LIN Session – Tissue Adhesive

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Nurses Edition Commentary

Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN

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Jay H., M.D. -

I have used tissue adhesive on the elderly patient presenting with a pinhole size stream of blood from a lower extremity varicosity: elevate the leg to collapse the vein and stop bleeding and apply the adhesive.

I intend to use it on my next nail bed laceration: thank you as always for your tips.

jonathan b., pa-c -

Great stuff, indeed. Thank you!

In addition to the Tegraderm lesson, use a viscous damn or mound as a blockade with either neosporin ointment or calmoseptine goo when repairing orbital area lac's.

Clay S. -

Additional tip for the elderly or steroid patient with that thin skin that just won't let your suture bite:

Dermabond the skin edges around the circumference of the wound first and allow it to dry. Then suture the skin as you would otherwise. This often gives the skin some additional strength allowing your sutures to take when skin is otherwise paper thin and they would pull through.

David H., M.D. (@BritFltDoc) -

Another use....I have also heard of Dermabond being used to temporarily suture down a central line in a crash situation. Much quicker than taking the time to suture.

David H., M.D. (@BritFltDoc) -

typo above....."temporarily secure down a central line..."

Sarah B -

Varicose vein bleeds. Cut bottom off plastic medicine cup, place over bleeding area and press down. This stops the bleeding and allows tissue adhesive to work.

joel s. -

right after listening to this segment, I get to work, and what do you know?! An 82 year old metrosexual is trimming his scrotal hairs with a scissors. Well, he miss fired and put a 2 mm gash into his scrotum that was gushing. After slowing enough with pressure, lathered up with some adhesive, and he was good as gold!!!

Matthew M. -

I've had good luck using steri-strips then a tissue adhesive on top. Definitely allows for a more precise approximation. This is especially true on kids where all it takes is a poorly timed squirm to ruin your closure.

Roy K., MD -

Nail bed skin glue.... Block, remove nail, then glue bed lac, then replace nail?

Michelle Lin, MD -

@Roy K: Well said. Couldn't have summarized it better.

Jacques R. P., M.D. -

A colleague, Dr. Troy Coon, showed me this trick. For skin avulsions of the pad of the finger, place the injured fingertip in lidocaine-epinephrine-tetracaine solution to stop the bleeding of the avulsion. Dry off the fingertip, coat with a couple layers of skin adhesive. The LET stops the bleeding so the adhesive may be applied well; adhesive covers the avulsion but allows good use of the finger.

Mike Yip, MD -

Katie Bakes taught me this great extra trick for removing solid foreign bodies from pediatric orifices when I was a med student rotating in Denver, which I have *slightly* modified with great success:
1) Directly and closely visualize the foreign body with an otoscope- preferably directly contacting it.
2) Detach the disposable otoscope speculum and leave it in place.
3) Proceed with the blunt-end-of-a-cotton-swab/tissue adhesive trick as Michelle describes, using the otoscope speculum to guard the surrounding mucosa from the glue.

Using the speculum as a guard is akin to the Tegaderm barrier trick for protecting the eye from inadvertent adhesion- an extra layer of protection from either the child's or an intern's (e.g. my) squirminess!

Julia G. -

Used the derma bond on a cotton tip applicator just last night to get a bead out of an ear! Worked like a charm!! Amazed the resident I was working with as well!

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