Make Correct Tape Application a Sticking Point
By Kelly M. Pyrek
A wide range of fixative aids are available to hold wound dressings and tubes in place. The most common of these -- tapes -- are designed to be highly functional, cost-effective and to simplify dressing- and device-retention techniques. Adhesive surgical tapes are used on smaller wounds to hold textile compresses in place, while hydrogel dressings, which have no adhesion fixation border, can be held in place with the appropriate plasters. Many clinicians consider the application of rectangular strapping (all four edges fixed with strips of tape) to be most effective, as this technique reduces wound irritation caused by movement of the dressing. Tapes may also be applied in a parallel fashion on minor incisional wounds healing by first intention, where being left undisturbed is not of primary importance.
Because surgical tapes are used in a wide range of medical applications, a variety of products may be necessary to meet the requirements of different procedures, wounds, skin types and medical devices such as nasogastric tubes or catheters that must be affixed. Surgical tapes can be constructed of textile fabric, silk and nonwoven textiles, as well as from waterproof or porous transparent film.
A survey of the surgical tape marketplace in 20021 revealed the presence of more than a dozen different kinds of paper, plastic, silk, elastic, cloth and waterproof tapes. A majority of these tapes were designed to be hypoallergenic, breathable and latex free, to avoid triggering contact dermatitis. Non-allergenic contact dermatitis can result when tackifiers are trapped between the skin and the adhesive. The affected area can appear red, blistered, swollen or weeping. Allergic contact dermatitis reactions can be triggered by a component of an adhesive or a backing, and they occur infrequently. Clinical signs and symptoms include well-defined areas of erythema and edema, vesicles and small erosions.
Many of them are coated with a plaster mass made from rubber adhesive systems containing zinc oxide or from synthetic polyacrylate adhesives. Although zinc oxide self-adhesive plasters have excellent adhesive properties, they are sometimes not tolerated by the skin. For patients with sensitive skin, it is preferable to use surgical tapes with skin-compatible polyacrylate adhesives.
Irritation caused by surgical tapes has been documented in the literature. In one study of cutaneous reactions to surgical preparations and dressings, 100 surgical patients were monitored for the causes of contact dermatitis.2 Patch testing with the North American Contact Dermatitis Standard Series and additional agents used in the surgical preparation and dressing was performed on 11 patients with postoperative dermatitis or a history of allergic reactions to tape. Twelve patients were diagnosed as having irritant (mechanical) contact dermatitis. One patient had allergic contact dermatitis to benzoin postoperatively, while another patient with a history of adhesive tape allergy had a positive patch test to thiuram mix, rubber accelerators formerly present in adhesive tapes. The study found that irritant contact dermatitis is a common problem among surgical patients, while allergic contact dermatitis is less common -- occurring in 2 out of 100 patients.
One study that evaluated surgical tapes for wound closure examined a nonwoven microporous tape, a nonwoven microporous reinforced tape, a gauze tape and a polyurethane tape.3 The performance of the tapes was assessed by measuring their breaking strength, degree of elongation under pressure, adhesion to skin, air and water vapor transmission, and bacterial growth under the tape. On the basis of these in vitro and in vivo studies, the researchers concluded that nonwoven microporous tape performed the best because it has an adhesive that aggressively adheres to the underlying skin, is strong enough to resist breakage during clinical use, and elongates sufficiently to prevent blister formation. Its microporous structure allows for rapid air transmission in vitro and results in an environment that is antithetical to bacterial growth.
Securing intravenous catheters, tubing and dressings requires a tape that is durable and conforms to body contours, according to Hy-Tape International. Patients who are receiving long-term infusion therapy or chemotherapy are especially in need of a tape that will not traumatize the skin. Elderly, immunosuppressed and dehydrated patients who receive IV therapy are highly susceptible to bacterial invasion through microscopic fissures in the skin. This may, in turn, increase the risk of skin breakdown, phlebitis, sepsis and trauma from adhesives.
Acute wound management requires stringent safeguards against infection by foreign matter; they are usually closed with sutures, staples or closure tapes, according to DeRoyal Wound Care. They are usually dressed with a dry adhesive bandage. Wounds closed with closure tapes develop resistance to infection more quickly and effectively than stapled or sutured wounds, since the staples or sutures can bring bacteria under the skin.
According to 3M Health Care Services, if tape does not adhere well to the patient's skin, the following should be checked:
- If a prep solution containing surfactant was applied, was it allowed to dry first?
- Was the tape gently but firmly stroked after being applied?
- Were gaps left between the tape and the dressing or tubing?
- Was the most appropriate kind of tape used for a particular application?
Tapes must be used with care to avoid superficial skin damage such as tension blisters and skin stripping, according to 3M clinicians. Skin damage can be avoided by correct choice and use of the tape, attention to skin preparation, and proper application and removal of tape. The most common adhesive-related skin injuries are as follows:
- Skin stripping is a partial thickness injury occurring when an adhesive bond between the tape and the skin is greater than the bond between the epidermis and the dermis. As tape is removed, the epidermis remains attached to the adhesive, resulting in skin damage. To prevent stripping, a hypoallergenic tape should be used, matching the strength of the adhesive to the clinical needs and condition of the patient's skin.
- Mechanical injuries due to tension include inappropriate strapping of tape during application and distention of skin under an unyielding tape. Blisters and skin tears can form. To reduce the risk, identify patients who are at an elevated risk for distention, including those with fragile skin or those with conditions where edema is anticipated. Tape should be applied without tension, and if any swelling is detected, the tape should be noted, loosened, repositioned and/or replaced.