A Message FOCUS ON ADHESIVE TRAUMA. New Zealand Dermatology Nurses Society National Conference, Copthorne Hotel, Queenstown

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1 ISSUE 2, July 2012 A Message from the Editor Welcome to Issue 2 of the 3M RISE Newsletter! Where do the months go? I hope you are all looking after your skin as the winter months draw in! Moisturise, moisturise, moisturise!!! I know that nurses are the last ones to look after themselves but we need to keep our skin intact too, especially our hands with all the hand washing that we undertake. This issue has a focus around adhesive trauma. This can often be an area of skin care that is not addressed until signs of skin damage are evident and intervention is required. We have all seen the consequences of adhesive trauma which can often be more distressing to the patient or resident than the primary wound or medical intervention. Adhesive trauma can lead to increased pain and suffering, the potential inability to use adhesive securement dressings and devices, increased risk of infection and in the case of intravenous devices the need to move the infusion site. You will hear from one of authors that this is particularly distressing for our paediatric patient group and something that should be avoided at all costs! Preventing skin breakdown will not only save nursing time, but cost to the organisation and minimise prolonged hospital stay due to secondary complications. Intact skin is our patient s first line of defense and we need to keep it that way! A huge thank you to this issue s authors who were all so passionate to contribute to such an important subject. It is also great to see an article from our New Zealand colleagues and these newsletters are a joint collaboration between our countries to further share and learn from each other. As always, we really welcome and encourage your input, which can be in the form of case studies, general articles, book or article reviews and conference reviews. Next issue will be around the challenges of peri wound management so please contact me if you would like to contribute. So until next issue, happy reading! Victoria Moss RN / Technical Specialist Skin & Wound Care 3M Australia vmoss2@mmm.com DIARY DATES 9-10 August August New Zealand Dermatology Nurses Society National Conference, Copthorne Hotel, Queenstown New Zealand College of Primary Health Care Nurses, Claudelands Conference and Exhibition Centre, Hamilton FOCUS ON ADHESIVE TRAUMA Table of Contents A Message from the Editor 1 Dates for the Diary 1 Managing to Prevent Adhesive Trauma 2 Sticky Issues 3 Maintaining Skin Integrity - A Paediatric Focus 8 See Your Name In Print! Wanted Case studies, articles, journal or book reviews, conference and educational day reports. This can include but is not limited to discussion on different risk factors, prevention and management of skin breakdown and input from a wide variety of share experience and knowledge. Please the editor with your submission or any of your ideas, Vicky Moss vmoss2@mmm.com 1.

2 Natalie Seymour, Clinical Manager, Cedar Manor Care Home, Tauranga, New Zealand. Natalie has worked in aged care since the age of 15. She started as a care giver and worked her way through to becoming a Registered Nurse and Clinical Manager. She has recently joined the team at Cedar Manor and is enjoying the role and the challenges that it brings. Natalie s role as Clinical Manager includes educating both the residents and staff, providing medical and nursing oversight and advice, wound care and pressure management. A 92 year old gentleman has a ten year history of post surgical wounds, with extensive purulent exudate. These wounds were sustained following a reconstructive hip joint replacement. After initially healing, these wounds dehisceised, then have healed superficially over time but then have broken again due to poor management and infection. During the past four years the wounds have sinused in four areas that vary in depth from 2cm to 0.5cm, and, they have never fully closed. These wounds continue to cause significant trauma to the surrounding skin from both high wound exudate and adhesive trauma from daily dressings and removal of tape. This gentleman also has double incontinence and requires full assistance with his Activities of Daily Living (ADLs) and uses continence products to manage. Over the ten years of these wounds, many skin emollients and moisturisers have been tried and tested to prevent deterioration of skin, however have not been successful. 3M Cavilon No Sting Barrier Film Spray was commenced nine weeks ago on a trial basis to aid in protection from on going trauma caused by daily dressing changes, the removal of tapes, and from the high purulent exudating wounds. On initial assessment the surrounding skin to the surgical wounds was irritated, inflamed and scaly. There was obvious trauma caused by constant removal of tape and long term use of zinc based products. 