Episode 246 — Tape With Dr. Phil Carullo
Highlights
- The Anatomy of Tape
Key takeaways:
(* Tape is composed of two layers., * The backing and the adhesive., * The adhesive is usually acrylate., * To get a tape through the FDA, manufacturers must submit safety and efficacy data.)
Transcript:
Speaker 1
And they're categorized based off of how critical they are for sustaining life. So a class one device is what tape would be considered or a piece of gauze or an oral airway or an oxygen mask. And these devices are valuable for patient care, but their failure wouldn't necessarily result in significant harm to a patient. Whereas a class three device like an ECMO machine or a ventilator, a defibrillator, these things are critical for sustaining life. And so to get these devices through the FDA, you really have to submit to them a lot of safety and efficacy data to ensure that safe for patient use. So now that we've defined tape as a strip of fabric with an adhesive, we can really define the anatomy of tape. And tape is really composed of two layers. One is the backing. And the backing is what we call the tape. Hey, I need some paper tape for the eyes or I need some silk paper. We like to use cloth tape in the next, you know. And so that is the backing. That's what we know the tape as. And then the second layer is the adhesive. This is kind of what's layered onto the backing. It's the sticky stuff.
Speaker 3
That's what helps it form a bond.
Speaker 1
And there are all different types of adhesives. But in the medical world, almost all of it is acrylate. It's acrylate adhesive. So it's the same whether you're talking about tegoderms, Ia bands, dairy strips, derma bond. The adhesive is all the same. (Time 0:14:35)
- The Effect of Sweating on Tape Bond Strength
Key takeaways:
(* Tape can increase bond strength over time., * Breathable tape can hold bond strengths for a long time.)
Transcript:
Speaker 1
But over the next 24 hours, both of those tapes are going to increase linearly. That bond strength is going to increase to a pretty significant degree. But after 24 hours, that strength kind of flat lines actually can decrease over time because, for many reasons, but one of them is that the skin sweats and that sweat can kind of deteriorate the acrylate bond and weaken the strength of it. The other kind of thing you'll learn by looking at these tape profiles is that breathable tape, like the cloth tape that's used in the ICU. That the breathable tape can hold bond strengths for a very long time. And that's because the sweat that would normally deteriorate the acrylate can evaporate through the cloth material. And so it doesn't really compromise the bond strength. (Time 0:20:03)
- The Advantages and Disadvantages of Acrylate Tape
Key takeaways:
(* All medical tape is made of acrylate., * Acrylate tape has a high bond strength, but it can decrease over time., * Breathable tape, like the cloth tape used in the ICU, has a long bond strength.)
Transcript:
Speaker 1
But over the next 24 hours, both of those tapes are going to increase linearly. That bond strength is going to increase to a pretty significant degree. But after 24 hours, that strength kind of flat lines actually can decrease over time because, for many reasons, but one of them is that the skin sweats and that sweat can kind of deteriorate the acrylate bond and weaken the strength of it. The other kind of thing you'll learn by looking at these tape profiles is that breathable tape, like the cloth tape that's used in the ICU. That the breathable tape can hold bond strengths for a very long time. And that's because the sweat that would normally deteriorate the acrylate can evaporate through the cloth material. And so it doesn't really compromise the bond strength.
Speaker 3
And so breathable tape can hold its bond for a very, very long time.
Speaker 1
So that kind of summarizes the business discussion on tape. I'm going to dive in a little bit to some of the clinical things here.
Speaker 2
Okay, so Phil, you mentioned that all the tape is acrylate. Is there any, I know silicone tape is another thing. It sounds like that's not used as much medically. Is that something that we might see more of? Is there any advantage to that? Or no? Stay with us. We'll be right back with Phil's thoughts on silicone tape. (Time 0:20:03)
- Adhesive Options for Medical Professionals
Key takeaways:
(* Silicone tape is a type of adhesive that is more expensive than other adhesives, but it has a stable bond strength that is gentle on the skin., * It is mainly used to secure the eyes, prevent corneal abrasion, and close the eyes during surgery.)
