Barrier Cream on a Skin Tear?

[kparry]

Any reasons not to put Barrier Cream (20% zinc oxide in petrolatum base) on a skin tear?

What I'm hearing is band-aids and diaper creme are within policy for CNA's to apply. So they are using it on everything. (When all you have is a hammer everthing looks like a nail...)

I recently had to clean a pretty thick layer of it off a 25mm x 35mm skin tear where the CNA had trimmed away the flap of skin herself because "it wouldn't stretch back over wound."

That issue aside, what and when are the negatives of zinc-oxide and petrolatum on wounds?

[CapeCodMermaid, RN]

Yowza!!! Your CNAs are cutting skin flaps off skin tears?? I'd fire someone for doing that. The skin needs to be kept somewhat moist and clean. Zinc oxide would not help healing at all and bandaids don't do good things to old skin.

[caliotter3]

Wherever I have been, the CNA's brought broken skin to the attention of the nurse.

[VivaLasViejas, ASN, RN]

We always try to approximate the edges with steri-strips, but if there's a skin flap we can't do anything with, we simply cleanse the wound gently with NS and cover with a nonstick pad, then secure with a stockinette (instead of tape) and change the whole thing daily. This way the wound is protected, and yet gets some air circulation.

I'm not a fan of using any kind of cream or ointment on skin tears. If you put ABX ointment on them, they get macerated, and if you put zinc oxide on them, they dry out but don't heal well. And no one at my building is allowed to sustain a skin tear without my knowing about it---this requires an incident report and alert charting.

[laderalis]

I agree with the above. I would be livid if someone (aid or nurse) did that!

we use steri-strips, a non adherent dressing and wrap with something so no tape is used on the skin directly. its usually changed daily. if it is not draining, sometines we'll use an opsite/tegaderm over it so we can monitor it w/out having to remove a dressing every day.

[SRK77]

I can't even begin to imagine a CNA trimming off skin that wouldn't stretch back. I clean skin tears with normal saline. Apply steri-strips. Cover with Telfa and secure with Kerlix and monitor daily for s/s of infection. I have seen some nurses apply steri-strips, cover with tegaderm and then change q 3 days instead of just monitoring. When they change the tegaderm, it just pulls off the steri-strips and reopens the wound. But I am definitely fine with tegaderm for monitoring.

[kparry]

Thank you for the insightful input. Unfortunately, CNA's are allowed by policy to apply ZnO, and Band-Aids. So they combine the liberties and apply both to every cut scrape or skin tear they find. It seems like common sense not to do this.

I didn't write the policy manual, don't own the facility, and really have no idea how to fix this. I feel a little bit better knowing most agree that ZnO isn't the best thing for wounds. But I doubt the DoN will accept forum posts as evidence based best practices. There are times when I just plain want to give up.

[CompleteUnknown]

Maybe the band-aids are more of a problem than the zinc oxide cream? I've worked in several facilities but never one where band-aids were allowed, I'm really surprised by that. They're not at all kind to fragile skin, they either get wet and stay wet thus macerating the skin underneath or stick so firmly that you can't get them off without causing more problems.

I wouldn't put zinc oxide on a minor skin tear, but I do often put it on the 'good' skin to prevent maceration. Having said that, I think the other thing to keep in mind is that most minor skin tears are going to heal no matter what is put on them, especially if it's something small enough to be covered by a band-aid or two.

What size and severity of skin tear are we talking about here?

[CapeCodMermaid, RN]

Have your DON ask a WOCN....they are all about evidence based practice.

[Kabin]

A lot of times less is more with skin tears. After a day or so covered I prefer to leave them open to air. The skin can more quickly dry, heal, and toughen up.

[gymrat33, LPN]

The new place I started also uses bandaides. I do not like that idea. We had one skin tear that they were changing 3 times a day. I think that is too excessive. In my past experience, the more you mess with the wound/skin tear, the more irritated it becomes. I think the most you should change it is once daily and prn if drainage is excessive. Also Allevyn and tegaderm works well if steri strips are not required. Steri strips tend to tear the skin even more. The cna's not telling you about the skin tears is not good practice and if it should get infected, thats on you, not them. I would require that they tell you about each and every one.

Good luck!!

[Havin' A Party!, ASN, RN]

Tegaderm -- change every 3 days and PRN.