Skin tear in Assisted Living

[MommaRN86]

I work in an assisted living/independent living facility and last night I got an emergency call(I am the only nurse in the building in the evening). So I went to the resident's room and she had fallen and had a skin tear. I cleansed the wound, used a bit of bacitracin covered with a absorbent foam pad and covered with a 4x4 and used paper tape. Is that the best way to treat the skin tear? I know in the hospital we commonly used tegederm, but it really seems that that would pull off more skin when its removed. Any ideas???? thanks in advance!!

[Double-Helix, BSN, RN]

Tegaderm, or other transparent dressings are not good for skin tears. They do tend to remove a lot of skin, especially if the dressing is not removed correctly.

Really, any dressing that covers and protects the skin tear is fine. A dressing that doesn't need to be changed daily gives the best opportunity for the skin to heal. Personally, I like Mepilex boarder, because it covers and pads the wound, you don't need tape, you can lift it up and look at the wound and it will still stick again and you can leave it on for several days.

[MommaRN86]

Thanks for the response! I think I have used Mepilex before in the hospital I think. Very nice product. Wish we had it, I guess it's too much $$$$ but I will suggest it!

[biker nurse]

I personally like to butterfly it back into position! we've had the best success with that!! but you should have a protocol!!

[NurseKatie08, MSN]

Tegaderm, or other transparent dressings are not good for skin tears. They do tend to remove a lot of skin, especially if the dressing is not removed correctly.

Really, any dressing that covers and protects the skin tear is fine. A dressing that doesn't need to be changed daily gives the best opportunity for the skin to heal. Personally, I like Mepilex boarder, because it covers and pads the wound, you don't need tape, you can lift it up and look at the wound and it will still stick again and you can leave it on for several days.

I respectfully disagree re: your comment about transparent dressings. I have healed many a skin tear with OpSite. I like it because you can visualize the wound, and you don't need to change it every day. I tend to use OpSite when there isn't a skin flap to approximate. If there is a flap, I'd typically use steri strips and a protective dressing. Love Mepilex Boarder as well, but we don't stock it regularly.

[tyvin, BSN, RN]

Approximate then do steri-srtips is the standard. But with certain tears opsite does well in that the wound can be observed without compromising the drsg. It's a judgement call thing. Oh, do I have to mention to clean the wound first, ect...

[VivaLasViejas, ASN, RN]

Your company should have a wound care protocol and standing orders signed by a doctor or other licensed practitioner. If not, you need to obtain them yourself, because without an order you're essentially practicing medicine without a license (and putting your own at risk). Too many things can go wrong---I've seen even the simplest skin tears become badly infected when not treated correctly, or when changes in the wound weren't addressed and the staff kept doing the same treatment for weeks or months.

Of course, IRL you're not going to let a skin tear stay open indefinitely while you call the PCP and wait for him/her to fax you orders. You treat it as indicated by your nursing knowledge and the condition of the injury, while you shoot a fax over to the provider describing the wound and telling him/her what you did to address it, then asking if this is OK or if he/she would prefer a different treatment. That way the skin tear gets taken care of and YOUR butt stays out of a sling.

Ideally, however, the corporation or management company that oversees your building should have developed protocols for the different basic types of wound care (and home health should be called in for the ones that are more complex). And FWIW, I like the cleanse-approximate edges-steristrip-cover-with-Opsite procedure myself for the simple skin tears.

[pedicurn, LPN, RN]

Your company should have a wound care protocol and standing orders signed by a doctor or other licensed practitioner. If not, you need to obtain them yourself, because without an order you're essentially practicing medicine without a license (and putting your own at risk). Too many things can go wrong---I've seen even the simplest skin tears become badly infected when not treated correctly, or when changes in the wound weren't addressed and the staff kept doing the same treatment for weeks or months.

Of course, IRL you're not going to let a skin tear stay open indefinitely while you call the PCP and wait for him/her to fax you orders. You treat it as indicated by your nursing knowledge and the condition of the injury, while you shoot a fax over to the provider describing the wound and telling him/her what you did to address it, then asking if this is OK or if he/she would prefer a different treatment. That way the skin tear gets taken care of and YOUR butt stays out of a sling.

Ideally, however, the corporation or management company that oversees your building should have developed protocols for the different basic types of wound care (and home health should be called in for the ones that are more complex). And FWIW, I like the cleanse-approximate edges-steristrip-cover-with-Opsite procedure myself for the simple skin tears.

In Australia we don't need an order for a dressing. We attend inservices re wounds and products and are expected to make an appropriate decision regarding what product/s to use.

Is that standard in the US ? Needing orders for dressing a skin tear?

Just wondering

[Brea LPN]

We use TAO and tefla pads in my facility.

[Hospice Nurse LPN, BSN, RN]

I respectfully disagree re: your comment about transparent dressings. I have healed many a skin tear with OpSite. I like it because you can visualize the wound, and you don't need to change it every day. I tend to use OpSite when there isn't a skin flap to approximate. If there is a flap, I'd typically use steri strips and a protective dressing. Love Mepilex Boarder as well, but we don't stock it regularly.

I have also used OpSite for years, however @ a recent wound care workshop I attended, the speaker stated that OpSite is not the best thing to use. (1) you are covering a warm, moist area and (2) there is an increased risk of further damaging the skin when the OpSite is removed. She suggested steri-strips or liquid bandage. Just my

[Forever Sunshine, ASN, RN]

We use TAO and tefla pads in my facility.

TAO?

I find bacitracin and telfa wrapped in gauze roll heal just fine.

If its been 2 weeks then we try another treatment.. usually xeroform.

[NurseKatie08, MSN]

I have also used OpSite for years, however @ a recent wound care workshop I attended, the speaker stated that OpSite is not the best thing to use. (1) you are covering a warm, moist area and (2) there is an increased risk of further damaging the skin when the OpSite is removed. She suggested steri-strips or liquid bandage. Just my

Good points. In my experiences where OpSite has been used I've found it to be less harmful than protective dressings (have had quite a time with xeroform, etc stuck to skin tears and making a holy mess). But really I guess as a PP mentioned it all comes down to making a judgement call for the specific wound (and of course following orders/whatever your protocol is). Thanks for your insight.