Patient Safety Topics
:
Tubular Dressing Retainers
Overview

Tubular dressing retainers are commonly used to apply and hold dressings, creams, and other devices in place. However, improper application of the retainer and use of incorrect size, especially on digits, has caused harm to patients. Injury can occur if the tubular dressing retainer is mistakenly used as the gauze dressing, especially if multiple layers are applied with multiple turns. Facilities may reduce harm to patients by implementing processes to improve the safety of tubular retention dressings. An inventory of tubular dressing retainers in a facility can help target strategies to be implemented. Education for physicians, nurses, and other healthcare providers involved in the application of these dressings is essential. Patient education and instructions regarding these dressings are necessary to reduce harm.

Key Data and Statistics

Event Reports

Since June 2004, the Pennsylvania Patient Safety Reporting System (PA-PSRS) has received two reports indicating problems with tubular dressing retainers. The reports indicated that the patient’s circulation was compromised due to use of incorrect size and improper application of the dressing. The reports below illustrate harm to patients.

[Patient] came to the emergency department (ED) for laceration of finger. [The laceration was] treated and [patient was] released. [The patient] returned for dressing being wrapped too tight. The wound assessment identified the wound to be healing satisfactorily. The finger was dressed with the wrong dressing size; tubular dressing retainer size 1 had been used as the dressing. [emphasis added] It was meant to be used as a single strip to hold the actual dressing in place. The area [appeared necrotic], requiring amputation of the finger tip.

The patient [was seen in] the ED for cuts on two fingers. [Patient] presented again [a few] days later with impaired vascular status of digits. The wrong dressing was used: tubular dressing retainer size 1. This was meant to be a single strip to hold the actual dressing in place; instead, it was used as the dressing. It got tighter with each successive application and turn of the metal ring. The patient was referred to a plastic hand [specialist] for surgery. The patient is currently undergoing physical therapy.

A search of the U.S. Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database using the keyword search term “tubular dressing retainer” revealed five reports between 1992 and 1998 describing events of vascular complications following application of tubular dressing retainers on digits including the thumb. Similar to the PA-PSRS reports, the MAUDE reports describe patients complaining of increased pain during a two-to-three-day period after application of the dressing retainer.  Removal of the dressing and reassessment of the wound did not occur until several days after the dressing was applied, despite early onset of pain. Vascular compromise was identified during reassessment, and symptoms ranged from discoloration of the digit to permanent disability and, in some cases, amputation of the digit.

Strategies

Facilities may reduce harm to patients by implementing processes to improve the safe use and application of tubular dressing retainers. For example, education for physicians, nurses, and other healthcare providers involved in the application of these dressings can include correct application and awareness of the mechanisms that may result in complications (see Figure).

Figure. Correct Application of Tubular Dressing Retainer

Excerpted from: Tubular dressing retainer: retention without restriction. Pa Patient Saf Advis 2008 Dec. http://patientsafety.pa.gov/ADVISORIES/Pages/200812_127.aspx.

Educational Tools

​Tips for Application of Tubular Dressing Retainer
This quick reference card can be carried by practitioners who apply tubular dressings or kept with the dressing materials.

Multimedia

​​Visit this section in the future for any multimedia associated with this patient safety topic.

Advisory Articles

 

Safety Tips for Patients

 

 

©2018 Pennsylvania Patient Safety Authority