Frequent dressing change and use of tape

[Milkchoco]

I would like to ask if I can use tape (Medipore) to fix dressings in place, if I need to change dressing for a patient 3 times a day; she has a pressure ulcer stage 3 in sacrum-coccyx area with no signs of infection or slough/necrotic tissue. The surrounding skin is in good condition. Thank you so much for your replies.

[NMRN2017]

Tape is often a necessary evil. If skin is intact, not fragile and no allergies to tape are seen, then yes, minimal tape is often necessary. Just use caution when removing it so as not to damage skin.

Good luck!

[vampiregirl, BSN, RN]

I've found Medipore to be pretty gentle to skin... if removed with caution. I also try to vary my taping patterns. If the skin starts to show signs of irritation or breakdown, a skin barrier/ prep can be helpful.

[Turtle in scrubs]

For skin protection (before tape application), I like Cavilon No Sting Barrier Spray. I would recommend using this (or another skin barrier) to clean, dry skin before applying tape.

If skin is impaired and it is a sacral injury you could also skip the tape by securing dressing with underwear. In acute care setting if you have access to mesh/disposable panties, those work nicely.

But I can't help wondering why the patient needs dressing changes 3 times a day. It is highly exudative? Is it a wet to dry dressing?

[rkitty198, BSN, RN]

For skin protection (before tape application), I like Cavilon No Sting Barrier Spray. I would recommend using this (or another skin barrier) to clean, dry skin before applying tape.

If skin is impaired and it is a sacral injury you could also skip the tape by securing dressing with underwear. In acute care setting if you have access to mesh/disposable panties, those work nicely.

But I can't help wondering why the patient needs dressing changes 3 times a day. It is highly exudative? Is it a wet to dry dressing?

This. The wound in an early phase might drain like this but should require only daily changes or q3day changes if the right product is used. We love using aquacel with abd pads and changing the pads prn. We also use allevyn dressings because they are waterproof, which if the patient has stool or urine they can be wiped off.

[jbudrick, MSN]

Another option is Montgomery straps. If you really need to change the dressing three times daily, this is low cost way to to keep the dressing in place and reduce skin damage. Best wishes.

Diana

[Wound Nurse - Sales]

Placing and removing tape 3x day??

I remember reading a study that stated wound healing is set back 4-6 hours per dsg change

(I am sure there is someone on here smarted than I that can elaborate of this statement)

Is excessive drainage the reason? if so, Previous post Montgomery straps excellent idea for tape trauma.

Also there are a ton of products that will handle 500 - 800 ml of drainage.

Incontinence soiling dressing?

Consider covering dressing w/ transparent file (Tegaderm)

Educate staff to wipe center of dressing out (to prevent rolling up of film)

[carrie276]

If the wound is clean, maybe a wound vac is appropriate

[Ellekat2]

Has a culture been obtained to rule out infection? It sounds like the wound has excessive exudate. Changing the drsg TID seems excessive. We tend to change dressings every other day in the inpatient setting, longer in outpatient. Most foams can be left up to a 7 days on most wounds, 5 days on sacral wounds

We have excellent results with Cavilon Skin Barrier (spray, "lollipop", or 2x2) and Medipore tape. For delicate skin or allergies to adhesives, we usually use a border foam. There is silicone-based tape available separately, but it might be cost-prohibitive.

[hppygr8ful, ASN, RN, EMT-I]

This. The wound in an early phase might drain like this but should require only daily changes or q3day changes if the right product is used. We love using aquacel with abd pads and changing the pads prn. We also use allevyn dressings because they are waterproof, which if the patient has stool or urine they can be wiped off.

I am actually dealing with a dehisced abdominal wound of my own and the wound Dr. told me to change dressing every other day unless there is a lot of exudate then daily but not more often. I am doing this by myself at home so I can't actually see the wound well. The wound care clinic sees me twice a week and will soon be putting a wound vac on.

But even when I was doing wound care in the nursing home and home care multiple dressing changes a day were not warranted and actually impaired healing. The only thing I can think of in this case is if the dressing is being compromised by feces.

Hppy

[jennivesterLPN2RN]

This. The wound in an early phase might drain like this but should require only daily changes or q3day changes if the right product is used. We love using aquacel with abd pads and changing the pads prn. We also use allevyn dressings because they are waterproof, which if the patient has stool or urine they can be wiped off.

Ditto!