Cath Lab Digest

  Who is most at risk for having a skin tear? We know that the elderly are at risk because the rete ridges (epidermal junction), which help secure the epidermis and dermis layer together, start to flatten, allowing the epidermis to separate and causing a skin tear. Other patients at risk for skin tears include persons who are bed- or chair-bound or otherwise unable to change positions themselves; persons with inadequate nutrition or hydration intake; persons experiencing certain disease processes; and persons taking numerous medications.

  Prevention is most important when it comes to skin tears. Suggestions to prevent them include wearing long sleeves and pants to protect the extremities. Caregivers should always use caution when moving a bed-bound patient; two people should be available to help lift when using a draw sheet to avoid dragging the patient and causing injury to the skin from shearing. Increasing fluid intake and maintaining good nutrition will help promote healthy skin, as will applying lotion to prevent dry skin that can tear easily. The application of tape directly on the skin should be avoided by using a stockinette or other wrap that will secure on itself. If tape is absolutely necessary, it should be removed with extreme caution.

  Once a skin tear has occurred, make sure to cleanse gently using saline or a wound cleanser; do not rub the skin. If possible, attempt to re-approximate any loose skin over the open area. Dry the surrounding skin lightly with fluffed gauze. Bandage is very important and should be based on the amount of drainage coming from the open wound. If there is minimal drainage, an application of a single layer of petrolatum gauze is appropriate. Place a 4 x 4 gauze over the petrolatum gauze to manage any drainage, then wrap with Kerlix to secure. Make sure to tape only on the gauze and not on the skin. Such dressings should be changed daily to prevent them from becoming dry and adhering to the wound bed. If there is a large amount of drainage, a foam dressing is more appropriate. It will not adhere to the wound bed and can be left in place up to 5 days and still manage the drainage. If a family member will be participating in the dressing changes, make sure you instruct them on the proper techniques of applying the dressing, as well as how to prevent skin tears from occurring.

–Donna Breedlove, LVN, CWCA, Wound Program Manager/Field Staff, NationsMed Healthcare, Stafford, TX