3M Cavilon No Sting Barrier Film was applied to the wound site and any raw areas each morning post ADLs. Additionally, 3M Cavilon Durable Barrier Cream was applied to the sacral area. The surgical wounds were managed with an alginate dressing and covered with an absorbent dressing. This worked well in conjunction with Cavilon No Sting Barrier Film as it does not inhibit the adhesive properties of the dressings or tapes used. An education session was conducted with the Nursing staff highlighting the correct use of 3M Cavilon products. During the first week of daily application, the gentleman showed no signs of discomfort or distress during the application and it became evident that it was aiding with reduction of trauma caused by removing tape from the skin daily and reinstating normal skin integrity. During the following weeks there was a noticeable improvement in overall skin integrity with no maceration, or friction sites. The nursing staff also reported that skin turgour had improved and presented as being well hydrated which was an issue previously due to being washed regularly and by over use of soap. Conclusion: The nursing staff reported that it was easy to apply and they found that if applied correctly the tape adhered to it better than any other products previously used. There was considerable improvement in the condition of this gentleman s skin integrity and the 3M Cavilon Skin Protection range has become part of our skin care approach for all residents who are at risk and to manage complex skin breakdown. Product Update Managing to Prevent Adhesive Trauma 3M Cavilon No Sting Barrier Film & Adhesive Trauma Protection Epidermal cells are removed every time an adhesive dressing is removed from the skin. This may involve just a few cell layers of the stratum corneum, but, even the removal of a few layers is an injury that signals the body to trigger inflammation and begin repair. Over time, the affected area can become red, swollen and painful. If underlying anchoring structures are inadequate-as is often seen in the aged, the entire epidermis can be traumatically stripped away with adhesive removal. This creates a partial thickness wound and an extremely difficult management situation. It is easy to understand why repeated dressing changes can become problematic, and why prevention of skin damage should be a major goal for care. Your solution: 3M Cavilon No Sting Barrier Film forms a protective interface between the prepped epidermis and the adhesive coating of the dressing. When the dressing is removed, it removes the Cavilon No Sting Barrier Film instead of skin cells. 3M Cavilon No Sting Barrier Film: forms a transparent protective film between skin and dressing is sterile, fast drying and hypoallergenic is alcohol-free allows for painless application is non-cytotoxic 2.

3 ISSUE 2, July 2012 STICKY ISSUES Michelle Gibb, Nurse Practitioner Wound Management, Wound Healing Community Outreach Service, Queensland University of Technology Kerrie Coleman, Nurse Practitioner Wound Management, Wound Healing Community Outreach Service, Queensland University of Technology The prevalence of skin breakdown increases with age and it is estimated that up to 70 percent of older people have a problem with their skin and that wounds affect up to 5 10% of the over 80 years age group in Australia (Australian Bureau of Statistics, 2008). The skin of older persons is more likely to be susceptible to adhesive trauma secondary to the normal physiological changes that occur as you age (Konya et al., 2010). Adhesive trauma in older persons can result in longer healing times, increased risk of infection, pain and suffering (Konya, et al., 2010). The Skin The skin is the body s largest organ. It comprises 15% of the total body weight, has an area of approximately 7600 square centimetres and receives one-third of circulating blood volume in the average adult (Shores, 2007). Maintaining skin integrity is a complex process, one that is often taken for granted until damage occurs. The skin has to perform many different functions. Having a good understanding of the layers of the skin and functions of normal skin is important so that you are able to recognise risk factors for poor skin integrity and to undertake actions to prevent skin breakdown or to improve wound healing outcomes. The thickness of the skin varies depending on location, with skin thickness ranging from mm. The thickest skin is on the soles of the feet and the palms of the hands. The thicker the skin the better it is able to withstand injury. The skin consists of three layers including the: Epidermis (outermost layer of the skin) Dermis (middle layer) Subcutaneous layer (bottom layer of the skin) Table 1: Functions of the Skin Function of the Skin Protection Temperature control (thermoregulation) Sensation and communication Metabolism Elimination Explanation The skin provides a covering that is designed to protect us from damage or injury. As your body sweats the sweat evaporates and cools the skin. Blood vessels also dilate and constrict to prevent heat loss and maintain a stable body temperature. Nerve endings and receptors are found in the skin and these help us to respond to touch, pain, heat or cold. The skin helps us to metabolise Vitamin D through exposure of the skin to sunlight. The skin helps us to eliminate waste through its function of excretion and secretion. Did you know? In a prospective cohort clinical study, on patients 65 years and older, the cumulative medical tape injuries to skin were found to be 15.5% over 8 weeks and those injuries led to infection 8% of the time. Patients with skin trauma experience discomfort, require more nursing time, and have increased risk of infection and chronic wounds. 1, 2 Patients with skin trauma take longer to heal. 1, 2 Skin tears may become infected, may require surgical intervention or may become chronic wounds. 1, 2 Tissue trauma, caused by the removal of adhesives tapes and dressings, can exacerbate pain, increase wound size and delay healing, thereby increasing health-care costs and reducing patients quality of life. 3 References: 1. Lober et al. Southern Med J. 1991;39: White, et al. Primary Intention. 2001;9(4): Cutting, et al. Journal of Wound Care 2008;17(4) 3.

