Medical Adhesives in the NICU

Carolyn Lund, RN, MS, FAAN


NAINR. 2014;14(4):160-165. 

In This Article

Medical Adhesive-related Skin Injury

Skin injury results when the skin to adhesive attachment is stronger than skin cell to skin cell attachment. As a result, the epidermal layers separate or the epidermis separates completely from the dermis. Adhesive removal itself results in detachment of varying amounts of superficial epidermal cell layers even in adult skin; and repeated application and removal result in changes in skin barrier function; measurable disruption in skin barrier function has been reported after 10 consecutive removals of tape containing acrylate adhesives in adults.[34–36]

Classification of MARSI includes mechanical injuries such as epidermal stripping, tension injury or blistering, and skin tears. Epidermal stripping is frequently the mechanism seen in MARSI for neonates (Fig. 1), while skin tears are more common in the elderly population and involve a separation of skin layers.[37] Tension injury or blistering is seen in orthopedic patients but can also be seen in neonates (Fig. 2), and is caused by a separation of the epidermis and dermis resulting from distension of skin under an unyielding tape or dressing, inappropriate strapping of tape or dressing during application, or when a joint or other area of movement is covered by unyielding tape.[38,39]

Figure 1.

Two infants with epidermal stripping from removal of medical adhesives.

Figure 2.

Tension blisters on the finger following removal of medical adhesive tape that was securing hand to IV board.

Another category of MARSI is dermatitis reactions such as irritant contact dermatitis, and allergic dermatitis.[40–42] Complete differentiation between an irritant and an allergic response is somewhat difficult. In the first, a non-allergic contact dermatitis occurs as a result of chemical irritation; the skin appears red, is well marginated with precise borders (Fig. 3), and usually resolves in a day or two if the adhesive is removed and not replaced. In allergic dermatitis, a cell-mediated immunologic response occurs in response to a component of the adhesive or backing of the tape or dressing; the skin is red with vesicles and a pruritic dermatitis results, persisting for up to a week.

Figure 3.

Two infants with irritant contact dermatitis reaction from medical adhesives; one caused by transparent adhesive dressing, the other from hydrogel EKG electrodes.

Other types of MARSI include maceration of the skin because of moisture being trapped against the skin for a long period of time; the skin appears white/gray in color, is wrinkled and is susceptible to damage from friction or irritants. Folliculitis, an inflammatory reaction in the hair follicle that can appear as papules or pustules, can also be considered a MARSI, but is not commonly seen in the NICU population.