Skin Tears........

[BIG T]

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

[sandiid47]

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

[achot chavi]

The best care is prevention and it might help te educate the staff. A gentle touch and daily moisturizing will protect dry skin. Once the skin is torn I clean with a squirt of N.S pat dry apply a thin layer of bactroban, bacitracin, polydin oint, etc. and then cover with Adaptic a vaseline impregnated woven non stick dressing and then kerlix. once a day and have each shift moniter for signs of infection.

Make sure the patient eats and drinks well. Vit C can help.

Some like Aloe Vera.

Keep the Pt's nails cut short and buffed so they dont cut themselves or others.

Keep 'grabbers' out of arms reach!

Factors to take into account: Is the Pt on Coumadin or any blood thinners?

Does the patient suffer from very dry skin? Does the patient have Poor circulation? Our geriatric population tend to be noncompliant and may disturb the dressing. You may benefit by having the area covered with a long sleeve or sock on the arm (cut off the toe end so it is a tube)

Tip make a big deal 0out of it so your staff gets the message and may be more careful next time

[pmsrn76]

Thin foams (Mitraflex or Flexan) work well and can be left in place 7 days.

[suebird3]

public aid won't pay for op-site...and i have one rezzie who is always getting into scrapes!!! :uhoh3:

in fact, p. a. is not paying for many tx's!

suebird

[sharlynn]

My facility is very cost conscious. BID dressing changes are avoided whenever possible. Our medical director and our policy recommends cleaning with NS, using tincture of Benzoin to intact skin surrounding the tear and 1/2" paper tape. On small tears we cut it to 1/4". Infections are very rare.

We also recommend long sleeves to families when they are admitted.

[suebird3]

My facility has those "slip on" sleeves......they are pretty good, unless the person likes "stripping"!!! :chuckle :chuckle

Suebird

[wocnnurse]

Hi! I am both for steri strips and opsites depending on the type of skin tear. If it is a clean linear type, steri strips is best to approximate the edges and let the wound heal itself. Then you can use a protective dressing like a telfa and wrap it with kerlix so that the wound will stay clean. For scrapes and tears with irregular edges, I use opsite. After the first day one maybe amazed of the increased drainage accumulating there which forms a pouch. That is part of wound healing process, I usually change it since I don't want the periwound area get macerated by the drainage. Usually from the 2nd or 3rd changes daily, can I safely say I leave it for 3-4 days or until the wound heals. 3M has a product named "non- stick skin barrier" that I apply to the periwound before I place the opsite so that I can take it out easily. Then I still place a protective dressing as well to alert the other members of the team that there is a skin tear there and they should be careful in handling that part.

I am not so much for any antibiotic ointment if I am not sure that the wound is infected. A clean wound should heal without it, most of the time it just increases the local bacterial count of a clean wound with its sticky consistency.

Goodluck!:)

[princesscakes]

I work in LTC and we use a silicone mesh that is coated in vasoline like substance. It is made to be used on burns. We try to push the skin flap over if possible and the mesh will hold the skin together and provide moisture to the wound.You can leave the mesh on for awhile and just cleanse with saline and apply dressing over top. Our wound products are from company called Aloe Vesta and alot of their products work well in LTC.

[jonamb]

In our facility, we have a variety of dressings to choose from. Most nurses opt for transparent dressings (Tegaderm, Bioclusive) that can be changed every 3-5 days for skin tears. I have found that these dressings are usually good for small tears on people who have fairly good skin. However, most of our residents have very fragile skin, and often the transparent dressings will make the tear worse or cause another tear when they are removed. Personally, I prefer to use vaseline gauze wrapped in Kerlix. It needs to be changed at least daily, but the gauze will not stick to the wound and the healing time seems to be faster. Also, geri-gloves (sleeves) and long-sleeved shirts can be very helpful in deterring "pickers". And I have to agree with wocnnurse: antibiotic ointments usually aren't necessary. Most wounds will heal fine without them if they are kept clean. We only use ATB ointment if there is definitely an infection present. With the problem of over-use of ATB's in this country, why use ointment unless it is clearly needed? Just my opinion.

[nowhappywoundnurse]

I agree that TAO or other antibacterial ointment is not necc. But...have had good luck using healthpoint xenaderm under a telfa and steristrips. Nice moist wound bed!