4 Skin changes associated with ageing Up to 70% of older people have problems with their skin so it is very important to be able to recognise the common characteristics of ageing skin (Lawton, 2007). There are two types of skin ageing, including: Intrinsic ageing alterations in the structure and function of the skin due to normal maturity which occurs in all people; and, Extrinsic ageing due to constant or repeated exposure to environmental elements such as the sun. Some of the skin changes associated with aging are outlined in the following table. Table 2: Skin changes associated with ageing Type of problem Decreased sensory perception Increased dryness The skin becomes thinner and less elastic Decreased vitamin D synthesis Reduction in immune response Decrease in temperature control or thermoregulatory functioning Vascularity or blood supply of the skin is diminished Hormonal changes Changes in hair colour and balding The amount of subcutaneous tissue decreases Explanation This means when an older person injures their skin they may not be aware they have done so until they see the injured body part. The skin becomes drier and less supple because sebaceous and sweat gland activity decreases as you age. This is why many older people complain of dry, itchy skin. The skin decreases in turgor or thickness because of reduced collagen and elastic fibre production. The collagen present becomes thinner and when combined with less adipose or fatty tissue, the skin support structure is compromised and skin wrinkling occurs. Such skin is subject to friction and shearing trauma. The skin on the back of the hands becomes thin and transparent, whilst the skin on the back of the neck has a furrowed appearance. Ageing skin has more risk of skin tears and bruises and lesions as a result of thinner, less flexible skin and a lifetime of exposure to the sun. This is often due to inadequate exposure to sunlight, decreased dietary intake or a medical condition. It may take longer for skin to repair and older people have an increased risk of fractures. Cells which trigger the immune system are slower to respond and less effective. This increases the risk of infection for even minor injuries to the skin. Older people are less able to regulate their body temperature due to changes in environmental temperature. This is why some older people complain of being cold even on a hot day. Blood vessels in the dermis become more fragile and there is a decreased peripheral circulation. This is why older people bruise more easily and may explain why fingernails lose their luster and toenails thicken. Facial hair in males decreases and yet increases in females. Pubic and axillary hair thins, straightens, greys and lessens because of reduced hormonal functioning. Both males and females experience overall hair loss from the trunk and extremities. Hair loss on the lower limbs may also occur when peripheral vascular disease is present. Hormonal changes also lead to drier skin. Scalp hair greys and balding occurs because of a reduction in the number and functioning of melanocytes, the cells which give hair and skin their colour. The density and rate of scalp hair growth also declines and the size of hair follicles change leading to baldness. The amount of subcutaneous tissue decreases particularly in the extremities, giving joints and bony prominences a sharp, angular appearance. The hollows in the thoracic (chest), axillary (under the arms) and supraclavicular (collar bone) regions deepen. Case Study #1 - Patient with mixed venous/arterial ulceration What not to do / why this is a problem The use of multiple dressings increases the risk of skin trauma to at risk skin rolled edges, skin reactions, skin stripping Patients who have sensitive skin may have a hyper inflammatory response to either the adhesive product or to the tape tension i.e. blistering Consider using dressings with no adhesives or a silicone based adhesive Consider using a paste impregnated bandage Use of assistive devices to hold dressings in place such as undercast padding or cotton tubular bandage 4.

