Medical Adhesives in the NICU

Carolyn Lund, RN, MS, FAAN


NAINR. 2014;14(4):160-165. 

In This Article

Abstract and Introduction


Skin injury from medical adhesives is a known problem for neonatal intensive care unit (NICU) patients. Medical adhesive-related skin injury (MARSI) for all patient populations includes mechanical problems such as skin stripping, skin tears, and tension blisters; dermatitis reactions such as irritant contact dermatitis and allergic dermatitis; and other complications such as skin maceration and folliculitis. The most common seen in neonatal patients is epidermal or skin stripping; chronically hospitalized infants may also experience irritant contact dermatitis to a variety of adhesive products. Preventing MARSI is the goal, using the fewest and least irritating adhesive products; yet, secure fixation of medical life support equipment is imperative. This article will explore differences in neonatal skin that place NICU patients at risk for MARSI and selecting products that are most appropriate for the desired result. Barrier films and adhesive removers are also discussed in detail to determine which may be potentially beneficial to the NICU population.


Medical adhesives comprise an integral part of healthcare delivery in the Neonatal Intensive Care Unit (NICU) and in virtually all other inpatient and outpatient settings, as a component of a variety of products, including tapes, dressings, electrodes and ostomy supplies. Medical adhesives are applied and removed many times a day in the typical NICU. Premature and full-term infants who require medical interventions and constant monitoring are exposed to adhesives for a wide variety of indications. They secure both critical life support equipment such as endotracheal tubes, intravenous and arterial catheters, and chest tubes, as well as monitoring devices such as electrocardiogram electrodes, pulse oximeter probes and temperature sensors.

Skin injury from medical adhesives is a known problem among healthcare providers in the NICU. In the 2001 evidence-based practice project conducted in 51 US nurseries involving 2820 premature and term neonates, adhesives were the primary cause of the observed skin breakdown.[1] A descriptive cohort study conducted in Australia found the incidence of "pressure injuries" (which is a broader category of iatrogenic tissue damage that includes epithelial stripping) in 247 neonates to be 31.2%; medical devices were the most common risk factor associated with the skin injuries.[2]

In the broader pediatric population, a 1-day prevalence audit reported that 8% of hospitalized infants and children were found to have tape-related skin stripping,[3] and the 2003 National Pediatric Pressure Ulcer and Skin Breakdown Prevalence Survey found that the prevalence of skin stripping related to adhesive tape was 17%.[4] Because of these studies and a general concern in all populations of hospitalized patients, the acronym "MARSI" was coined, standing for "medical adhesive-related skin injury".[5]

In an effort to increase awareness of MARSI and define best practices for prevention of this skin injury, a consensus panel of 22 health care providers from a variety of disciplines (nursing, medicine, physical therapy) and specialties (neonatology, pediatrics, geriatrics, orthopedics, dermatology, infusion nursing, infectious disease) convened to establish consensus statements on the assessment, prevention, and treatment of MARSI. Additional goals included defining knowledge gaps regarding medical adhesives and skin safety, documenting the spectrum of care settings and medical applications where MARSI occurs, and identifying research priorities for development of new adhesive technologies and protocols for skin protection. Following this meeting, a white paper was published with the 25 consensus statements reached by the group.[5]

This paper will explore the unique differences in newborn skin that place NICU patients at high risk for MARSI, and the types of MARSI seen in this population. Following this, background on the science of medical adhesives and how adhesives interact with the skin, and the types of adhesives and adhesive products commonly used in the NICU is described. In addition, products that protect skin from adhesive damage or facilitate removal of adhesives without injury to the skin will be discussed.