Make Correct Tape Application a Sticking Point

Make Correct Tape Application a Sticking Point

By Kelly M. Pyrek

A wide range of fixative aids are available to hold wound dressings and tubesin place. The most common of these -- tapes -- are designed to be highlyfunctional, cost-effective and to simplify dressing- and device-retentiontechniques. Adhesive surgical tapes are used on smaller wounds to hold textilecompresses in place, while hydrogel dressings, which have no adhesion fixationborder, can be held in place with the appropriate plasters. Many cliniciansconsider the application of rectangular strapping (all four edges fixed withstrips of tape) to be most effective, as this technique reduces wound irritationcaused by movement of the dressing. Tapes may also be applied in a parallelfashion on minor incisional wounds healing by first intention, where being leftundisturbed is not of primary importance.

Because surgical tapes are used in a wide range of medical applications, avariety of products may be necessary to meet the requirements of differentprocedures, wounds, skin types and medical devices such as nasogastric tubes orcatheters that must be affixed. Surgical tapes can be constructed of textilefabric, silk and nonwoven textiles, as well as from waterproof or poroustransparent film.

A survey of the surgical tape marketplace in 2002¹ revealed thepresence of more than a dozen different kinds of paper, plastic, silk, elastic,cloth and waterproof tapes. A majority of these tapes were designed to behypoallergenic, breathable and latex free, to avoid triggering contactdermatitis. Non-allergenic contact dermatitis can result when tackifiers aretrapped between the skin and the adhesive. The affected area can appear red,blistered, swollen or weeping. Allergic contact dermatitis reactions can betriggered by a component of an adhesive or a backing, and they occurinfrequently. Clinical signs and symptoms include well-defined areas of erythemaand edema, vesicles and small erosions.

Many of them are coated with a plaster mass made from rubber adhesive systemscontaining zinc oxide or from synthetic polyacrylate adhesives. Although zincoxide self-adhesive plasters have excellent adhesive properties, they aresometimes not tolerated by the skin. For patients with sensitive skin, it ispreferable to use surgical tapes with skin-compatible polyacrylate adhesives.

Irritation caused by surgical tapes has been documented in the literature. Inone study of cutaneous reactions to surgical preparations and dressings, 100surgical patients were monitored for the causes of contact dermatitis.²Patch testing with the North American Contact Dermatitis Standard Series andadditional agents used in the surgical preparation and dressing was performed on11 patients with postoperative dermatitis or a history of allergic reactions totape. Twelve patients were diagnosed as having irritant (mechanical) contactdermatitis. One patient had allergic contact dermatitis to benzoinpostoperatively, while another patient with a history of adhesive tape allergyhad a positive patch test to thiuram mix, rubber accelerators formerly presentin adhesive tapes. The study found that irritant contact dermatitis is a commonproblem among surgical patients, while allergic contact dermatitis is lesscommon -- occurring in 2 out of 100 patients.

One study that evaluated surgical tapes for wound closure examined a nonwovenmicroporous tape, a nonwoven microporous reinforced tape, a gauze tape and apolyurethane tape.³ The performance of the tapes was assessed bymeasuring their breaking strength, degree of elongation under pressure, adhesionto 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 concludedthat nonwoven microporous tape performed the best because it has an adhesivethat aggressively adheres to the underlying skin, is strong enough to resistbreakage during clinical use, and elongates sufficiently to prevent blisterformation. Its microporous structure allows for rapid air transmission in vitroand results in an environment that is antithetical to bacterial growth.

Securing intravenous catheters, tubing and dressings requires a tape that isdurable and conforms to body contours, according to Hy-Tape International.Patients who are receiving long-term infusion therapy or chemotherapy areespecially in need of a tape that will not traumatize the skin. Elderly,immunosuppressed and dehydrated patients who receive IV therapy are highlysusceptible to bacterial invasion through microscopic fissures in the skin. Thismay, in turn, increase the risk of skin breakdown, phlebitis, sepsis and traumafrom adhesives.

Acute wound management requires stringent safeguards against infection byforeign matter; they are usually closed with sutures, staples or closure tapes,according to DeRoyal Wound Care. They are usually dressed with a dry adhesivebandage. Wounds closed with closure tapes develop resistance to infection morequickly and effectively than stapled or sutured wounds, since the staples orsutures can bring bacteria under the skin.

According to 3M Health Care Services, if tape does not adhere well to thepatient'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 tensionblisters and skin stripping, according to 3M clinicians. Skin damage can beavoided by correct choice and use of the tape, attention to skin preparation,and proper application and removal of tape. The most common adhesive-relatedskin 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.