We are seeing an increase of skin reactions to tegaderm on our patients. Anyone have any suggestions why the increase in reactions, and any issues in your facilities. Wondering how you handle it. Thanks
I am going to assume the reactions are skin rashes or something along that line.
My first thought would be to watch a few nurses changing the dressings. It has happened occasionally - and often related to somebody either being in a hurry or just not thinking and placing the tegaderm before the skin was totally dry.
You didn't say where you are in the question. I am wonderng what the Tegaderm company would say about the extreme heat we have been having. Are there more apt to be reactions with the continued high heats? Should dressings be changed more often in the heat? I guess if the patient is outpatient this might be more important to question.
I would also want to know what skin antiseptic you are using and if you are using a skin protectant solution. As Gail said, these must be thoroughly dry and nurses can get in a hurry and forget that fact. Are these occuring on a particular nursing unit or with a particular group of nurses? A particular group of patients? There could be numerous factors influencing this and you will need to do a lot more investigation and observation of actual technique. Lynn
Sorry I can't remember the article but some chemotherapy drugs for breast cancer in particular can cause skin reactions with tegaderm. You might want to consider this if you are administer chemotherapy agents through any kind of line. I does go away afterwards. I did a test patch on a patient about 6 months past her chemotherapy with no more reaction. Mary Penn RN
I have never seen this described in any literature. Can you be more specific? Are you saying this skin reaction occurs only with the combination of the Tegaderm® brand from 3M or are you meaning that this can happen with certain chemo drugs in combination with any brand of TSM dressing? I would really appreciate a reference for this information. Thanks, Lynn
My apologies. This article actually focuses on the caustive agent being the CHG cleansing but can be exacerbated by the exfoliating action when the tegaderm is removed adding to the irritation. The patient I was working with was a post chemotherapy patient who was insisting she was allergic to tegaderm. I did a test patch on her skin cleaning first with CHG and applying a small piece of tegaderm with no further reaction. This stuck in my mind because I had just gotten this article on my computer from medscape. This is still a very interesting article to read as we may deal with this sort of irritation. It gave very good treatment options. Thank you for your forbearance. Mary Penn RN
Thanks. True allergic reactions to TSM dressings are not common but there are many other types of skin conditions that can develop. Again I doubt this article focused on the specific brand of Tegaderm®. This is a specific brand made by 3M yet there are numerous other brands of transparent semipermeable membrane dressings on the market. Tegaderm should not be used in a generic manner. Lynn
Point well taken. The article refers to transparent semipermiable dressings. At our facilities where the patient I took care of came from and the facility I work at we DO use Tegaderm brand. I do see the exfolliating action. In this case and the question asked by Ballance I don't really think it matters what you call it. The effect of exfolliating the top of the skin is the same. What do you call generic "band-aids"? Right at this moment I can't think of the appropriate terminology. For the sake of discussion how about not getting so piccy. (pun intended) At our group of facilities I am known as the PICCIEST PICC nurse when it comes to patient care and safety. This is a forum for discussing/solving problems. I made a suggestion to consider and actually it turned out to be the CHG under the transparent semipermiable dressing but the article felt that the exfoliating action of such dressings could be a contributor to the problem and offers suggestions be it Tegaderm brand or a generic product. I don't know what area Ballance works in. I hope that the article referernce helps her regardless of what are she works in or what brand dressing she uses. The treatment suggestions may be of assistance to anyone who is dealling with patients having skin reactions regardless of the source of the reaction. You have to figure out some way to protect the site while you are figuring out the source. Mary Penn RN
I guess I don't consider it being picky. I consider it being accurate in our taxonomy and that leads to more effective communication. Using any brand name when we are talking in a generic sense leads to misinterpretation of the message and that prevents us from solving problems. I see lots of examples of this communication problem in many areas of practice and it does not help matters. If the CHG is the problem in this case, then that would bring up questions about the CHG-gel dressings, which is a Tegaderm brand, and also the CHG pad dressings as well as the skin antiseptic solution. Thanks for clarifying what the article stated. Lynn
