Use of Adhesive Dressings in Skin . Care: DuoDERM Extra Thin . Donna Ching, MN, CPNP, and Donna L. Mell, RN, ET
D
uoDERM Extra Thin (ConvaTec, Princeton, NJ) is a hydrocolloidal adhesiveCGF dressing that is used in the managementof early skin breakdown. It contains hydroactive particlesembeddedin a polymer base. When applied to the skin, DuoDERM Extra Thin provides a secure,water-resistant,occlusive seal. Moisture does not interfere with the adherent properties of the product. The outer surface of the dressing is smooth and transparent, which allows continued observation of the skin beneaththe dressing.The primary indication for useof this product is generallyfor the treatment of superficialdermal ulcers or pressuresores. An occlusive dressing often is used as an adjunct to wound healing becausethis type of dressing is effective in altering the wound microenvironment, primarily by providing moisture. Moisture under occlusion facilitatesepithelial migration without thicker scab formation. The increasedrate of reepithelialzation is directly related to the low pH, low oxygen environment createdby the dressing,which also may act as a physical barrier to outside contaminants. The authors report experiencein the clinical use of DuoDERM Extra Thin as a treatment to maintain the integrity of healthy skin and to prevent skin breakdown. The increaseduse of illegal drugs in the general population is paralleled by a rise in the number of women who use substancesthroughout pregnancy. Detecting toxic substancesin newborns has become a key factor in planning appropriatenursing, medical, Donna K. Ching is in private practice and is part-time research nurse for Perinatology Associates of Emanual Hospital and Medical Center, Portland, Oregon. Donna L. Mel1 was an enterostomal therapist at Oregon Health Sciences University and currently is working with a medical supply distributor.
JOURNAL
OF PEDIATRIC
HEALTH
CARE
and social interventions. Toxicologic urine screening reportedly is becoming commonplacein many newborn nurseries.Collection of urine is usually accomplished by obtaining the urine sample with a urine collection bag placed over the infant’s genitals. The bag remains in place with the adhesiveend of the bag placed directly on the infant’s skin. This collection bag is left in place for a few hours. When the sampleis collected, the bag is removed by pulling it away from the skin. Meconium contamination of the urine or leakageof the urine out of the bag and into the diaper often have necessitatedmultiple applications and removal of the specimenbag to obtain the required sample volume. The repetitive shearing of the skin each time the urine bag is removed has led to secondary erythema, maceration, or open sores over the involved area.The use of DuoDERM Extra Thin may provide an innovative approach to minimizing or eliminating this repetitive shearing and subsequentdamageof the skin. DuoDERM Extra Thin is cut in the sameconfiguration as the open end of the urine collection bag. The adherent side of the DuoDERM Extra Thin is placed directly onto healthy skin, and the urine bag is then placedon the outer surfaceof the DuoDEFW Extra Thin. The size of the urine bag is trimmed by one-quarter inch so that a small area of the bag can be lifted off and separatedfrom the outer surfaceof the DuoDERM Extra Thin when the bag needs changing. It was anticipated that the occlusiveproperties of the DuoDERM Extra Thin would provide a better seal than placing the bag directly onto skin. In addition, if any meconium leaked into the bag, requiring a change, the bag would be pulled away from the outer surfaceof the DuoDERM Extra Thin in-
155
stead of from the underlying skin. Minimizing the number of times the urine bag is applied and removed should minimize the risk for injury or reinjury to the
Although the DuoDERM Extra Thin did not sarisfy the clinical needs of this practice as to the number of times the skin was subjected to pulling or shearing, the product did not contribute to skin breakdown. DuoDERM Extra Thin is vcn~ flexible and conforms nicely to surface areas. The authors suggest that this product might also be used in special care nurseries to promote maintenance of healthy skin. Infants in neonatal special cart units often have feeding tubes, lines, or lonpterm nasal prongs anchored to the skin with tape. Irritation of the skin caused by frequent taping might be minimized by placing DuoDERM Extra Thin bctween the skin surface and the tape.
