Skin Tears........

I work in a LTCSNF and we have our share of skin tears. We have been in quite a debate lately over what Tx is best to use. I love Opsites and have found great success with them but many of the nurses I work with including my DON remain stubborn and uneducated as to the science behind good wound healing. I have tried to educate them and our skin policy states to use opsites but they still want to use steri strips and bacitracin with a dcd to cover. They think that the brown gooey stuff under the opsite is bad and I have told them time and time again that this may look bad but it is really very good for the wound. I have told them to leave it in place for at least 3 days before changing but they refuse to listen. Does anyone know where I can find a healing comparisson study to show people the science and shut them up. thanx BIG T

I am also looking for the best treatment for skin tears. Do opsites tear fragile skin when removed? If the skin tear if bleeding, itcan get messy under the opsite. I was taught in school that if the skin can be pulled back in place, steri strips would be best to minimize scarring, but if not, then to use opsites.

I have tried to educate them and our skin policy states to use opsites but they still want to use steri strips and bacitracin with a dcd to cover.

It's been a long while since I worked LTC, but I remember we always used steri strips and bacitracin ointment... and it's always what the MD ordered. If your skin policy states to use opsites, why is everyone else not following policy?

I work in a LTCSNF and we have our share of skin tears. We have been in quite a debate lately over what Tx is best to use. I love Opsites and have found great success with them but many of the nurses I work with including my DON remain stubborn and uneducated as to the science behind good wound healing. I have tried to educate them and our skin policy states to use opsites but they still want to use steri strips and bacitracin with a dcd to cover. They think that the brown gooey stuff under the opsite is bad and I have told them time and time again that this may look bad but it is really very good for the wound. I have told them to leave it in place for at least 3 days before changing but they refuse to listen. Does anyone know where I can find a healing comparisson study to show people the science and shut them up. thanx BIG T

How sad that your DON does not want to follow policy. Opsite is wonderful for skintears and stage 1 and 2 pressure ulcers. They can be left in place for 5-7 days. The only time that I dont use opsite is when it needs steri-strips because the opsite pulls the strips off when removed.

Oops , just wanted to add that your DON needs to look at the cost savings when using Opsite. The dressing change can be once weekly. The nursing time saved compared to a a guaze and bacitracin that needs to be done daily or sometimes twice daily will add up quickly.

Our dermal nurse uses telfa over skin tears and I hate it! :angryfire Even with soaking it always reopens the tear. I talked to her and she is still going to use the telfa. These elderly people have such thin skin and I feel it isn't going to heal if we keep putting telfa over it.

My only concern is if/when the resident deciedes to pull off the opsite. I have one resident (demetia, doesn't follow directions, rarely speaks, completely confused), who will always play with the dressing no matter what you do. Her skin tear took twice as long to heal because she would pull off the dressing and play with the wound. She would get a dressing change constantly throughout the shift. We tried wrapping rolled gauze around it (to keep her from getting to the wound) and 15 minutes later there she was pushing herself down the hall and rolled gauze would be in a pile behind her.

As far as keeping them on, have you tried distraction techniques? Something they can "play" with in their hands? One of the stress balls or something like that. Just to use as a distractor. I haven't worked in LTC, but I have a grandmother with alzheimers and distractors usually works with her. She's in late stage, but it has worked all along.

Hope this helps

Does anyone know where I can find a healing comparisson study to show people the science and shut them up. thanx BIG T

Here's an interesting article on managing skin tears, hope it's useful :)

http://www.findarticles.com/p/articles/mi_qa3977/is_200309/ai_n9274432

We use a NS wash followed by Xeroform (yellow gauze impregnated with ointment), wrapped up by Kerlix. Tape is taped to Kerlix to avoid taping the skin and causing further skin tears. The Xeroform is great because the wound doesn't stick to it and heals quickly. We change the dressing bid.

As far as keeping them on, have you tried distraction techniques? Something they can "play" with in their hands? One of the stress balls or something like that. Just to use as a distractor. I haven't worked in LTC, but I have a grandmother with alzheimers and distractors usually works with her. She's in late stage, but it has worked all along.

Hope this helps

I don't know...when she focuses on something that's all she wants. She hates the lapbuddy on her wheelchair. No matter what we do we'll find it on the floor somewhere. If I try to distract her with something I'll find the distractor on the floor and the lapbuddy two feet away from it.

i work in LTC/Rehab also. if a resident or patient sustain a skin tear, we use adaptic and neosporin, then gauze wrap to hold it into place, works like a charm every time. dressing change is QD. hope this helps!!! peace out!

I use elastogel on skintears covering with kling p cl c NS and change the dressing q 3 days and prn,I also use steri-strips until they have fallen off then use TAO c bandaid if the tear is oozing or use TAO and leave open to air until healed.

I feel the air aids in healing the tear by drying it out and is less time consuming.Just an idea give your DON a skintear to treat her way and you treat another res with a tear your way and compare the effectiveness of each. Also it takes a person who has a higher calling to be a Treatment Nurse.

Some nurses do not like the wound Care part of Nursing or they just do not understand; agree

Sandiid47