I don't know about the concentration on CHG in the pads or the gel in the tranparent semipermiable membrane dressings. The article references the concentration of CHG in the cleaners. Why don't you read it and maybe we can have an effective discussion about the matter and their treatment recommendations and how it might help other issues with skin irritations for the benefit of all. Mary Penn RN
The article listed earilier in this thread is a review on the potential causes and appropriate prevention and management of irritant contact dermatitis that can occur in the skin area surrounding a PICC insertion. Since this is in an oncology journal, the authors included a discussion of skin irritation that can occur when the patient is also receiving 5FU and taxanes. Literature is also cited that gives data on incident rates of skin irritation from CHG compared to povidone iodine. The authors emphasized the friction used to apply CHG along with the chemical source of irritation. It did include a short discussion of "occlusive transparent cover dressings", but did not mention a particular brand. The article provides guidance on prevention and treatment which focuses on avoidance of the agent or device that is causing the problem. In other words, substituting povidone iodine for the CHG and using other types of dressings. This is followed by reintroduction of the original agent or device. Other interventions are included with many based on personal communications with other nurses and not on research, probably because there is a lack of research in this area. I think this article supports the point I was making about using the correct terminiology. This article did not call out a specific brand name for any product. It included all concentrations of CHG and all formulations. I do think it provides a very good review of the problem along with appropriate methods to manage and prevent the problem. Lynn
A couple of years ago, we experienced an increased occurrence of skin irritation around and under Tegaderm dressings. At the INS convention in Louisville, I talked with a 3M RN rep. She told me that this can happen if the dressings are placed on the skin with "tension" - sort of stretching the dressing unintentionally when placing it over the IV site. It creates a "pull" or "shear" on the skin, even though it may not appear to be tight. She explained and demonstrated how to place it over the site, allowing it to lay or "drape" over the "landscape" created by the IV cath and extension, etc. Allowing the skin to dry thoroughly after cleaning it, and using this technique when applying the Tegaderm has alleviated this problem for us with very few exceptions. I cannot speak to the CHG gel - we stopped using shortly after trying it because it was so messy and difficult to work with.
I am going to assume the reactions are skin rashes or something along that line.
My first thought would be to watch a few nurses changing the dressings. It has happened occasionally - and often related to somebody either being in a hurry or just not thinking and placing the tegaderm before the skin was totally dry.
You didn't say where you are in the question. I am wonderng what the Tegaderm company would say about the extreme heat we have been having. Are there more apt to be reactions with the continued high heats? Should dressings be changed more often in the heat? I guess if the patient is outpatient this might be more important to question.
Let us know what you find.
Gail McCarter, BSN,CRNI
Franklin, NH
I would also want to know what skin antiseptic you are using and if you are using a skin protectant solution. As Gail said, these must be thoroughly dry and nurses can get in a hurry and forget that fact. Are these occuring on a particular nursing unit or with a particular group of nurses? A particular group of patients? There could be numerous factors influencing this and you will need to do a lot more investigation and observation of actual technique. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Sorry I can't remember the article but some chemotherapy drugs for breast cancer in particular can cause skin reactions with tegaderm. You might want to consider this if you are administer chemotherapy agents through any kind of line. I does go away afterwards. I did a test patch on a patient about 6 months past her chemotherapy with no more reaction. Mary Penn RN
I have never seen this described in any literature. Can you be more specific? Are you saying this skin reaction occurs only with the combination of the Tegaderm® brand from 3M or are you meaning that this can happen with certain chemo drugs in combination with any brand of TSM dressing? I would really appreciate a reference for this information. Thanks, Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
plain Tegederm and/or Tegederm CHG? are you seeing red rimmed beige erosion areas? have you collected swabs?