Transcript:
Speaker 1
Silicone tape is actually awesome. It's really the only other adhesive you'll see in the medical world. But it's way more expensive right now. It's probably about 10 times more expensive for a role. Silicone tape is special because we talked about accurate adhesive that forms a bond strength and then over the next 24 hours that bond strength increases. Silicone tape has a pretty stable bond strength. You can put it on and it has an initial bond strength and then it stays the same bond strength for like days. It doesn't change and that's kind of a property of the adhesive itself. And there are really good things about that. So if you have really sensitive skin then you put silicone on there, silicone adhesive and it forms a bond strength that is generally pretty weak compared to accurately. But it won't get stronger and so if you take that tape off in a week it's less likely to cause skin injury. So it's mostly used for securing the eyes, preventing a corneal abrasion or after a blood draw, just securing a piece of gauze to the skin for a few minutes. So silicone tape is actually great but it's not used so much clinically and so I didn't really include it in here but keep an eye out for it and if you see it just know it doesn't form a super strong bond but it's very gentle and so it's a great thing to use when securing just maybe part of an IV line on the arm or closing the eyes shut during case. Okay, awesome. (Time 0:23:00)
- How to Apply Medical Tape
Key takeaways:
(* Silicone tape is a gentle adhesive that can be used to secure IV lines or close eyes during surgery., * The tape should be applied gently and pushed down into the skin to ensure a strong bond.)
Transcript:
Speaker 1
So silicone tape is actually great but it's not used so much clinically and so I didn't really include it in here but keep an eye out for it and if you see it just know it doesn't form a super strong bond but it's very gentle and so it's a great thing to use when securing just maybe part of an IV line on the arm or closing the eyes shut during case. Okay, awesome.
Speaker 2
All right, so let's turn to the tape skin interface and tell me about that. What exactly does the tape do when it hits the skin?
Speaker 1
Right, so like we said, you know, the adhesive is all the same in the medical world and it's an act-related adhesive and when you apply that adhesive to the skin you should gently push down on that tape and adhesive so that when the skin warns the adhesive that adhesive can kind of flow into the crevices of the epidermis and form a nice strong bond that will increase over time. Now the skin itself has several layers, the epidermis, dermis, hypodermis and the most superficial layer of the epidermis is called the stratum cornea and it's really important to appreciate that some skin in general is vulnerable to injury because of how the layers of the skin are composed. So classically in pediatric anesthesia we worry about neonatal skin but in adult anesthesia we're worried about the elderly and their skin tends to be a little bit more vulnerable to injury because they either (Time 0:24:06)
- The Adhesive's Risks: How to Avoid Tape-Related Injury
Key takeaways:
(* Adhesive tapes can be used to form a strong bond with the skin,., * It is important to be careful when using adhesive tapes, as there are risks associated with them.)
Transcript:
Speaker 1
Right, so like we said, you know, the adhesive is all the same in the medical world and it's an act-related adhesive and when you apply that adhesive to the skin you should gently push down on that tape and adhesive so that when the skin warns the adhesive that adhesive can kind of flow into the crevices of the epidermis and form a nice strong bond that will increase over time. Now the skin itself has several layers, the epidermis, dermis, hypodermis and the most superficial layer of the epidermis is called the stratum cornea and it's really important to appreciate that some skin in general is vulnerable to injury because of how the layers of the skin are composed. So classically in pediatric anesthesia we worry about neonatal skin but in adult anesthesia we're worried about the elderly and their skin tends to be a little bit more vulnerable to injury because they either have less epidermal cells in the stratum corneum or they don't have as much elasticity or tensile strength in the tissue itself and the reason why that's important is because if you're using a tape with the strong backing for example like silk tape on the eyes you rarely see people do that but let's say you did. That silk tape is going to form a pretty strong bond with the skin maybe actually way more than the strength of paper tape on the eyes and when you go to remove that tape it's possible that the taped skin bond is stronger than the skin skin bond and so instead of removing the adhesive from the skin you're stripping layers of the epidermis from itself and so that is you know one of the things you have to be careful about when you're using the tape is to realize that there are risks associated with it which kind of leads us to a discussion about tape related injury and there's a whole term for this called Marcy medical adhesive related skin injury and this is just a collective way to talk about the different forms of skin (Time 0:24:38)
- The Importance of Knowing the Difference Between an Allergic Reaction and a Non-Allergic Reaction to Tape
Key takeaways:
(* Tape allergies are very rare and usually a result of a chemical irritant., * It is important to be gentle when applying tape, and to be aware of any potential allergies the patient may have.)
