View from the Chair: Taming Terrible Tape Troubles
Pain is a leading reason why people choose to stop life-saving treatment.1 And, itching, a type of pain, is its own kind of hell. In a DOPPS study, the 42% of patients who itched also tended to be depressed, feel drained, sleep poorly—and not to live as long as those who did not.2 So, finding ways to reduce dialysis pain and itching may save lives. Cleaning skin and securing needles and catheters with tape can impact patients’ day-to-day suffering, body image, and quality of life. With allergies to antiseptics, plastics, or adhesives, patients are at risk for infection, or even sepsis. Tape troubles may cause itching, burning, rash, blisters, bruising…pain:
“This tape has my arm almost raw meat.”
“The tape is pulling his skin off!”
Threads on multiple Facebook sites go back for years on this topic—but there are few studies. So, for now, here is a 3-part strategy and lots of tips from the compiled group wisdom.
First: Prevent Skin Breakdown
The best defense is a good offense. Some dialyzors know they have issues with skin sensitivity. Believe them. Thin, dry, and/or older skin may have more problems with tearing or bruising.
Test for sensitivity. In a prospective trial of 75 patients, 25% had at least one positive skin test.3 A nurse suggested, “when I have a patient I suspect has an allergy to the tape, I use an alternate type...AND go a step further. On the other arm, in the crook of the elbow, I cleanse a spot with an alcohol pad, and apply a square piece of each type of tape and have the patient remove them when they take off their bandages. If one of the tape squares also reacts, we know it is the culprit.” NOTE: It’s not just tape (and latex4) that cause problems. Patients can be allergic to skin prep products like alcohol, Betadine5, Chlorhexidine6, povidone iodine,7 as well as to topical anesthetics with lidocaine, such as EMLA:8
“Chloraprep gives me nasty blisters.”
“My rash was from the chlorhexidine and triple antibiotic ointment, not the tape.”
“When my husband was in-center with a CVC, he had a horrible rash for months. Turns out he’s allergic to betadine.”
“We figured that where my red, itchy was, it was not the tape but the iodine pads I used to clean my fistula. I switched, and no problems since.”
“We found out the problem was lidocaine cream—after we tried every kind of tape and even the self sticking wrap.”
Protect skin before taping if adhesives are a problem. Products like betadine (for those who are not allergic), Smith & Nephew Skin Prep® or 3M Cavilon® wipes, swabs, or sprays coat skin to keep tape from touching it.
“One of my PD nurses started to ‘paint’ my skin with betadine wipes and let it dry just before putting on tape. I never had another blister!”
“I use a skin prep wipe before I use tape on my skin, or I’ll have welts by the end of treatment. The no sting barrier film by Cavilon works best for me. I have to buy it myself, but it’s worth it. I can usually find a good deal on eBay, if not Amazon.”
Clean skin well before you apply new tape. Adhesive residue can build up and make skin irritation worse. Patients used dish soap, coconut oil, alcohol, Exsept, or De-Solv-It orange oil adhesive remover for this purpose.
Limit skin contact time with tape. Clinics varied a lot in how long they told patients to keep tape on after hemodialysis (HD; if they gave any tips at all). Lacking guidance, some took off post-HD bandages in 15 minutes; others waited 24 hours. Patients’ consensus was that a scab needs to form on a fistula or graft to be safe. Some took off bandages and put on gauze and a self-cling wrap to prevent bleeding and avoid tape. PD exit site and HD catheter tape may stay in skin contact even longer. Patient tips included:
“I move tape sites slightly to avoid using the same spots.”
“Let your skin breathe at night.”
“Use moisturizer on your skin on off-days.”
“I leave my tape on until the next morning, or it rips my skin off.”
“I keep my tape rolls in the fridge. It gets more sticky when it’s hot, so cold is better. It does warm up after about 4 hours, but that’s better than nothing.”
“I switch between two types of tape. They both cause redness and irritation, but it’s not as bad when I trade off.”
Remove tape slowly and gently. Ripping tape off quickly may tear fragile skin. Patients reported using tricks to make tape removal as gentle as possible:
“Use a cloth and wet the tape. It comes off much easier.”
“I remove my tape under water in the shower or sink. My skin does not get so irritated if I do this. Then I rub cream on it.”
“Have the tape tabs on the ‘inside’ of your arm, so you can pull away from you. It is less painful.”
“I use a little vaseline on my arm at night after the tape is off. It helps me, because the dryer my skin is, the worse it is.
Second: Sooth Irritated or Broken Skin
It is best to avoid using tape on torn or blistered skin. If irritation is mild, some patients have found that coconut oil or lavender oil helps to soothe it. For more severe problems, hydrocortisone cream, lotions with no alcohol, or triamcinolone cream (prescribed) may calm skin. A dermatologist may be advised.
Third: Switch to a Hypoallergenic Tape or Wrap
One definition of insanity is to do the same thing and expect a different outcome. When a patient has a known allergy to a skin prep product, topical anesthetic, or tape, that product must not be used. There are many options. Some said cloth Bandaids® helped (“Kind of like Post-it notes for your skin!”)—but patients often must pay out of pocket for products a clinic does not supply. Here are some that were suggested:
3M Durapore® tape. Hypoallergenic and “silk-like,” this tape is strong, and easy to remove. Low cost.