5 ISSUE 2, July 2012 Factors affecting the skin and wound healing Being able to recognise factors that can impact on skin integrity is essential so that you can take steps to either remove the factors or, if possible, minimise their impact. Some factors that may affect skin integrity include the following outlined in the table below. Table 3: Factors affecting skin integrity Factor Comorbidities Nutrition and hydration Medications Age Obesity Psychological state Decreased blood supply Infection Foreign bodies Pressure, friction, shear Temperature Exudate Loss of sensation Smoking Explanation Case Study #2 - Venous leg ulcer Illnesses such as renal failure, heart failure, a cerebral vascular accident, diabetes, malignancy, rheumatoid arthritis, and autoimmune disorders increase a person s risk of suffering impaired wound healing because of the way these diseases affect all body systems. For example, poorly controlled diabetes can lead to neuropathy, ischaemia and infection and anaemia reduces the supply of circulating red blood cells and the oxygen carrying capacity of blood to the wound. Poor nutrition and hydration will slow down the wound healing process because the body will not have enough nutrients to promote wound healing. A wound increases the body s need for nutrients, protein and energy. Patients need to drink at least 6 to 8 glasses of fluid per day because a lack of fluids impairs the blood flow which reduces oxygen and nutrients needed in the tissue to promote wound repair. Dry skin is less elastic and more likely to breakdown. Sources of fluid include water, juice, milk, jelly, ice-cream, yoghurt, soup, tea and coffee. Some medications that make the blood less likely to clot (e.g. anticoagulants) or steroids (e.g. taken for conditions such as rheumatoid arthritis) make the skin thinner and more likely to tear and suppress the inflammatory phase of healing Blood flow decreases with age and the older a person is the more likely they are to have problems with their skin. Adipose tissue is poorly vascularised and can delay wound healing or lead to dehiscence of the wound edges There is a link between high levels of stress and impaired wound healing. The presence of a wound can affect a person s body image, self-concept and sexuality. Hardened, narrowed or blocked arteries reduce blood supply to the skin. This slows down wound healing because blood carries nutrients and oxygen. The presence of a wound infection slows down healing. A foreign body such as wound debris, sutures, dirt, hair, dressing products or infection in a wound delays wound healing. Dry skin is more likely to tear due to friction, shearing or pressure Wounds need a stable temperature, approximately 37 o Celsius, to heal more rapidly High volumes of wound exudate can delay wound healing and increase the risk of wound infection and breakdown of periwound tissue Wounds need a moist wound environment to heal so that epithelial cells can migrate across the wound surface. Achieving optimal moisture balance in the wound bed is a key goal of wound healing Scab formation in the wound bed delays epithelialisation because epithelial cells have to migrate under the scab Decreased sensation, loss of consciousness, an injury to the central nervous system, a cerebrovascular accident, major surgery, spinal cord injury or medications such as steroids or anticoagulants, increase the risk of skin damage. This is because the patient may not be aware that an injury to the skin has occurred. Cigarette smoking is a well known risk factor for impaired wound healing because it leads to hardening of the arteries (atherosclerosis) and ischaemic heart disease. Prevention hints and tips: Avoid using dressings with adhesives on patients with venous leg ulcers underneath compression systems There are a number of patients with chronic venous insufficiency that have contact allergies and often have eczematous or fragile surrounding skin greater care in the application and removal of dressings is recommended. If using a foam dressing consider one that has bevelled edges to prevent indentation around the wound Use of barrier wipes/creams to protect the intact skin Remember any tapes that are wrapped around the leg can have a tourniquet effect 5.

