Most people simply expect their medical tape to stick the way they want it to. Most of us don’t give too much thought to the adhesive properties of tape until they use one that comes off too easily or one that adheres so aggressively that it won’t come off easily during a change. For people with simple medical tape needs, the adhesive properties of tape may not matter. However, the factors that influence medical tape adhesion are matter a great deal to the very young, the elderly, people with chronic medical conditions, and those with life-threatening illnesses.
The dangers of MARSI
MARSI stands for Medical Adhesive-Related Skin Injury. MARSI is the trauma that occurs when medical tape or other products with medical adhesives tear, strip, or blister the skin.1 It may also cause skin inflammation (dermatitis), skin breakdown from excess moisture under the tape (maceration), and hair follicle inflammation (folliculitis). MARSI occurs when adhesive sticks more aggressively to the top layers of skin than the top layer of skin is attached to the body.
MARSI happens under one or more of the following conditions:
- The skin is not properly prepared
- The skin is not properly maintained
- Adhesive changes occur too frequently
- Adhesive changes do not occur frequently enough
- The adhesive product is removed carelessly or too quickly
- The user chooses the wrong kind of medical tape for the job
Risk factors for MARSI
Some patients are at increased risk for MARSI. For example, neonates and the elderly have delicate skin, skin that is vulnerable to trauma. Dehydration and malnutrition can also increase the risk of MARSI. People with diabetes, chronic kidney disease, severe infections, or those receiving radiation therapy on immunosuppressants or long-term corticosteroids are at much greater risk for MARSI.1
On the other hand, some circumstances make MARSI more likely to occur. For example, patients who need critical devices such as endotracheal tubes or indwelling arterial catheters need a medical tape that will keep these devices secure and immobile. Thus, many healthcare providers tend to select tapes and securements with aggressive adhesives—often too aggressive, even for those important purposes.2 Dry skin, caused by severe dehydration, low humidity or harsh skin cleansers can predispose skin to tape-related injury.
Importantly, these risk factors only indicate those patients and situations at increased risk—every is at risk for MARSI.1 Fortunately, most cases of MARSI are avoidable.1 Proper medical tape selection and use are the keys to reducing MARSI and proper medical tape adhesion.
| Common Adhesives and Backings Used in Medical Tape | ||
| Adhesive | Pros | Cons |
| Natural rubber latex-based |
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| Latex-free, zinc oxide-based (“pink tape”) |
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| Acrylate |
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| Silicone |
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| Hydrocolloids |
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| Adapted from McNichol L, Lund C, Rosen T, Gray M. Medical Adhesives and Patient Safety: Consensus Statements for the Assessment, Prevention, and Treatment of Adhesive-Related Skin Injuries. Diabetes. 2012. | ||
Ways to prevent MARSI
Selecting the right tape for medical tape adhesion
Trauma to the skin can be minimized or avoided by selecting the right tape for the job and using it properly. Specific applications may require specific tapes as detailed in the table. Hy-Tape is an excellent all-purpose medical tape for most clinical and home health situation. It holds with just the right amount of strength and does not become overly aggressive over time. It can also maintain adhesion when subjected to soiling or moisture. Hy-tape is latex-free and does not provoke or extend a latex allergy. It removes cleanly and gently from all types of skin.
Properly placing medical tape
It is important to properly prepare the skin before having proper medical tape adhesion. The area should be clean and relatively dry. While alcohol-based skin wipes can sterilize the area, the alcohol can dry out the skin and increase the risk for MARSI. So, unless sterility in necessary, avoid alcohol-based skin prep for non-sterile medical tape uses.
Medical tape should be applied without pulling or stretching the skin. The adhesive in the tape is what holds the dressing or device. Putting tension on the skin risks discomfort, pain, and injury. Press gently but firmly and do not leave gaps or bubbles. When taping an area that the patient will move (e.g. wrist, knee), place the tape in line with the direction of movement.
Properly removing medical tape
Start by loosening the edges of the tape or other adhesive material. If the patient is moderately or severely uncomfortable, consider numbing the area with topical anesthetic prior to tape removal. With one hand, press down on the skin to stabilize it while gently removing the tape with the other. As more skin is exposed, support it with the free hand. The goal is to prevent the underlying skin from being forcibly pulled up from the underlying tissue. Moving slowly helps to avoid dermatitis and folliculitis.
The edges of tape strips should be slowly removed first, moving toward the wound or device. Once both sides are loosened, the strip can be removed from the center.
Depending on the adhesive and the patient’s particular risk of MARSI, the use of an adhesive remover may be advised. A sterile adhesive remover may benefit patients for high-risk patients with open wounds, the very young (e.g. neonates), and those who have indwelling lines/catheters.
References
1. Fumarola S, Allaway R, Callaghan R, et al. Overlooked and underestimated: medical adhesive-related skin injuries. J Wound Care. 2020;29(Sup3c):S1-S24. 10.12968/jowc.2020.29.Sup3c.S1
2. Maene B. Hidden costs of medical tape-induced skin injuries. Wounds UK. 2013;9(1).