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LPN taking wound care course; skin tear question

Wound   (20,651 Views 15 Comments)
by followyourbliss followyourbliss (Member) Member

followyourbliss has 6 years experience and specializes in Wound Care , Foot Care,and Geriatrics.

5,019 Profile Views; 100 Posts

Hello Fellow Wound Care Nurses,

 

I am a LPN taking a wound care course in B.C; I am loving it! Very in depth :]

 

My question is this; what are you all using for skin tears? There seems to be some varying degrees of opinion on a) tegaderm, using films, and jelanet.

 

I would love it if you all weigh in please on a) what are you using, b) how long are you leaving it "insitu" c) facility policy.

 

That would be great, I know there has been a lot of change, new products, new policies re wound care products in the last 5-10 year regarding "best practice".

 

Thank- you in advance,

 

Follow Your Bliss

 

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PsychNurseWannaBe has 7 years experience as a BSN, RN and specializes in Psych, LTC, Nursing Management, WCC.

745 Posts; 8,810 Profile Views

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.

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5 Posts; 1,359 Profile Views

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.

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643 Posts; 8,153 Profile Views

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)

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PsychNurseWannaBe has 7 years experience as a BSN, RN and specializes in Psych, LTC, Nursing Management, WCC.

745 Posts; 8,810 Profile Views

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.

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tcarter6 has 10 years experience.

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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.

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nursetiffany. specializes in LTC.

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I HATE TEGADERMS!!!

;)

Granted I work in LTC.

I use a lot of telfa. ;)

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10 Posts; 1,020 Profile Views

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.

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74 Posts; 3,975 Profile Views

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.

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mommy.19 has 7 years experience as a MSN, RN, APRN.

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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.

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