6 In addition to the factors above, other influences that can affect skin integrity include socioeconomic status, ability to self-care, mobility, and our own knowledge and beliefs (Lawton, 2007). Taking steps to prevent skin breakdown is essential and listed in the table below are some simple strategies that you can do. Table 4: Preserving skin integrity Prevention strategies Assess skin regularly Use emollient soap substitutes for washing or cleansing Avoid products that may irritate the skin Dry the skin thoroughly Apply a ph neutral moisturiser and/or barrier cream at least twice daily When applying moisturiser and/ or barrier cream, follow the direction of body hair and gently smooth into the skin Encourage patient to wear loose, cotton clothing where possible Case Study #3 - Explanation This enables you to put in place and evaluate correct and suitable preventive measures This reduces the drying effects of soap and water. Emollients restore the natural barrier function of the skin by replacing lost water and provide a protective film over the surface of the skin. Emollients include creams, ointments, lotions, bath oils and soap substitutes. Products such as perfumes, bubble baths and talcum powder can irritate the skin and cause itching or discomfort. Drying should involve a light patting and not rubbing as this may lead to abrasion and/or weakening of the skin. If skin is left damp, it is vulnerable to excess drying from the environment and at risk of fungal and bacterial contamination This will help to prevent dry skin. A ph neutral moisturiser is one that is neither acid or alkaline. It has a ph between 6.5 and 7.5. A barrier preparation can be a cream, ointment or spray which contains substances that repel water such as silicone or zinc oxide. Rubbing can cause irritation. Rubbing moisturiser against the direction of hair growth increases the risk of an infection occurring in the hair follicles This helps the skin to breathe better and reduces the risk of sweating from nylon fabrics. The use of limb protectors can also protect fragile limbs Adhesive trauma sacrum Hints and tips for prevention of other types of adhesive trauma Keep skin clean and hydrated Manage any fungal infections promptly Use of appropriate barrier wipes/creams to protect from chemical/tape/shear forces When using barrier creams avoid applying thick layers as this will prevent assessing of the skin integrity surrounding the wound Carefully assess the level of exudate and match the dressing - if requires daily dressing than adhesive dressings should be avoided Consider if the use of an adhesive dressing in the sacral area will remain in place Did you know? Tape related skin injury may result in infection as much as 8.8% of the time. 1 Tape is the third most cited cause of skin tears following hospital beds and patient positioning. 2 Trauma can lead to: Increased risk of infection, particularly Catheter Line Associated Blood Stream Infections (CLABSI). CLABSIs are an acknowledged problem affecting clinical outcomes (both morbidity and mortality) 3 References: 1. White, et al. Wounds UK. 2005;1: PAPSRS. Skin Tears: the Clinical Challenge. Accessed July Abad, CL and Safdar, N. Catheter-related Bloodstream Infections. Infectious Disease. (Special Edition) McMahon Publishing 6.

7 ISSUE 2, July 2012 Adhesive Trauma Adhesive trauma is a serious and yet largely preventable problem. The pain and trauma associated with dressings can cause anxiety and suffering for patients and healthcare professionals (Shannon & Chakravarthy, 2009). Many of the adhesives dressings and tapes we use in every day clinical practice can significantly impact on the skin by causing damage to the surface of the skin upon removal and hypersensitivity of the skin. Repeated application and removal of dressings or tape in the same location can cause skin stripping (Dykes, Heggie, & Hill, 2001; Shannon & Chakravarthy, 2009). This is where the superficial stratum corneum of the skin is removed causing changes in the barrier function of the skin. This damage is characterised by inflammation, erythema, oedema, vesicular changes and is frequently very painful and stressful for the patient (Dykes, et al., 2001). Inappropriate removal of adhesives can result in blisters and breaks in the skin increasing the risk of infection (Shannon & Chakravarthy, 2009). Judicious use of products that preserve the barrier function of the skin and maintenance of good skin hygiene can reduce the risk of this problem occurring (Konya, et al., 2010). These case studies demonstrate the deleterious effects of adhesive trauma on the skin and provide some