Skin.
Clinical experience with DuoDERM Extra Thin confirmed its adherent properties even m the particularly warm, moist diaper area. The product did not cause any erythema, irritation, or maceration of the underlying skin, and DuoDERM Exua Thin was less abrasive to the skin. Unfortunately, the seal between the outer surface of the DuoDERM Extra Thin and the adhesive side ofthe urine bag remained a problem because the urine bag did not separate easily from the DuoDERh4 Extra Thin. Therefore, the number of times the urine bag was applied was not minimized.
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I
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1933 NAPNAP Conference
The Program Committee is accepting clinicd projects for presentation at the 12th Annual NAPNAP Conference, to be held April 7-10, 1991 in Philadelphia. The purpose of the Clinical Project Presentations is to provide a forum for the presentation of clinical projects that relate to the delivery of service by nurse practitioners. The clinical project must include one of the following concepts: Promote health and well-being among the pediatric population. l Minimize or prevent behaviorally or environmentally induced health problems that compromise the quality of life in the pediatric population. l Reduce the negative impact of health technologies in the adaptive abilities of the pediatric population and their families when they are faced with acute or chronic health problems. The &a&e for submitting abstracts is June 1, 1990. Please submit four copies of the following: 9 A 1 -page fact sheet that includes the title of the project, l
the name of the presenter, institutional affiliation, phone number (work and home), and address (work and home). n A 1 -page abstract of 500 words or less, single-spaced, double-spaced between paragraphs, without au&or identification, but with title at the top of the page. . If the project is a tool, please submit a copy of the tooI along with the abstract. Submit papers to:
Gdelines requested.
Nancy Barber, MS, CPNP Program Chair NAPNAP National Office 1101 Kings Highway North, Suite 206 Cherry Hill, NJ 08034 are available from the National Office, if
Abstract presenters must be available to present their papers at the conference and are responsible for all expenses. One complimentary regist&ion to th& conference is provided per presentation.
-,
D
uoDERM Extra Thin (ConvaTec, Princeton, NJ) is a hydrocolloidal adhesiveCGF dressing that is used in the managementof early skin breakdown. It contains hydroactive particlesembeddedin a polymer base. When applied to the skin, DuoDERM Extra Thin provides a secure,water-resistant,occlusive seal. Moisture does not interfere with the adherent properties of the product. The outer surface of the dressing is smooth and transparent, which allows continued observation of the skin beneaththe dressing.The primary indication for useof this product is generallyfor the treatment of superficialdermal ulcers or pressuresores. An occlusive dressing often is used as an adjunct to wound healing becausethis type of dressing is effective in altering the wound microenvironment, primarily by providing moisture. Moisture under occlusion facilitatesepithelial migration without thicker scab formation. The increasedrate of reepithelialzation is directly related to the low pH, low oxygen environment createdby the dressing,which also may act as a physical barrier to outside contaminants. The authors report experiencein the clinical use of DuoDERM Extra Thin as a treatment to maintain the integrity of healthy skin and to prevent skin breakdown. The increaseduse of illegal drugs in the general population is paralleled by a rise in the number of women who use substancesthroughout pregnancy. Detecting toxic substancesin newborns has become a key factor in planning appropriatenursing, medical, Donna K. Ching is in private practice and is part-time research nurse for Perinatology Associates of Emanual Hospital and Medical Center, Portland, Oregon. Donna L. Mel1 was an enterostomal therapist at Oregon Health Sciences University and currently is working with a medical supply distributor.
