When to remove steri-strips

[SwissMiss28]

I work in LTC & have a resident with a skin tear to the LLE. Today it was discovered the wound is infected with MRSA & several other bacteria. The MD had dressed the wound at the last visit & asked us to change the dressing. The steri-strips had been left on by other nurses because they were intact & dry. Today, the resident's wound began to bleed. The strips were loose with only 1/3 still stuck to the leg... But that 1/3 was over the wound. I soaked them with NS & removed them because they were covered with blood & purulent drainage. Was that ok to do? Also, I did not reapply the strips because I would be placing them right over the open wound- 3cm x 4cm area. Should i apply steri-strips over an open sore- even if the edges are not approximating? I'm a new nurse & cover 50 residents by myself. Everything is usually fine, but at a time like this I wish I had another nurse with me! Any advice would be appreciated!

[followyourbliss]

Hi Swiss Miss28,

Glad you posted! Skin tears, and the treatment of them is a particular interest to me.

In addition to working in a Outpatient Wound Clinic I also work LTC.

I have some easy, fast, and cost effective ways to approach skin tears that are not traumatic to the skin.

There are some great PDF's on Wounds International called " Skin Tears Made Easy"- very helpful and informative.

When addressing skin tears, and the elderly we know we are dealing with compromised thin fragile skin, and run the risk of stripping the skin and causing secondary damage by improper application of, and removal of products.

In many places in regard to Wound Care policy and procedures Steri Strips are contraindicated except for use on the face only.

The premise of this is that although it may " seem" like a good approach at the time they are extremely adhesive, skin stripping, and can cause secondary trauma when removed; they are also a barrier to wound healing as the area needs to be moist and the skin and cells need to be able to migrate across and close.

Whether the location is the arm, leg, or elsewhere you want to : protect and maintain that balance of moist and covered.

The first layer you can apply is :

A) A non adherent such as Jelonet, Mepitel, Adaptic layed over the tear. Using a antimicrobial such as Inadine or Restore is considered this as well.

B) a NON adhesive foam dressing such as Mepilex with NO adhesive borders, this is the protection layer.

c) wrapping cast padding, profore, or similar around the arm, leg etc for protection; you can make a cast pad " pillow" to lay over for extra safety.

d) use a mild stretch such as blue or yellow line to secure.

You have a cheap, easy, fast, and effective dressing that 1) protects and you can address infection, 2) can allow exudate to be absorbed and not be held against skin contributing to maceration 3) maintain moist healing, and 4) change it with no further traumatic skin stripping/affecting friable/ and healing tissue etc.

Also Viscopaste is amazing as a step 1 or 2 over non adherent- let's you secure step 1, zinc is soothing and healing to skin, and

again no adhesives!!

Hope this helps! We have seen so many nasty skin tears that we have had to soak off stuck on steri strips, which are caked with crap read " bacterial buffet" and never should be on fragile skin.

Keep us posted- there are many great articles on " Best Practice" regarding Skin Tears now. Perhaps you can be the one to start a new and healthy Skin Tear policy where you work :)

Take Care,

Followyourbliss

[agldragonRN]

Usually, steri-strips is not removed until they fall off by themselves. In your case, I would have removed it as well so I can clean the whole wound properly. If the treatment order says use steri-strips, I would call the doctor to get it changed.

Your skin tear is +MRSA. Did the doctor order Bactroban oint? If I were to recommend a Tx for your skin tear, I would recommend the following: LLE skin tear - Cleanse with NSS. Pat dry. Apply Bactroban oint. Cover with Vaseline gauze, 4x4. Wrap with Kerlix (Kling) BID, PRN x 14 days.

Do you have a wound care nurse in your facility? I would let her/him know if you have one.