Combining skill and knowledge ensures safe removal.
- Improve your knowledge on how to remove medical tape or wound dressings
- Discover products and strategies to ease the tape removal experience for your patients
By Ann-Marie Taroc, MSN, RN, CPN
All nurses have struggled with removing pressure sensitive adhesives (PSAs)—medical tape, plastic bandages, wound dressings—from fragile skin, next to healing wounds, or from sites of frequent reapplication. For some patients, removal can cause medical adhesive–related skin injury (MARSI), which presents as persistent erythema, skin stripping, blisters, or bleeding. (See Who’s at risk for MARSI.) And other patients may feel anxious because of previous experiences with painful PSA removal.
Who’s at risk for MARSI?
Our understanding of PSAs and their removal can help prevent harm and patient anxiety. This article will look at the qualities of PSA adhesives and backings, explain the principles of removal, and discuss products that aid removal.
PSA adhesives and backing
The skin’s surface qualities—moisture, hair, oil, and shedding dead cells—make PSA adhesion challenging. PSAs are designed to overcome these challenges, while balancing successful adherence and easy removal. Both the adhesive side of the PSA as well as its backing material play a role in adherence and removal.
Acrylate, silicone, and hydrocolloid are three commonly used adhesives. They each work in different ways. (See Comparing adhesives.)
As acrylate adhesive warms, it fills in the skin’s rough surfaces. Many medical tapes and some dressings contain acrylate with varying levels of adhesion, making some easier to remove than others. Some strongly adhering acrylates place patients at risk for MARSI.
Silicone adhesives—found in wound dressings and tape—adhere to the rough surfaces of the skin at initial application. This low-energy connection separates easily from the skin. Because it easily detaches, silicone PSAs aren’t appropriate when adhesion is critical, such as when securing an endotracheal tube.
The adhesion of hydrocolloid products increases with time, creating the same level of risk for MARSI as a well-adhered acrylate. Detachment requires a combination of manipulating the PSA backing and dissolving the adhesive.
PSA backing materials also affect removal. To separate the PSA adhesive from the skin, we have to distort the backing by stretching or pulling. The challenge with stretching, however, is our ability to maintain directional control. In the presence of hair, a wound, or a catheter, we don’t want to cause discomfort, distortion, or dislodgment. Consequently, the removal procedure we select includes assessing both the adhesive and backing of the PSA as well as the presence of any object we don’t want to disturb.
Principles of PSA removal
You have two options for PSA removal: low and slow or distortion. With low and slow, pull back the PSA at a low horizontal angle, away from the corner or edge, separating it from the skin. Distortion requires stretching the PSA backing to shear the adhesive from the skin. However, PSA removal is more than selecting one of two procedures; it requires understanding the core principle of supporting the skin while correctly detaching the product.
Skin is a soft and flexible organ that moves and bends in the direction we pull. Pulling off a PSA at a vertical angle creates the greatest force, but it may injure skin and distort a healing incision. Consequently, you must support the skin with your hands by anchoring the adhesive on the dressing (when stretching) or the newly exposed skin (when peeling back). A low angle of peel requires less force to separate adhesive from skin, which you accomplish with either procedure by keeping the PSA low and close to the surface. The goal is to avoid MARSI by minimizing the amount of force needed for detachment.
Silicone-based adhesive-removal products are the best option for aiding PSA removal. They evaporate, leave no residue on the skin, and are not noted for causing dry skin. If you don’t have access to silicone-based products, other options include water, alcohol, or emollients. Understanding the pros and cons of each will help you choose the right solution.
Water may be easily accessible, but it can weaken water-permeable PSA backings, separating them from the adhesive but not affecting its connection to the skin, leaving behind a sticky residue. Alcohol, on its own or combined with an antiseptic like chlorhexidine, can solubilize an adhesive, making it easier to detach. However, alcohol evaporation causes vasoconstriction and dries the skin. In contrast, emollients, such as mineral oil or lotions, facilitate separation of adhesive from the skin, causing no harm. Unfortunately, emollients may separate the adhesive from the backing and leave a sticky residue.
To ensure successful use of adhesive-removal products, follow product instructions. For example, an adhesive-removal product made with an odorless mineral spirit can effectively dissolve the adhesive for pain- and injury-free removal. However, if you don’t follow the product instructions to wash off any remaining product with soap and water, the patient’s skin may dry and crack.
Removal products aren’t appropriate in all cases. For example, they may be contraindicated in the presence of dermal glue or in close proximity to an incision.
Combine knowledge and skill
PSA removal is a combination of skill and knowledge. No single solution fits every patient or care environment, so understanding the qualities of various PSAs, the principles of removal, and the pros and cons of removal products helps ensure safe removal.
Ann-Marie Taroc is a staff nurse at Seattle Children’s Hospital in Seattle, Washington.
Czech Z, Kowalczyk A, Swiderska J. Pressure-sensitive adhesives for medical applications. In Akyar I, ed. Wide Spectra of Quality Control. Rijeka, Croatia: InTech; 2011; 309-32.
Denyer J. Reducing pain during the removal of adhesive and adherent products. Br J Nurs. 2011;20(15):S28, S30-5.
Konya C, Sanada H, Sugama J, et al. Skin injuries caused by medical adhesive tape in older people and associated factors. J Clin Nurs. 2010;19(9-10):1236-42.
Matsumura H, Ahmatjan N, Ida Y, Imai R, Wanatabe K. A model for quantitative evaluation of skin damage at adhesive wound dressing removal. Int Wound J. 2013;10(3):291-4.
Matsumura H, Imai R, Ahmatjan N, et al. Removal of adhesive wound dressing and its effects on the stratum corneum of the skin: Comparison of eight different adhesive wound dressings. Int Wound J. 2014;11(1):50-4.
McLafferty E. (2012). The integumentary system: Anatomy, physiology and function of skin. Nurs Stand. 2012;27(3):35-42.
McNichol L, Lund C, Rosen T, Gray M. Medical adhesives and patient safety: State of the science: Consensus statements for the assessment, prevention, and treatment of adhesive-related skin injuries. J Wound Ostomy Continence Nurs. 2013;40(4):365-80.
Reevell G, Anders T, Morgan T. Improving patients’ experience of dressing removal in practice. J Community Nurs. 2016;30(5):44-9.
Salmanoğlu M, Önem Y. Diabetic foot: Even the most innocent may turn into a threat. Euro J Gen Med. 2014;11(2):117-8.
Taroc A. Staying out of sticky situations: How to choose the right tape for your patient. Wound Care Advisor. 2015;4(6):21-6.
van Schaik R, Rövekamp MH. Fact or myth? Pain reduction in solvent-assisted removal of adhesive tape. J Wound Care. 2011;20(8):380-3.