Skin Adhesive: Assisting

Assess the area for inflammation: heat, pain, redness, and swelling.
Assess circulation, sensation, and movement (CSM), using the 8 Ps

    * Pain
    * Pallor (i.e., color)
    * Pulses (i.e., circulation)
    * Paresthesias (i.e., sensation)
    * Paralysis (i.e., movement)
    * Puffiness (i.e., edema)
    * Position (i.e., angulation)
    * Pressure (i.e., tense compartment)

 Perform hand hygiene and apply gloves.

  1. Verify the patient's identity in accordance with institutional policy.
  2. If necessary, the physician or advanced practice nurse anesthetizes the wound or performs a digital block to facilitate cleansing.
  3. Clean and irrigate the wound.
  4. Establish hemostasis with direct pressure, and dry the area completely. Water accelerates the polymerization process; thus skin adhesive should not be applied to wet wounds.
  5. For deeper wounds, the physician or advanced practice nurse places subcutaneous sutures to help approximate the skin.
  6. Position the area horizontally to prevent the skin adhesive from running onto adjacent tissue. If the wound is near the eye, position the wound slightly downhill from the eye and hold the eye closed with a gauze dressing.
  7. Administer tetanus prophylaxis as indicated.

Prepare the applicator

  1. Dermabond: Hold the applicator with the white tip up and squeeze to crush the inner glass ampule. Then invert the applicator, squeezing gently.
  2. Indermil: Hold the ampule upright and twist the cap off. If desired, a blunt-tip applicator can be attached to the tip.
  3. Approximate the wound with forceps or gloved fingers and evert the wound edges slightly. Avoid excessive pressure.
  4. The physician or advanced practice nurse gently applies the adhesive using the following methods. Note: The patient may feel warmth as the adhesive polymerizes.
  5. Dermabond: Gently apply a thin, even layer of adhesive to the wound edges and 0.5 cm beyond. Allow 30 seconds for the adhesive to dry between layers, and apply at least two thin layers in this fashion. Maintain wound-edge approximation manually or with forceps for 60 seconds after the last layer is applied. Full strength is attained about 2.5 minutes after the last application.
  6. Indermil: Apply as tiny drops or a very thin film along the edges of the wound. Maintain wound-edge approximation with light pressure for 30 seconds to allow the adhesive to cure.
  7. If the adhesive runs onto adjacent areas, it can be wiped off for the first 10 seconds. A petroleum-based ointment can be immediately applied to unintended areas of adhesive coverage to help promote dissolution.
Reassess the following factors:

  1. Pain status
  2. Neurovascular status
  3. Do not apply ointment.
  4. No dressing is needed. If a dressing is preferred, wait at least 5 minutes to be sure that the adhesive is no longer sticky before applying a dry, sterile dressing.
  5. Do not apply skin tapes or adhesive tape directly to the skin adhesive.
  6. Discard supplies, remove gloves, and perform hand hygiene.
  7. Document the procedure in the patient's record.



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