UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES

MEDICAL CENTER

PROCEDURE

PROCEDURE:

198

EFFECTIVE:

7/05

REVISION:

 

APPROVED:

7/05

PROCEDURE FOR USE OF DERMABOND® ADHESIVE

 

PURPOSE:      To outline the procedure for use of DERMABOND® Adhesive

 

EQUIPMENT:

  1. DERMABOND® adhesive

  2. Wound cleanser (as ordered)

  3. Sterile gauze

  4. Sterile gloves

  5. Sterile forceps

  6. Protective dressing

 

NURSING ACTION:

 

PROCEDURE STEPS: 

  1. Explain procedure to patient.

  2. Thoroughly cleanse the wound.  Follow standard surgical practice for wound preparation before application of high viscosity DERMABOND® adhesive (i.e., anesthetize, irrigate, debride, obtain hemostasis and close deep layers).

  3. Pat the wound dry with dry, sterile gauze to assure direct tissue contact for adherence of the adhesive to the skin.

KP:  Moisture accelerates DERMABOND® adhesive’s polymerization & may affect wound closure results.

  1.  Hold wound in a horizontal position and apply the adhesive from above the wound.

KP:  This prevents inadvertent flow of liquid high viscosity DERMABOND® adhesive to unintended areas of the body.  DERMABOND® adhesive should be used immediately after crushing the glass ampule since the adhesive will flow freely from the tip for only a few minutes.  Follow manufacturer guidelines for the different types of DERMABOND® items, i.e., pen, ampule, blister pack, plastic vial.

  1. Don sterile gloves.

  2. Approximate wound edges with gloved fingers or sterile forceps.  Slowly apply the liquid adhesive in multiple ( at least two) thin layers to the surface of the approximated wound edges using a gentle brushing motion.  Wait approximately 30 seconds between applications or layers  Maintain manual approximation of the wound edges for approximately 60 seconds after the final layer.

KP:  DERMABOND® polymerizes through an exothermic reaction.  If the liquid DERMABOND® is applied so that large droplets are allowed to remain without being evenly spread, the patient may experience a sensation of heat or discomfort.  The sensation may be higher on sensitive tissues.  This can be minimized by applying DERMABOND® adhesive in multiple thin layers ( at least two).  NOTE:  full apposition strength is expected to be achieved about 2.5 minutes after the final layer is applied, although the top adhesive layer may remain tacky for up to approximately 5 minutes.  Full polymerization is expected when         the DERMABOND® adhesive layer is no longer sticky.

 

KP:  Excessive pressure of the applicator tip against the wound edges or surrounding skin can result in forcing the wound edges apart and allowing adhesive into the wound.  The adhesive within the wound could delay wound healing and/or result in adverse cosmetic outcomes.

 

  1.  Do not apply liquid or ointment medication onto wounds closed with DERMABOND® adhesive.

KP:  This will  weaken the polymerized film, leading to wound dehiscence.

 

  1. Protective dry dressings such as gauze may be applied only after adhesive film is completely solid/polymerized  not tacky to touch.  Allow the top layer to fully polymerize before applying a bandage.

KP:  If a dressing, bandage, adhesive backing or tape is applied before complete polymerization, the dressing can adhere to the film.  The film can be disrupted from the skin when the dressing is removed and wound dehiscence can occur.

  1. Instruct patients not to pick at the polymerized film of the DERMABOND® adhesive.

KP:  Picking at the film can disrupt its adhesion to the skin and cause dehiscence of the wound. 

  1. Apply a dry protective dressing for those patients who may not be able to follow instructions for proper wound care.

  2. Instruct patient that DERMABOND® adhesive will slough naturally (usually 5-10 days).  There should be only transient wetting of the treatment site. 

KP:  Patients may shower and bathe the site gently.  The site should not be scrubbed, soaked, or exposed to prolonged wetness until after the film has sloughed naturally and the wound has healed closed.  Instruct patients not to go swimming during this period.

  1. If removal of DERMABOND® adhesive is necessary for any reason, carefully apply petroleum jelly or acetone to the DERMABOND® film to help loosen the bond.  Peel off the film, do not pull the skin apart.

                                                                                          

REFERENCES:    DERMABOND® Topical Skin Adhesive Manufacturer Guidelines.  Ethicon, INC.

 

RESOURCE  PERSON(S):   Pam LaBorde, RN, MSN