JOURNAL
OF PEDIATRIC
HEALTH
CARE
and social interventions. Toxicologic urine screening reportedly is becoming commonplacein many newborn nurseries.Collection of urine is usually accomplished by obtaining the urine sample with a urine collection bag placed over the infant’s genitals. The bag remains in place with the adhesiveend of the bag placed directly on the infant’s skin. This collection bag is left in place for a few hours. When the sampleis collected, the bag is removed by pulling it away from the skin. Meconium contamination of the urine or leakageof the urine out of the bag and into the diaper often have necessitatedmultiple applications and removal of the specimenbag to obtain the required sample volume. The repetitive shearing of the skin each time the urine bag is removed has led to secondary erythema, maceration, or open sores over the involved area.The use of DuoDERM Extra Thin may provide an innovative approach to minimizing or eliminating this repetitive shearing and subsequentdamageof the skin. DuoDERM Extra Thin is cut in the sameconfiguration as the open end of the urine collection bag. The adherent side of the DuoDERM Extra Thin is placed directly onto healthy skin, and the urine bag is then placedon the outer surfaceof the DuoDEFW Extra Thin. The size of the urine bag is trimmed by one-quarter inch so that a small area of the bag can be lifted off and separatedfrom the outer surfaceof the DuoDERM Extra Thin when the bag needs changing. It was anticipated that the occlusiveproperties of the DuoDERM Extra Thin would provide a better seal than placing the bag directly onto skin. In addition, if any meconium leaked into the bag, requiring a change, the bag would be pulled away from the outer surfaceof the DuoDERM Extra Thin in-
155
stead of from the underlying skin. Minimizing the number of times the urine bag is applied and removed should minimize the risk for injury or reinjury to the
Although the DuoDERM Extra Thin did not sarisfy the clinical needs of this practice as to the number of times the skin was subjected to pulling or shearing, the product did not contribute to skin breakdown. DuoDERM Extra Thin is vcn~ flexible and conforms nicely to surface areas. The authors suggest that this product might also be used in special care nurseries to promote maintenance of healthy skin. Infants in neonatal special cart units often have feeding tubes, lines, or lonpterm nasal prongs anchored to the skin with tape. Irritation of the skin caused by frequent taping might be minimized by placing DuoDERM Extra Thin bctween the skin surface and the tape.
Skin.
Clinical experience with DuoDERM Extra Thin confirmed its adherent properties even m the particularly warm, moist diaper area. The product did not cause any erythema, irritation, or maceration of the underlying skin, and DuoDERM Exua Thin was less abrasive to the skin. Unfortunately, the seal between the outer surface of the DuoDERM Extra Thin and the adhesive side ofthe urine bag remained a problem because the urine bag did not separate easily from the DuoDERh4 Extra Thin. Therefore, the number of times the urine bag was applied was not minimized.
---
I
--
-_.-..------..----_--_.-.
_____
1933 NAPNAP Conference
The Program Committee is accepting clinicd projects for presentation at the 12th Annual NAPNAP Conference, to be held April 7-10, 1991 in Philadelphia. The purpose of the Clinical Project Presentations is to provide a forum for the presentation of clinical projects that relate to the delivery of service by nurse practitioners. The clinical project must include one of the following concepts: Promote health and well-being among the pediatric population. l Minimize or prevent behaviorally or environmentally induced health problems that compromise the quality of life in the pediatric population. l Reduce the negative impact of health technologies in the adaptive abilities of the pediatric population and their families when they are faced with acute or chronic health problems. The &a&e for submitting abstracts is June 1, 1990. Please submit four copies of the following: 9 A 1 -page fact sheet that includes the title of the project, l
the name of the presenter, institutional affiliation, phone number (work and home), and address (work and home). n A 1 -page abstract of 500 words or less, single-spaced, double-spaced between paragraphs, without au&or identification, but with title at the top of the page. . If the project is a tool, please submit a copy of the tooI along with the abstract. Submit papers to:
Gdelines requested.
Nancy Barber, MS, CPNP Program Chair NAPNAP National Office 1101 Kings Highway North, Suite 206 Cherry Hill, NJ 08034 are available from the National Office, if
Abstract presenters must be available to present their papers at the conference and are responsible for all expenses. One complimentary regist&ion to th& conference is provided per presentation.
-,
