Skin glue Dermabond

Disclaimer

These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline. 

Read the full PCH Emergency Department disclaimer.

Aim 

To guide PCH ED staff with the use of Dermabond® skin glue.

Background

Indications

  • Simple clean superficial lacerations (less than 3 cm)
  • Good wound approximation 
  • Low wound tension.

Contraindications

  • Jagged lacerations
  • Bites, punctures or crush wounds
  • Contaminated wounds
  • Mucosal surface
  • Axillae and perineum (high moisture areas)
  • Hands, feet and joints (unless kept dry and immobilised).

Properties

  • Maximum bonding strength is at 3 minutes
  • Can be applied without anaesthetic
  • Water resistant
  • The glue will slough off within 5-10 days
  • Equivalent cosmetic result to sutures.

Procedure

  • Assistance with the procedure will generally be required, especially with an active child (4 hands are better than 2).
  • Apply topical anaesthetic (ALA / Laceraine) if required to stop the bleeding
  • Wait 30 mins
  • Irrigate with 0.9% saline
  • Dry with gauze
  • Appose wound edges
  • Crush Dermabond® vial and invert
  • Gently brush adhesive over laceration
    • Do not place glue into the wound - this will impair wound healing and lead to wound dehiscence.

Skin glue application

  • Wait 30 seconds
  • Apply second layer in an oval motion around the wound – coverage of a larger skin surface area adds to strength of wound closure
  • Apply a third layer after a further 30 seconds if required
  • No dressing is required but in small children a dressing may be required to prevent picking of the glue.

Lacerations near the eye

Methods to prevent glue entering the eye:

  • Lower the head end of the bed
  • Apply Vaseline below the wound
  • Hold gauze over the eye
  • Ensure the child is compliant or well held.
  • In the unfortunate event of glue getting in the eye ,wash immediately with water and use Vaseline to soften the glue.

Bibliography

  1. Lin M, Coates WC, Lewis RJ. Tissue adhesive skills study. Pediatr Emerg Care. 2004;20(4):219–223.
  2. Bruns TB, Worthington JM. Using tissue adhesive for wound repair. Am Fam Physician. 2000;61(5):1383–1388.



Endorsed by:  Director, Emergency Department  Date:  Feb 2018


 Review date:   Oct 2021


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