How To Get Bandage Tape Surgery Off Your Skin

Combining skill and knowledge ensures safe removal.

Takeaways:

Better your knowledge on how to remove medical tape or wound dressings
Discover products and strategies to ease the tape removal experience for your patients

By Ann-Marie Taroc, MSN, RN, CPN

All nurses have struggled with removing pressure sensitive adhesives (PSAs)—medical tape, plastic bandages, wound dressings—from delicate peel, next to healing wounds, or from sites of frequent reapplication. For some patients, removal can cause medical agglutinative–related skin injury (MARSI), which presents every bit persistent erythema, peel stripping, blisters, or haemorrhage. (Run across Who'south at hazard for MARSI.) And other patients may feel broken-hearted because of previous experiences with hurtingful PSA removal.

Who'southward at gamble for MARSI?

Patients with fragile or delicate peel are at risk for medical agglutinative–removal peel injury (MARSI). These patients will take a weakened connectedness betwixt skin layers that may exist injured when pressure-sensitive adhesives are removed. Before beginning removal, consider these patient factors:
• Newborns —The connectedness betwixt the epidermis and dermis is weaker than in adults.
•Older adults—As people age, the peel structure weakens and loosens, resulting in separation of the skin layers upon adhesive removal.
•Medications—Some drugs, such equally corticosteroids, tin can cause thinning of the skin, which increases a patient's risk for MARSI and delayed healing.
•Malnutrition and aridity—Patients who are malnourished or dehydrated may take weakened pare integrity.

Our agreement of PSAs and their removal tin can assistance preclude harm and patient anxiety. This commodity will await at the qualities of PSA adhesives and backings, explicate the principles of removal, and talk over products that assist removal.

PSA adhesives and backing

The skin's surface qualities—wet, hair, oil, and shedding expressionless cells—make PSA adhesion challenging. PSAs are designed to overcome these challenges, while balancing successful adherence and piece of cake removal. Both the agglutinative side of the PSA as well as its backing material play a role in adherence and removal.

Adhesive

Acrylate, silicone, and hydrocolloid are three commonly used adhesives. They each work in different ways. (Run across Comparing adhesives.)

As acrylate agglutinative warms, information technology fills in the skin's rough surfaces. Many medical tapes and some dressings contain acrylate with varying levels of adhesion, making some easier to remove than others. Some strongly adhering acrylates identify patients at gamble for MARSI.

Silicone adhesives—found in wound dressings and tape—adhere to the rough surfaces of the skin at initial application. This low-energy connection separates hands from the skin. Because it hands detaches, silicone PSAs aren't advisable when adhesion is critical, such every bit when securing an endotracheal tube.

The adhesion of hydrocolloid products increases with fourth dimension, creating the same level of risk for MARSI equally a well-adhered acrylate. Detachment requires a combination of manipulating the PSA backing and dissolving the adhesive.

Comparing adhesives

Backing

PSA backing materials likewise touch on removal. To separate the PSA adhesive from the skin, nosotros accept to distort the backing by stretching or pulling. The challenge with stretching, however, is our ability to maintain directional control. In the presence of hair, a wound, or a catheter, we don't desire to cause discomfort, distortion, or dislodgment. Consequently, the removal procedure we select includes assessing both the agglutinative and backing of the PSA as well as the presence of any object we don't want to disturb.

Principles of PSA removal

You take two options for PSA removal: depression and wearisome or baloney. With low and slow, pull back the PSA at a low horizontal angle, away from the corner or border, separating information technology from the skin. Distortion requires stretching the PSA bankroll to shear the adhesive from the skin. However, PSA removal is more than selecting one of two procedures; it requires understanding the core principle of supporting the skin while correctly detaching the product.

Skin is a soft and flexible organ that moves and bends in the direction nosotros pull. Pulling off a PSA at a vertical angle creates the greatest force, but information technology may injure skin and distort a healing incision. Consequently, you must back up the skin with your hands by anchoring the adhesive on the dressing (when stretching) or the newly exposed skin (when peeling back). A low bending of peel requires less force to separate agglutinative from skin, which you achieve with either procedure by keeping the PSA low and shut to the surface. The goal is to avoid MARSI by minimizing the amount of force needed for disengagement.

Adhesive-removal products

Silicone-based agglutinative-removal products are the best option for aiding PSA removal. They evaporate, go out no residue on the skin, and are non noted for causing dry peel. If you lot don't have admission to silicone-based products, other options include water, alcohol, or emollients. Understanding the pros and cons of each will help y'all cull the right solution.

