Wounds are dressed every day, and much goes into the choices that are made to properly apply wound dressings. The condition of the periwound skin should be a major factor in the decisions made, as injuring this area can extend the wound and cause considerable pain. Tape removal is one of the most painful areas of wound care.1
Periwound skin is affected by the dressing choice in several ways. If the wound is wet or the dressing is unable to manage the exudate, then the periwound skin may macerate. Exudate lying on the skin may also cause irritation, itching, and inflammation. Thirdly, the dressing product used (or the adhesive incorporated into it) may cause a localized sensitivity reaction. Last but definitely not least there is iatrogenic damage caused by the dressing application or removal, also known as tape stripping and medical adhesive-related skin injury (MARSI). Not only are dressings responsible for MARSI, but also any adherent device—from catheter securement devices to electrodes. Different adhesives have different properties, and some are more likely than others to damage skin. A company merely stating that a border dressing is safer on the skin does not necessarily make it so. There has been much press given to safer adhesive technology, and a little less to other aspects of reducing the possibility of MARSI.
Earlier this year, Yates et al set the standard for MARSI interventions.2 Interestingly, the mechanics of proper adhesive removal were found very difficult to describe, though maybe this is understandable in the setting of a consensus approach. Common sense and pictures may better convey some dos and don'ts, at the risk of being less agreeable to some. You can decide how you learn best. The term tape is used below for border dressing, semi-permeable transparent films, and negative pressure wound drape.
Finally, adhesive remover wipes are designed to remove adhesives. They work. Use them. Sadly, most are tiny pads - they need to come in a larger size! Tape removal is one of the most painful parts of a dressing change. The pain caused is held in memory, and increases pain and anxiety at subsequent procedures. Please use adhesive remover wipes and take time to remove tape. Your patients will thank you. Image Credit: Margaret Heale. Used with Permission
1. Denyer, J., Reducing pain during the removal of adhesive and adherent products., in British Journal of Nursing. 2011. p. S28-S35.
2. Yates, S.M., L; Heineche, SB; Gray, M., Embracing the Concept, Defining the Practice and Changing the Outcome. Journal of Wound, Ostomy and Continence Nursing, 2017. 44(1): p. 13-17.
About the Author
Margaret Heale has a clinical consulting service, Heale Wound Care in Southeastern Vermont and draws on her extensive experience as a wound, ostomy and continence nurse in acute and long-term care settings to provide education and holistic care in her practice.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.