Management of Irritant Contact Dermatitis and Peripherally Inserted Central Catheters
Lia Kutzscher, RN(EC), BScN, MScN, CON(C), AOCNP®
Authors and Disclosures
Posted: 05/11/2012; Clin J Oncol Nurs. 2012;16(2):E48-55. © 2012 Oncology Nursing Society
My apologies. This article actually focuses on the caustive agent being the CHG cleansing but can be exacerbated by the exfoliating action when the tegaderm is removed adding to the irritation. The patient I was working with was a post chemotherapy patient who was insisting she was allergic to tegaderm. I did a test patch on her skin cleaning first with CHG and applying a small piece of tegaderm with no further reaction. This stuck in my mind because I had just gotten this article on my computer from medscape. This is still a very interesting article to read as we may deal with this sort of irritation. It gave very good treatment options. Thank you for your forbearance. Mary Penn RN
Thanks. True allergic reactions to TSM dressings are not common but there are many other types of skin conditions that can develop. Again I doubt this article focused on the specific brand of Tegaderm®. This is a specific brand made by 3M yet there are numerous other brands of transparent semipermeable membrane dressings on the market. Tegaderm should not be used in a generic manner. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Point well taken. The article refers to transparent semipermiable dressings. At our facilities where the patient I took care of came from and the facility I work at we DO use Tegaderm brand. I do see the exfolliating action. In this case and the question asked by Ballance I don't really think it matters what you call it. The effect of exfolliating the top of the skin is the same. What do you call generic "band-aids"? Right at this moment I can't think of the appropriate terminology. For the sake of discussion how about not getting so piccy. (pun intended) At our group of facilities I am known as the PICCIEST PICC nurse when it comes to patient care and safety. This is a forum for discussing/solving problems. I made a suggestion to consider and actually it turned out to be the CHG under the transparent semipermiable dressing but the article felt that the exfoliating action of such dressings could be a contributor to the problem and offers suggestions be it Tegaderm brand or a generic product. I don't know what area Ballance works in. I hope that the article referernce helps her regardless of what are she works in or what brand dressing she uses. The treatment suggestions may be of assistance to anyone who is dealling with patients having skin reactions regardless of the source of the reaction. You have to figure out some way to protect the site while you are figuring out the source. Mary Penn RN
I guess I don't consider it being picky. I consider it being accurate in our taxonomy and that leads to more effective communication. Using any brand name when we are talking in a generic sense leads to misinterpretation of the message and that prevents us from solving problems. I see lots of examples of this communication problem in many areas of practice and it does not help matters. If the CHG is the problem in this case, then that would bring up questions about the CHG-gel dressings, which is a Tegaderm brand, and also the CHG pad dressings as well as the skin antiseptic solution. Thanks for clarifying what the article stated. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I don't know about the concentration on CHG in the pads or the gel in the tranparent semipermiable membrane dressings. The article references the concentration of CHG in the cleaners. Why don't you read it and maybe we can have an effective discussion about the matter and their treatment recommendations and how it might help other issues with skin irritations for the benefit of all. Mary Penn RN
Yes, I will find and read it, just swamped this week. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
The article listed earilier in this thread is a review on the potential causes and appropriate prevention and management of irritant contact dermatitis that can occur in the skin area surrounding a PICC insertion. Since this is in an oncology journal, the authors included a discussion of skin irritation that can occur when the patient is also receiving 5FU and taxanes. Literature is also cited that gives data on incident rates of skin irritation from CHG compared to povidone iodine. The authors emphasized the friction used to apply CHG along with the chemical source of irritation. It did include a short discussion of "occlusive transparent cover dressings", but did not mention a particular brand. The article provides guidance on prevention and treatment which focuses on avoidance of the agent or device that is causing the problem. In other words, substituting povidone iodine for the CHG and using other types of dressings. This is followed by reintroduction of the original agent or device. Other interventions are included with many based on personal communications with other nurses and not on research, probably because there is a lack of research in this area. I think this article supports the point I was making about using the correct terminiology. This article did not call out a specific brand name for any product. It included all concentrations of CHG and all formulations. I do think it provides a very good review of the problem along with appropriate methods to manage and prevent the problem. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
A couple of years ago, we experienced an increased occurrence of skin irritation around and under Tegaderm dressings. At the INS convention in Louisville, I talked with a 3M RN rep. She told me that this can happen if the dressings are placed on the skin with "tension" - sort of stretching the dressing unintentionally when placing it over the IV site. It creates a "pull" or "shear" on the skin, even though it may not appear to be tight. She explained and demonstrated how to place it over the site, allowing it to lay or "drape" over the "landscape" created by the IV cath and extension, etc. Allowing the skin to dry thoroughly after cleaning it, and using this technique when applying the Tegaderm has alleviated this problem for us with very few exceptions. I cannot speak to the CHG gel - we stopped using shortly after trying it because it was so messy and difficult to work with.
Cindy A. Ceynar, RN, CRNI
League City, TX
Cindy A. Ceynar, RN, BSN, CRNI