3M Medipore® soft cloth surgical tape. This worked for some who were allergic to ALL other tapes. But, it is costly.3M Micropore Paper tape. For those who are not allergic to all adhesives, paper tape was often helpful. Some say the tan is gentler on skin than the white. Low cost.
3m NexCare Sensitive Skin tape. Water-resistant, “pain-free” tape. “The blue one.” More costly than most of the others.3M Tegaderm film dressing. Clear, breathable dressing for HD catheters. Low cost.
3M Transpore™ tape. Hypoallergenic, with no latex, and water resistant, this tape lets skin breathe, which may cause less irritation. Low cost.
Hypafix dressing retention sheet roll. Water-resistant and stretchy with a non-irritating adhesive that may work for some who can’t tolerate Tegaderm®. Moderate cost.
Mefix dressings and tape. Soft, non-woven cloth tape is perforated for easy tearing, with a solvent-free adhesive that some patients find gentle on their skin. Moderate cost.
Silicone tape. Silicone adhesives make this tape more gentle on skin. But, from every maker (3M Kind Removal, AWD Medical silicone tape, Cica Tape™, Hypafix®, Silikan tape, etc.) silicone tape costs far more than the others.Silk tape. Many patients said silk tape was less irritating than other types of tape. A number of companies make silk tape. Low cost.
Smith & Nephew IV3000 moisture responsive catheter dressing. Clear and breathable. Some found that these did not irritate their skin. Moderate cost.
Avoid All Use of Tape. Some patients are allergic to all tapes. PD patients used soft PD belts, tucked catheter ends into underwear, or wore a PD “necklace” as tape-free ways to hold a catheter in place. HD catheter care was, unfortunately, more challenging. One patient suggested cutting a rectangular hole in a shirt sleeve and taping to the sleeve—not the skin.
Self-cling wraps were the option of choice for HD patients with fistulas or grafts. Used as vet wrap or sports wrap, these stick to themselves—but not to skin or hair—are low cost (cheaper at feed stores), and come in colors. Some products include Coban, Cohesive bandage, Ever Ready First Aid self-adherent cohesive bandages, Kiseer, Medca, Nexcare Coban, and Pangda. Many patients were happy with these products—though others cautioned to not wrap too tightly:
“My aunt is elderly and has very paper thin, dry skin. Normally I use silk tape, but when her skin starts to get irritated we switch to sports wrap. I tape a little square of gauze over the needle spots, then wrap. I buy 3" wide at Walmart and wrap it twice around her arm and it holds.”
“You can cut off blood and clot her fistula using this kind of wrap.”
“We’ve (techs in-center) been doing it for months. Never an issue. Snug—not tight.”
“My aunt’s nurses all approved it, and her nephrologist, too. There wasn’t another option at first. The back of her arm was an open wound. No place to put tape.”
No doubt this review has missed products or tips that work for you—or it may contain some things that are not recommended. Please comment! And, consider doing some research—this is a neglected and important aspect of dialysis care.
Qazi HA, Chen H, Zhu M. Factors influencing dialysis withdrawal: a scoping review. BMC Nephrol. 2018;19:96. doi: 10.1186/s12882-018-0894-5.↩
Pisoni RL, Wikstrom B, Elder SJ, Akizawa T, Asano Y, Keen ML, Saran R, Mendelssohn DC, Young EW, Port FK. Pruritus in haemodialysis patients: international results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant. 2006. Dec;21(12):3495-505↩
Gaudy-Marqueste C, Jouhet C, Castelain M, Brunet P, Berland Y, Grob JJ, Richard MA. Contact allergies in haemodialysis patients: a prospective study of 75 patients. Allergy. 2009 Feb;64(2):222-8. Doi: 10.1111/j.1398-9995.2008.01833.x↩
Fuld RA. Adverse reactions to latex occurring in an outpatient dialysis access center. Sem Dial. 2008 Sep-Oct;21(5):45-8. Doi: 10.1111/j.1525-139X.2008.00458.x↩
Chasset F, Pecquet C, Cury K, Sese’ L, Moguelet P, Frances C, Gharbi C, Senet P. [Bullous rash around a peritoneal dialysis catheter exit site].[Article in French]. Ann Dermatol Venereol. 2015 Jun-Jul;142(6-7):438-42. Doi: 10.1016/j.annder.2015.04.016.↩
Chan FL, Merchant AA, Breede N, Lipszyc JC, House R, Tarlo SM. Chlorhexidine skin symptoms and allergy in dialysis patients and nurses. Clin Exp Allergy. 2019 May 24. Doi: 10.1111/cea.13440. Epub ahead of print↩
Yavascan O, Kara OD, Sozen G, Aksu N. Allergic dermatitis caused by povidone iodine: an uncommon complication of chronic peritoneal dialysis treatment. Adv Perit Dial. 2005;21:131-3↩
Perez-Perez LC, Fernandez-Redondo V, Ginarte-Val M, Paredes-Suarez C, Toribio J. Allergic contact dermatitis from EMLA cream in a hemodialyzed patient. Dermatitis. 2006 Jun;17(2):85-7↩
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