simple hints and tips that can be implemented to prevent adhesive trauma from occurring. Examples of adhesive trauma Adhesive Trauma - mixed venous/arterial leg ulcer Adhesive Trauma - venous leg ulcer References Australian Bureau of Statistics. (2008). Population Projections, Australia, Table B9. (3222.0). Dykes, P., Heggie, R., & Hill, S. (2001). Effects of adhesive dressings on the stratum corneum of the skin. Journal of Wound Care, 10(2), Konya, C., Sanada, H., Sugama, J., Okuwa, M., Kamatani, Y., Nakagami, G., & Sakaki, K. (2010). Skin injuries caused by medical adhesive tape in older people and associated factors. Journal Of Clinical Nursing, 19(9-10), Lawton, S. (2007). Addressing the skin care needs of the older person. British Journal of Community Nursing, 12(5), Shannon, R. J., & Chakravarthy, D. (2009). Effect of a water-based no-sting, protective barrier formulation and a solvent-containing similar formulation on skin protection from medical adhesive trauma. International Wound Journal, 6(1), Shores, J. (2007). Skin substitutes and alternatives: a review. Advances in Skin and Wound Care, 20, Product Update Product Update: 3M Cavilon No Sting Barrier Film & its use around IV sites Cavilon No Sting Barrier Film is an alcohol-free liquid barrier film that dries quickly to form a breathable, transparent coating on the skin. It is designed to protect intact or damaged skin from urine, faeces, body fluids, adhesive trauma, and friction. Cavilon No Sting Barrier Film may be applied over antimicrobial preparations once completely dry to protect the skin surrounding infusion devices from adhesive damage. Because of this, it is important to know that Cavilon No Sting Barrier Film is compatible with Chlorhexidine Gluconate (CHG) remaining on the skin following the use of a skin prep. The primary concern occurs when Chlorhexidine reacts with an anionic compound and is converted wholly or partly to an insoluble salt. In that situation, a loss of antibacterial action is to be expected. Cavilon No Sting Barrier Film contains a silicone acrylate terpolymer which is nonionic. It would be expected that the Cavilon No Sting Barrier Film and Chlorhexidine Gluconate would be compatible since the risk of interaction is primarily a concern with anionic materials. 3M conducted a study to further demonstrate the compatibility of Cavilon No Sting Barrier Film with Chlorhexidine gluconate 1. Careful consideration should be given when selecting a barrier film for the protection from adhesive trauma for IV Sites as any barrier films ( skin protectants ) which contain anionic polymers could, in theory interact with CHG and therefore be incompatible. In relation to optimal IV site protection as well as Chlorhexadine Gluconate compatability, other characteristics that should be considered when choosing a barrier film are, is the barrier film: Proven to protect skin from adhesive trauma Sterile Fast drying and non sticky (for ease of use and patient comfort) Non cytotoxic (will not interfere with wound healing if the skin is damaged) Hypoallergenic Non stinging (comfortable to be used on damaged skin) 1. 3M Data on File 7.

8 Julia O Brian, Paediatric Nurse Educator, Barwon Health, Geelong, Victoria. Julia has been a Paediatric Nurse Educator at Barwon Health for the last three years. She completed her paediatric nurse training at Great Ormond Street Hospital, London in 1998 and worked in various teaching hospitals across the UK covering areas in paediatric neurosurgery, general paediatrics, paediatric intensive care, paediatric surgery and paedaitric oncology. Julia is also now a Mum to 2 year old Benjamin! Did you know? Cavilon is a Latin word, meaning Protect. Product Update Maintaining Skin Integrity A Paediatric Focus A large number of infants and children we see on the ward require nasogastric tubes for either short term or long term therapy (such as nutritional support). This is an invasive and potentially traumatic experience for the child where distraction therapy and guided imagery is used to minimise distress. Many infants when unwell will sweat causing tapes to often peel off and the tube becomes dislodged or even falls out. The aim is to try to keep the insertion of tubes to an absolute minimal which this is less traumatic for the child and parents. Unfortunately, children with long term nasogastric tubes often have to have tubes reinserted in alternate nostrils due to breakdown of the skin and irritation. Infants admitted over winter with respiratory illness are treated with humidified oxygen and require nasal prongs placed into both nostrils and taped on both sides of their