Temple University School of Podiatric Medicine Journal Review Club
Article Title: Using the Entropic Wound Cycle as the Basic for Making Effective Treatment Choices
Authors: Mcguire, J, Sebag JA, Solnik, J
By Kathi Thimsen RN, MSN, WOCN
Practicing skin and wound care requires the clinician to have many tools to address the myriad of issues related to patient management. Maintaining the integrity of a bandage, device, or skin edge all require operational understanding of the sticky aspect of wound care: adhesives.
The science of adhesives is extensive, complex, and involves advanced technology. Adhesive technology is used in applications that vary from industrial strength grades used in underground drilling equipment, to delicate and fragile application in blood vessel reconstruction procedures.
Adhesives have several properties: tact, pressure, sensitivity (stripping), release, and peel. These aspects warrant consideration in wound management circles, calling clinicians to be knowledgeable about the specifics of the product matched against the patient need. This approach increases the potential of improved outcome.
TACK: The feeling of stickiness of an adhesive surface. Tack offers the initial skin/adhesive contact that begins the adherence process.
PRESSURE: The amount of force required to secure an object to a “sticky” surface. This quality is dependent on temperature and bonding of the adhesive chemistry to the surface. The bond in pressure sensitive adhesives is soft enough to flow or wet (stick to) a surface. The bond of the adhesive’s strength is related to the adhesive being hard enough to resist flow under pressure. Simply put: will the adhesive stay put or loosen when applied?
Example: consider the use of Band-Aids for children. Have you ever noticed that the Band-Aids used in pediatric practices for use over an immunization site have ease of application, but from a wear time perspective, have limited (hours to perhaps a day) adherence? This adhesive is meant to stay in place during the immediate time post-injection, but be removed without skin trauma and discomfort.
SENSITIVITY: The sensitivity that is provoked by any product should be of concern to the prescriber. Skin sensitivity is a complex subject. Due to the limitation of blogging, this brief discussion will be limited to cause and prevention.
An individual brings unique characteristics and predisposition to a variety of substances and ingredients to the exam table. Having a patient’s history of allergies should also include a check on sensitivities to tape. Specifically include asking the names of tapes, as some people do not think about tape as an allergen.
Select a tape that has low-allergy or “hypo-allergenic” labeling. The more porous a tape material is, the less potential there is for sensitivity or allergy to develop. Products made of plastics or non-breathable materials, while providing a waterproof barrier, may also have more tact and tenacious adhesive formulation.
Stripping is the action of the adhesive when removed from the skin, and should also be considered when selecting an adhesive for sensitive individuals.
RELEASE and PEEL: The amount of force or shear involved in the removal of an adhesive from the skin. Several wear-time scenarios that factor into adhesive release are: application and immediate removal, removal after short-term wearing, removal after exposure to water, removal after exposure to solvents, and removal after long term wear.
Some clinicians have shared their clinical strategies for your consideration:
• Persons with known sensitivity to adhesives may benefit from a skin barrier product application prior to the adhesive.
• Use of hydrocolloid technology based products as an interface material or layer improves periwound skin protection by providing a surface to apply the adhesives to, as opposed to application directly to the skin.
• Avoid the use of harsh cleansers or solvents. Always cleanse the area thoroughly with soap (no oil or cream based brands) and water. Pat the skin dry before applying adhesives.
• When managing persons with fragile and friable skin in wound care, cover and secure with a wrapping of the area. Apply adhesives directly to the wrapping, thus avoiding direct contact with the skin when removing.
• Persons with excessive hair growth may require the hair be trimmed (NOT SHAVED) prior to adhesive removal. Rationale: shaving may increase the potential for follicular inflammation and associated redness and skin weeping.
• Transparent film removal can be trauma-free when removal is accomplished by releasing a corner of the film from the skin. Follow with stretching the adhesive. Slowly lift as the adhesive releases from the skin.
I invite you to share your adhesive-related management strategies with us on this blog!
About The Author
Kathi Thimsen RN, MSN, WOCN is a leader in the field of wound and ostomy care, publishing articles, presenting at conferences nationally and internationally, and serving on numerous committees and education boards including the International Association of Forensic Nurses Ethic Committee.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.