LPN taking wound care course; skin tear question

PsychNurseWannaBe, BSN, RN · Nov 24, 2011

It depends... is the skin tear well approximated?? Then steristrips to keep in place. If not approximated, it depends. I will use a tegaderm + pad if there is minimal drainage which is normally the case with a skin tear. If no drainage, then a tegaderm.

DOU RN · Nov 26, 2011

We use A&D and an adaptic dressing covered with kerlix and changed daily. We don't want to use any dressing that is going to pull up on the tear and make it worse.

oldiebutgoodie, RN · Nov 30, 2011

I don't recommend Tegaderm at all. Many folks getting a skin tear are elderly or with fragile skin from steroids, and trying to removed the Tegaderm can be impossible without causing more skin tears. I have seen patients from nursing homes covered with Tegarders, with wound fluid bubbling up and leaking out the sides.

For skin tears with a flap, just irrigate with normal saline, put the flap back down over the tear, and you can secure with Steristrip or put a non-adherent dressing on it, like a foam (Polymem), vaseline gauze, or Adaptic. You may only need to change dressing every 2 or 3 days. Telfa pads seem to stick, don't use them. Here is a good article on skin tears:

http://findarticles.com/p/articles/mi_qa3977/is_200005/ai_n8894280/?tag=content;col1

Oldiebutgoodie (certified wound RN)

PsychNurseWannaBe, BSN, RN · Dec 1, 2011

I only use a tegaderm if it is necessarily and definitely depends on how fragile their skin is. I had a guy that I used a tegaderm to create a smooth surface for when he put his pants on over the wound, it was protected. Never had a problem taking off a tegaderm unless their skin is super fragile. Learned that lesson early on.

tcarter6 · Mar 21, 2012

Hello,

I use steri strips if the edges can be approximated without heavy bleeding and they are to be left on until they come off by themselves. If not we have a few things we can use that is on our formulary. Derma Gel is a sheet dressing that is yellow in color and feels like gel. It is a primary dressing and requires a secondary, I use kling wrap. Change Q3-5 days. It is very cooling and soothing to the patient. Optifoam is another good dressing if a lot of drainage is noted. It is very good on fragile skin.

nursetiffany. · Jun 28, 2012

I HATE TEGADERMS!!!

Granted I work in LTC.

I use a lot of telfa.

woundnurse1 · Jun 29, 2012

Approximate and steri strips ....I hate tegaderm too..But check your facility policy.

rehabwoundnurse · Jan 30, 2013

Yes, Tegaderms and Duoderms are horrible! Very bad for the skin. Our protocol is Optifoam, change weekly. If someone has several skins tears, or extra thin skin; we use Xeroform and wrap with Kerlix, changed daily. I have seen very good results with the Optifoam weekly.

lorirn58 · Jan 30, 2013

NO TEGADERM. NO TELFA. NO ANTIBIOTIC OINTMENTS (skin tears do not tend to be or to get infected, why add abx??!). NO other adherent dressings.

Keep it simple for the simple skin tears (most of the ones you will see). Clean well with NS, pat dry really well, apply Calmoseptine or Calazime all around the skin tear up to the edges, vaseline gauze, a chunk of 4x4s, wrap and change every 3 days. They heal the fastest with this method.

mommy.19, MSN, RN, APRN · Feb 2, 2013

Impregnated gauzes work well, and one thing I have had great luck with as far as keeping dressings in place on limbs (skin tears are general on arms/legs but obviously can happen anywhere), is tubifast or surgilast, any type of tubular elastic dressing retainer. I generally try not to include any frequencies in our protocols, I try to let the wound characteristics and drainage dictate dressing change frequency.

tktjRN · Feb 11, 2013

Mepilex is the best!