cheeks. The warm humidified oxygen can cause the tape under the nasal prongs to peel off. Because of this, frequent taping occurs to the infant s skin causing further potential for skin breakdown and irritation. From my previous experience in the UK with 3M Cavilon No Sting Barrier Film, I was keen to have it implemented in the paediatric ward at Barwon Health. Recently a series of education sessions for its use in minimising adhesive trauma were conducted. Staff are now being encouraged to use Cavilon No sting Barrier Film over the area where nasogastric tubes, other invasive devices, adheisive dressings and tapes will be placed. Additional benefits from implementing the 3M Cavilon Skin Protection Range of Products has also been recognised, in particular, for the prevention of nappy rash. This can be particularly challenging not only for our patients on antibiotic therapy but also our oncology children, where due to aggressive chemotherapy drugs experience frequent and caustic diahorrea which can be very damaging to their already fragile skin. We encourage staff to use 3M Cavilon Durable Barrier Cream as a preventative for those children that we know are more susceptible to breakdown around the nappy area and Cavilon No Sting Barrier Film if signs of skin breakdown becomes evident. The next phase is to conduct a revised education session for staff on the ward and to get feedback on their experiences of the use of the Cavilon Skin Protection Range of products and to gage an idea on how often it is being used. Future plans include an audit on our paediatric ward on the use of the Cavilon range of skin protection products, its effectiveness of the product, nurses experiences, cost savings for anticipated shorter time of admissions and reduced nurses time. Not to mention the main objective to minimise any pain and distress for our paediatric patient group and their families. 3M Cavilon No Sting Barrier Film: Adhesive Trauma Protection for Paediatrics Sanders et al, (2007) undertook a study to determine if the use of 3M Cavilon No Sting Barrier Film as part of a novel dressing removal technique resulted in shorter removal times, reduced the child s experience of pain and/or reduced parental anxiety when compared to a standard approach. The dressing with 3M Cavilon No Sting Barrier Film was significantly quicker to remove than the dressing with standard removal procedure, averaging 30 minutes (5-86 minutes) compared to 40 minutes ( minutes), respectively. There were no significant differences in child s pain or parental anxiety score between the two approaches. The novel dressing removal approach incorporating 3M Cavilon No Sting Barrier Film resulted in a significantly shorter dressing removal time than the standard procedure. Reference: Sanders C, Young A, McAndrew HF & Kenny SE. (2007). A prospective randomized trial of the effect of a soluble adhesive on the ease of dressing removal following hypospadias repair. Journal of Pediatric Urology. 3(3):

9 3M Kind Removal Silicone Tape Care More, Compromise Less. Skin Injury Is Occurring More Often Than You Think The problem occurs across units in the health care setting 1 and its prevalence is expected to grow as the number of patients with fragile skin continues to increase. Use of adhesive products such as tape can exacerbate the risk of skin injury. 2 Konya reported that cumulative incidence of skin injury caused by tape removal may be as high as 15.5% 3. To Care and Protect 3M builds upon its history of innovation to bring you 3M Kind Removal Silicone Tape - a new, silicone-based, adhesive technology that delivers reliable fixation and atraumatic removal in one easy-to-use, affordable tape. You can be secure in the knowledge that you will have the adhesion level needed to get the job done, and take comfort in knowing you can help minimise tape-related pain and skin injury. Skin tear Tension injury Skin stripping For a sample please 3mkrst@mmm.com Security Offers reliable yet pliable fixation, remains in place until you decide otherwise. 3M Australia Pty Limited ABN Building A 1 Rivett Road North Ryde NSW M New Zealand Limited 94 Apollo Drive Rosedale, Auckland 0632 Customer Service: References & Resources 1. PAPSRS.Skin Tears:the Clinical Challenge. Accessed July Baranoski et al.wound Care Essentials: Practice Principles. New York: Lippincott Williams & Wilkins; Konya, et al.j of Clinical Nursing 2010;19; M is a registered trademark of 3M. 3M All rights reserved. Comfort Removes cleanly, without disrupting fragile skin layers or causing patients any undue pain. Ease of Use Can be repositioned and neatly torn by hand.