Water may be hands attainable, simply it tin can weaken water-permeable PSA backings, separating them from the agglutinative simply non affecting its connectedness to the pare, leaving behind a sticky residue. Booze, on its own or combined with an antiseptic similar chlorhexidine, can solubilize an adhesive, making it easier to detach. Nonetheless, alcohol evaporation causes vasoconstriction and dries the peel. In contrast, emollients, such as mineral oil or lotions, facilitate separation of agglutinative from the skin, causing no harm. Unfortunately, emollients may separate the agglutinative from the bankroll and leave a sticky residue.

To ensure successful use of adhesive-removal products, follow product instructions. For example, an agglutinative-removal production made with an odorless mineral spirit can effectively deliquesce the adhesive for hurting- and injury-free removal. However, if you don't follow the product instructions to wash off any remaining production with lather and water, the patient's skin may dry and cleft.

Removal products aren't appropriate in all cases. For example, they may be contraindicated in the presence of dermal glue or in close proximity to an incision.

Case study:
Low and boring prevents injury
Joe Roberts, a 60-year-old man with type ii diabetes, is prepare for belch from the hospital. His nurse, Alice, must first discontinue his peripheral intravenous (PIV) catheter. Mr. Roberts is eager to get out and asks Alice to bustle.
Alice notes that the cannula is well secured with a transparent polyurethane dressing. Mr. Roberts' pare is dry and loose. During shift handoff, Alice learned that Mr. Roberts has peripheral neuropathy. She understands that removal of the PIV volition require cognition and skill to prevent MARSI.
As with removal of any PSA, the kickoff border is the almost challenging. Alice chooses to apply an agglutinative-removal product. Because transparent polyurethane dressings are h2o-resistant, Alice applies the removal production liberally, gently detaching a corner of the dressing from the skin. When she has the border of the dressing in her manus, she pulls it dorsum low and irksome. This technique gives Alice greater control and allows her to go on applying agglutinative remover, while supporting Mr. Roberts' skin. She removes the dressing from the edges toward the catheter, working with the management of pilus growth.
When Mr. Roberts grows impatient with the irksome progress, Alice takes the opportunity for patient education, explaining that her arroyo to removing the PSA volition forestall a skin wound that may be slow to heal because of his diabetes.

Case study:
Alleviating patient anxiety
Nine-year-old Emily Gray arrives in the emergency department for evaluation of a head laceration. Before assessment can begin, David, the emergency department nurse, must remove a large plastic bandage from Emily'due south forehead. Emily fearfully anticipates its removal.David recognizes that the acrylate agglutinative foam-backed bandage, placed an hour ago, may not have adhered well to the skin. Nonetheless, he realizes that sharing this logic may practice zippo to alleviate Emily's anxiety.To make sure removal of the bandage goes every bit smoothly every bit possible, David decides to use a removal aid. He chooses balm because he doesn't have access to products specifically designed for agglutinative removal. With patience and slow removal, he eases the cast off. David and then cleanses the peel to remove any remaining balm. This pain-gratuitous bandage removal may assistance Emily feel less anxious about similar situations in the future.

Combine knowledge and skill

PSA removal is a combination of skill and knowledge. No unmarried solution fits every patient or care environment, so understanding the qualities of various PSAs, the principles of removal, and the pros and cons of removal products helps ensure safe removal.

Ann-Marie Taroc is a staff nurse at Seattle Children's Hospital in Seattle, Washington.

Selected references

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Matsumura H, Imai R, Ahmatjan N, et al. Removal of adhesive wound dressing and its effects on the stratum corneum of the skin: Comparing of eight different adhesive wound dressings. Int Wound J. 2014;eleven(1):50-4.

McLafferty E. (2012). The integumentary system: Anatomy, physiology and role of peel. Nurs Stand. 2012;27(iii):35-42.

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Reevell G, Anders T, Morgan T. Improving patients' experience of dressing removal in practice. J Community Nurs. 2016;30(5):44-9.

Salmanoğlu M, Önem Y. Diabetic foot: Even the well-nigh innocent may plow into a threat. Euro J Gen Med. 2014;11(2):117-viii.

Taroc A. Staying out of sticky situations: How to cull the right tape for your patient. Wound Care Advisor. 2015;4(half dozen):21-6.

van Schaik R, Rövekamp MH. Fact or myth? Pain reduction in solvent-assisted removal of adhesive tape. J Wound Intendance. 2011;twenty(8):380-iii.

A guide for adhesive removal: Principles, practice, and products