Highlights
- ‘Medical adhesive-related skin injury’ is a term used to define any skin damage related to the use of medical adhesive products or devices such as tapes, wound dressings, stoma products, electrodes, medication patches and wound closure strips. This type of injury is largely avoidable (View Highlight)
- Medical adhesive-related skin injury can occur when the attachment between the skin and an adhesive is stronger than that between individual cells, causing either the epidermal layers to separate or the epidermis to detach completely from the dermis (mechanical trauma) (View Highlight)
- There are three main categories of medical adhesive-related skin injury: mechanical (skin stripping, blistering, skin tears), dermatitis (irritation in response to the adhesive) and other (maceration and folliculitis) (View Highlight)
- Surgical adhesive tapes often contain acrylate, the adhesiveness of which increases over time. In lengthy surgery, there is an increased risk of skin injury during removal (View Highlight)
- At birth, the skin is fragile due to the immature development of the stratum corneum, the skin's protective barrier: neonatal skin is 40–60% thinner than adult skin, with a lower cohesion between the dermis and epidermis (View Highlight)
- Older people experience loss of dermal matrix and subcutaneous tissue, epidermal thinning, lower cohesion between the dermis and epidermis, reduced blood supply to the skin, dehydration, and reduced collagen, elasticity and tensile strength (View Highlight)
- Oedema (swelling) can result in skin changes that increase the risk of a medical adhesive-related skin injury. The skin above a swollen area is generally tight and shiny, and can suffer a loss of elasticity and be prone to flaking or cracking (View Highlight)
- Adhesive and securement needs can be broadly categorised by purpose:
• General: to dress wounds and secure intravenous lines, non-critical tubing and cannula
• Flexible: securement when swelling or movement is anticipated
• Critical: to secure central venous catheters, nasogastric, tracheostomy and percutaneous endoscopic gastrostomy (PEG) fixation, and stoma pouches. Here, the need for high adhesion may supersede all other considerations. (View Highlight)
- Adhesives used in tapes and dressings are mainly acrylate, silicone, hydrocolloids and, more occasionally, polyurethane (View Highlight)
- as pressure is applied and the skin warms, acrylate adhesives fill the gaps between the adhesive backing/device and the skin's irregular surface, increasing the strength of the bond over time. In contrast, silicone-based adhesives are softer and gentler, and maintain a constant level of adherence over time. (View Highlight)
- Skin barriers form a protective interface between the skin and adhesive, thereby alleviating the risk of adhesive trauma (View Highlight)