Transcript:
Speaker 1
So that's something that we can do if we find there's a patient we'll worry about that has sensitive skin and we just want to be careful about injury. The second most common type of skin injury we interact with are patients that say they have allergies to tape and what they're really telling you is that when they have tape put on them they develop a dernititis and your job is to kind of know is it an allergy to tape which would actually be like an allergic reaction or is it a non-allergic response and most of the time that's just a chemical irritant so we'll talk a little bit about that because before this presentation I didn't really know how to counsel patients I think what we typically do is we maybe ask them a question or two and then we say okay we'll be as gentle as possible and we'll just you know for some things we really have to use the tape so I'm sorry but there's no alternative and that's fine and that's In reality what we do but there's a little bit more that you can get from them and reassure them and also educate them and I think that'll make your your daily practice a little bit stronger and so you know if you see somebody that has an adhesive allergy on the chart I think the most important thing to do is to appreciate that true allergies to tape vanishingly rare and that if you look in the medical literature for kind of case reports on this you'll see less (Time 0:30:20)
- Non-Allergic Dermatitis Associated with Tape Use
Key takeaways:
(* An allergy to tape is very specific and can only be caused by exposure to one type of tape., * Nonallergic dermatitis is more common and is caused by the tape itself being irritating.)
Transcript:
Speaker 1
So what does an actual allergy to tape look like well you kind of have a good sense of that you would see any rithematists or the secular proritic lesion it tends to be extremely specific to one type of tape and only one type of tape and it's consistently reproducible whenever they have an exposure to that tape so it doesn't matter if it touched their skin for five minutes or a day they will develop this dermatitis to that tape and this is mediated by delayed type hypersensitivity reactions by lymphocytes and really the best way to avoid this is to avoid that specific type of tape but what you'll see most commonly and which is about a hundred times more common than a true allergic reaction is a non allergic dermatitis which is basically an irritation from the tape itself and so there was a study done In the journal with dermatitis in 2015 where (Time 0:32:00)
- Non-Allergic Dermatitis to Tape
Key takeaways:
(* Tape allergies are very rare, and are usually due to nonallergic dermatitis., * Tape can cause an inflammatory response in the skin, which is not an allergy.)
Transcript:
Speaker 1
Develop this dermatitis to that tape and this is mediated by delayed type hypersensitivity reactions by lymphocytes and really the best way to avoid this is to avoid that specific type of tape but what you'll see most commonly and which is about a hundred times more common than a true allergic reaction is a non allergic dermatitis which is basically an irritation from the tape itself and so there was a study done in the journal with dermatitis in 2015 where some dermatologists looked at their medical record database and looked at three million records and they found that a tape allergy is reported in about 0.37 percent of their patients so about a hunt one in 270 patients report in tape allergy but again it's not really an allergy it's a hundred times more likely just to be what we call a non allergic dermatitis and so what This looks like is that you'll see a well demarcated area of erythema and edema that is strictly maintained within the bounds of that tape and it will happen to any type of tape and it's not consistently reproducible it's kind of the function of how long that tape stays in the skin and the mechanism behind this is that sweat which can be released when you occlude the skin it contains pro-inflammatory cytokines that can activate inflammation pathways and so what you're seeing is that you're seeing an inflammatory response but it's not an (Time 0:32:26)
- Tape Recycling and the Spread of Infections
Key takeaways:
(* Tape can be a source of infection, especially if it is contaminated with bacteria., * It is important to be careful when handling tape, and to discard it properly if it becomes contaminated.)
Transcript:
Speaker 1
Were recovered were things that you would not want to be spreading to other patients like staph aureus, pseudomonas, enterbacter and they also concluded that the flat surface of tape where it kind of sits on the table that that surface tended to be more contaminated than the outer rim and so they were not able to directly say oh this tape caused an infection but they were able to say tape gets dirty and in theory the things that get sturdy with could cause you know very little infections and the University of Toronto did a similar study about a couple decades later where they just randomly sampled tape rolls in the hospital they went to a single hospital they went in the ICU the ED the OR wherever they could find tape they took it and they cultured it and they found that 74 percent of the tape Had was colonized by pathogenic bacteria and interestingly they found that if you were to discard like one revolution of the tape a couple inches that only five percent of the specimens had significant growth afterwards so this kind of concluded that (Time 0:38:26)