What to Do if Your Patient Gets a Skin Tear

You may try as hard as possible and only use the gentlest touches, but unfortunately, skin tears are an inevitable part of caring for an older person.  Skin tears are traumatic wounds caused by shear or friction that result in a separation between the epidermis and dermis – the two outermost layers of skin.  They are most likely to happen in specific areas due to both skin exposure or most likely place of friction: the shins, face, back of hands, arms, and bottom of the feet.

However, why are older people more likely to suffer from a skin tear?  Ever had an elderly patient with skin so paper thin you are worried you will break it with the softest touch? As skin ages it loses much of its dermal thickness (the thickness of the tissues beneath the skin such as subcutaneous fat, collagen, and the vascular bed) decreasing elasticity and thickness, making it fragile and less able to stretch and withstand even the slightest friction.

Skin tears are a widespread occurrence in older adults, affecting around 1.5 million institutionalized patients in the US each year.

Risk Factors

There are many factors that leave a patient at higher risk of suffering a skin tear.

Advanced age

As people are their skin becomes thinner and less elastic, making their skin more fragile and prone to injury.  With people living well into their 90s and even into their 100s, the likelihood of them suffering from a skin tear becomes even more likely.

Corticosteroid Therapy

Unlike the anabolic steroids that bodybuilders use, corticosteroids are used as potent anti-inflammatories.  Many older people take long-term steroid therapy – for chronic lung problems, rheumatoid arthritis, or even for certain cancer treatments.  While patients can see amazing improvements with these powerful anti-inflammatory drugs, their skin can get thinner and more fragile, putting them at increased risk of suffering a skin tear.

Impaired Mobility

People who rely on walkers or wheelchairs to get around, or who rely on caregivers to transfer from bed to wheelchair are more likely to suffer a skin tear.  With all the extra equipment around they are more likely to hit their shin, and with staff helping them by grabbing an arm or wrist, the risk of applying a friction or shear force increases.

Poor Nutritional Intake

If your patient’s diet is poor, they may be left with dry, fragile skin that is more prone to injury, particularly those who are also dehydrated.

Prevention

Preventing skin tears is almost entirely in the realm of a CNA.  Since you are the one that provides the most care and has the most physical contact with the patient, you can make the most difference in preventing skin tears from happening.

Safe Environment

Skin tears are very common on the shins and often occur because of a run in with a piece of furniture or equipment.  To prevent this from happening, try to keep your patient’s rooms clutter free, avoid extra furniture and equipment, and ensure there is adequate lighting to help them see any obstacles in their path.

Clothing

Since skin tears often happen on a limb that is exposed, try to have patients wear long sleeves and pants to add an extra layer of protection.  If you need to reach out and stop someone from falling, you are far less likely to cause injury if you are grabbing their arm covered in a sweater rather than bare skin.

Nutrition and Hydration

Since poor nutrition and hydration can lead to dry, fragile skin try to promote adequate intake of food and fluids.  Always leave a glass of water at arm’s reach for your patients and try to learn your patient’s food preferences, so they eat enough at every meal.  Also, prevent further dry skin by always applying lotion to the arms and legs when providing care.

Safe Routine Care Practices

There are some simple changes that you can make when providing care that can prevent skin tears from occurring.  Always use a sheet to lift and turn to avoid friction and shearing forces on the back and buttocks.  Whenever possible use padded bed rails, and padded wheelchair arm and leg supports.  On higher-risk patients, considering covering sharp edges on a walker or a wheelchair with cloth or foam noodles.

The use of medical tape is one of the most common causes of skin tears.  If possible, use a stockinette or flexible netting to secure any dressing to arms or legs.  If tape must be used, be sure to use a tape with as little adhesive as possible – such as paper tape.  If you patient has recently been to the hospital or emergency department, check them promptly for any tape or other adhesive devices such as monitor daisies.  The longer these things stay on the skin, the more likely they are to cause injury.

Management

If a skin tear does happen, management is simple and straightforward.  The usual healing time of skin tears is around 3-10 days, depending on the health of the patient and the severity of the skin tear.  In some institutions, dressings may be done by the nurse, but others allow CNAs to perform simple dressings, such as for a skin tear.

First, cleanse the skin with normal saline or sterile water.  Avoid using harsh cleansers as this may damage the skin.  If a skin flap is present, try to put it back in place as this will help the skin tear heal faster.  Apply a moist, nonadherent dressing and if available use skin sealants and protectants to surrounding tissue.  Consider drawing an arrow on top of the dressing to indicate which direction it should be removed to prevent damaging the healing tissue when the dressing is changed.

Skin tears are an unfortunate occurrence in older adults and often occur as a direct result of providing care.  By following these easy preventive techniques and reducing the risk of accidental injury you can prevent skin tears in your elderly patients.