put this on, then stand back and leave them alone. Something that we find hard to do.....at times.
  9. Visit  leslie :-D profile page
    0
    Quote from kids-r-fun
    Oclusive dressings for skin tears are the standing order at the LTCs/SNFs in my area.

    The wound needs to be cleaned, aproximated, covered with the occlusive dressing and left alone. Only change the dressing when it comes loose on its own. I've seen the same dressings left in place for as long as 2 weeks.
    Blood trapped under the dressing can make it difficult to visulize the wound and turn green as it (the blood) breaks down so it is important to observe the skin surrounding skin for infection.

    In my experience skin tears heal faster and with less scaring in the moist environment of an occlusive dressing as opposed to dry dressings.
    Another reason I prefer occlusive dressings to dry is that in skin tears that have a flap the occlusive dressing will often get the flap to reattach where with a dry dressing the skin will die and slough leaving a larger wound bed to heal.
    opsites can stay on for a long time.
    duoderms are to be changed q3days; that was our policy.
    one time a duoderm was left on a patient's coccyx for close to 2 weeks and when it was removed, her ulcer was so much worse-it became necrotic with a lot of brown and yellow slough.
    we called up our wound consultant and she said that duoderms should be changed q3d, 5 days max.

    and whoever it was that was worried about opsite causing skin tear when removing, in 9 yrs i have never seen that happen.

    leslie
  10. Visit  sharann profile page
    0
    Quote from letina
    We have seen optimum results from Mepitel, secured with an absorbent secondary dressing and slinky bandage. It can be left insitu for up to 7/10 days. Tip : moisten your gloves with sterile water or saline before handling the Mepitel, this will prevent it from sticking to your gloves when handling
    What is this mepitel? Is is a gel like matrix? Clear. Is there another name for it? Thanks.
  11. Visit  Traveler profile page
    0
    <<and whoever it was that was worried about opsite causing skin tear when removing, in 9 yrs i have never seen that happen.>>

    I have seen it happen more than once especially on extremely fragile elderly skin. I based my recommendation on the fact that the question was posed by a nurse in the PACU. This patient is going to be in at least one other unit and I can almost guarantee that there won't be good communication about the skin tear. Five days down the road a nurse is going to see blood collected under the opsite and not be able to visualize the wound and will pull it off. That or well meaning family will do the same thing. In home health if we have a compliant patient/family we put it on, tell them to leave it alone and wait until it comes off on it's own.
  12. Visit  letina profile page
    0
    Quote from sharann
    What is this mepitel? Is is a gel like matrix? Clear. Is there another name for it? Thanks.
    Mepitel is a brand name but essentially it is a soft silicone primary wound dressing which is porous, semi-transparent, and low-adherent. The nature of the bond that forms between Mepitel and the skin surface is such that it can be removed with minimum pain and without damaging delicate new tissue.
    I'm not sure if there is another name for it but if you search google for 'mepitel' you may recoginise a similar product used in the US? It is widely used in the UK for the management of skin tears, with very good results.
  13. Visit  sharann profile page
    0
    Quote from Traveler
    <<and whoever it was that was worried about opsite causing skin tear when removing, in 9 yrs i have never seen that happen.>>

    I have seen it happen more than once especially on extremely fragile elderly skin. I based my recommendation on the fact that the question was posed by a nurse in the PACU. This patient is going to be in at least one other unit and I can almost guarantee that there won't be good communication about the skin tear. Five days down the road a nurse is going to see blood collected under the opsite and not be able to visualize the wound and will pull it off. That or well meaning family will do the same thing. In home health if we have a compliant patient/family we put it on, tell them to leave it alone and wait until it comes off on it's own.
    EXACTLY!!!!
    I am afraid of a few nurses down the line. I know I can't be responsible for everyone but I wondered if there was a way to avoid the opsite while still protecting the skin tear.
  14. Visit  sharann profile page
    0
    Quote from letina
    Mepitel is a brand name but essentially it is a soft silicone primary wound dressing which is porous, semi-transparent, and low-adherent. The nature of the bond that forms between Mepitel and the skin surface is such that it can be removed with minimum pain and without damaging delicate new tissue.
    I'm not sure if there is another name for it but if you search google for 'mepitel' you may recoginise a similar product used in the US? It is widely used in the UK for the management of skin tears, with very good results.
    Thank you letina
  15. Visit  RN8499 profile page
    0
    I have seen all sizes of skin tears and in the 15 years of nursing have seen excellent results with closing them with butterflies. Usually the small ones. Cover with telfa and kling. The next day take off telfa and leave to air. I never saw one infect and the butterflies fall off as the tear heals. Keep them dry.Opsite and such always come off and they smelled bad . Of coarse if you have no skin to close then you have no other choice . Yes the skin is so fragil on the elderly. Good luck


Nursing Jobs in every specialty and state. Visit today and find your dream job.

Top