Medical adhesive-related skin injuries (MARSI) represent a significant but often preventable clinical challenge in outpatient and acute care settings. For elderly patients or those with corticosteroid-induced skin thinning, the incorrect removal of surgical tape can lead to painful epidermal stripping and increased infection risk. By mastering specific application and removal techniques, practitioners can maintain wound security while prioritizing skin integrity.
Selecting the Right Material for the Patient
Not all clinical scenarios require the highest level of adhesion; selecting a tape based on the patient's skin condition is the first step in prevention. For fragile skin, silicone-based or soft cloth tapes like 3M Micropore are preferred over traditional silk tapes, as they allow for repositioning without traumatizing the stratum corneum.
Heavy-duty plastic tapes should be reserved for securing critical tubing or devices where high initial tack is necessary. In contrast, paper tapes are ideal for frequent dressing changes where the goal is to minimize cumulative friction and adhesive buildup.
The Tension-Free Application Method
One of the most common causes of skin tension blisters is applying tape under tension or stretching it across the skin. Tape should always be laid down on the skin "as is" and then gently smoothed from the center outward to ensure contact with the dermal contours.
When securing a joint or an area prone to swelling, choose a tape with cross-directional stretch properties, such as 2-inch wide elastic foam tape. This allows the material to expand with the patient’s movement or edema rather than pulling against the epidermis.
Utilizing Skin Barriers and Prep Wipes
Before applying any adhesive, ensure the skin is clean and dry to prevent moisture from being trapped beneath the tape. Alcohol-free skin barrier films provide a thin protective layer that shields vulnerable skin from aggressive adhesives and bodily fluids.
For clinics managing chronic wounds, these barriers are essential when using 1-inch or 2-inch medical tapes repeatedly in the same anatomical location. They create a physical interface that stays on the skin when the tape is removed, significantly reducing the risk of stripping.
Low-Trauma Removal Techniques
The technique used to remove tape is just as critical as the application; clinicians should always use the 'low and slow' method. Support the skin with one hand while folding the tape back over itself at a 180-degree angle, rather than pulling it upward at a 90-degree angle.
If an adhesive is particularly stubborn or the patient is at high risk for tears, medical adhesive removers in wipe or spray form can be used to dissolve the bond. This is especially useful when removing high-adhesion tapes from sensitive areas or following long-duration procedures.
Bottom Line for Clinical Staff
Preventing skin tears requires a combination of appropriate material selection and disciplined technique. By transitioning to silicone adhesives for at-risk populations and ensuring tension-free application, facilities can improve patient comfort and reduce the costs associated with treating secondary skin injuries.