Taking Skin Tear Prevention and Management Seriously

In the Past, Approaches to Skin Tears Were Inadequate

Many years ago, when I worked in a skilled nursing facility, it seemed my patients were always experiencing skin tears. We didn’t have wound care specialists then. My approach to these injuries, which I didn’t see as serious, was to cleanse them with saline and awkwardly attempt to reposition the detached flap. In retrospect, the nursing care I provided didn’t amount to much more than “a lick and a promise.”

Greater Awareness of Risks, Dangers of Skin Tears

screen-shot-2016-11-14-at-6-09-55-pmToday, we know that skin tears can evolve into serious, complex wounds. Available data indicate that in long-term care settings, these injuries affect up to 22% of residents. Wound care specialists have developed a classification system for skin tears—as for pressure injuries, specific recommendations from wound care specialists guide our nursing care.

In this month’s AJN, author Sharon Baranoski and colleagues from the International Skin Tear Advisory Panel detail the assessment and management of skin tears in “Preventing, Assessing, and Managing Skin Tears: A Clinical Review.” While the authors emphasize the need to involve wound care nurses in the management of these injuries, many readers may find the product selection guide in this article to be especially useful.

Skin Tear Prevention

As with pressure injuries, prevention of skin tears is important. Many patients, especially the very old and very young, are at high risk for skin tears for reasons most of us will easily identify, including immobility, neuropathy, vascular problems, and incontinence.

However, the extrinsic factors that contribute to skin tears remind us that the care we provide can make a difference for these patients. Without close attention on the part of caregivers, “simple” actions such as the application and removal of stockings, removing tape, blood drawing, and transferring can result in painful, costly, and complex skin tear wounds.

This continuing education article is free to read. Those interested in CE credit can also take the accompanying test (purchase required).

 

2016-11-21T13:00:49+00:00 November 14th, 2016|Nursing|3 Comments

About the Author:

Clinical editor, American Journal of Nursing (AJN), and epidemiologist

3 Comments

  1. Idalmis Aznay November 27, 2016 at 1:06 pm

    The tearing of skin is as a result of friction and forces that cause shearing or trauma from a blunt object. A tear causes the epidermis to separate from the dermis causing a partial thickness wound. Sometimes, both the dermis and epidermis can separate from underlying structures resulting in a full thickness wound.
    According to Todd (2016), most individuals perceive tears as minor wounds however they have the potential of evolving to complex wounds. It critical therefore to treat the tears before they become a major infection. The first step to treating the tears is cleaning the wound. To clean it properly use saline water to flush on the wound and the surrounding areas. In some cases, the skin flap from the wound is viable and can be put back. If it’s viable it is critical that you first hydrate the flap, you can achieve this by using a moist non-woven cotton swab. The final stage is bandaging the wound. Limited options are available for skin tears, one of them is using a petroleum based wrap and any material that is non-adhesive and can absorb excess moisture from the wound (Matzo and Sherman, 2010). When dressing the would it is vital that the method selected prevents dehydration.

  2. Melissa Miranda November 24, 2016 at 8:57 am

    Bed sores are caused by prolonged pressure on the skin that causes a tear. It is normally seen on areas of the body with bony prominences. The elderly and infants are more at risk for pressure ulcers because of immobility, neuropathy, vascular problems and incontinence. It is important to raise awareness of the dangers of skin tears and ways to prevent it. One of the main ways to prevent pressure ulcers are to continuously change the patient’s position to not allow them to spend to much time on one area. This goes the same for tape, Band-Aids or restraints. Anything that is left on the skin for a long period of time should be rotated. Preventative care is most important in reducing the risks for skin tears. All health care providers should preserve their patient’s skin integrity and take precautions to prevent pressure ulcers.

  3. Mariana Martinez November 22, 2016 at 12:57 pm

    Skin tears are an issue that affects most patients regardless of their reason for stay. The prevention of these tears depends a lot on the careful management of the patient’s skin both on part of the patient and nurse. Up until relevantly recently, these tears were not taken seriously because they seem harmless and small, but the danger is how quickly these injuries can progress and become a severe source of infection for the patient if not well taken care of. What can make these injuries difficult to heal is the lack of education on how to heal certain types of wounds. The type of wound dressing changes depending on the aspects of the wound, and if the wrong dressing is used, it can end up worsening the situation rather than alleviating it.
    I see this topic as important because even the healthiest of patients can end up with tears that lead to large and infected wounds due to lack of attention. In my clinical experience, I have seen numerous patients with deep skin ulcers that developed from a simple tear due to lack of skin care, when they originally came into the hospital for something completely irrelevant. As nurses, we must remember that the skin is the largest organ of our body, protecting all the inner body parts. The smallest break in integrity to this organ can lead to any other organ to be affected. Unfortunately, in the hospital many of the interventions done involve irritation to the skin including “application and removal of stockings, removing tape, blood drawing, and transferring”.
    This blog is very useful in reminding us how the smallest of skin tears can lead to large health issues if not properly taken care of. It reviews changes that occur in the skin in the elderly and why even more precaution needs to be taken with them. It also explains intrinsic causes for fragile skin in patients such as diabetics, those who are immobile, have vascular issues, and or are incontinent. With the use of specialized teams such as wound care specialists, patient turning teams, and transferring teams, the prevention and treatment of these tears has greatly improved

Comments are moderated before approval, but always welcome.