Tissue adhesives (management of accidental injury)

Objectives

Guidance on the management of accidental injury from tissue adhesives (cyanoacrylate) in children.

Scope

Children presenting to the children's ED at RHC with accidental exposure to tissue adhesives.

Audience

Emergency department staff at RHC.

Cyanoacrylate adhesive is a very fast setting and strong adhesive. It bonds human tissue, including skin in seconds. It has been in everyday use for many years. Experience has shown that accidents due to Cyanoacrylate are handled best by passive, non-surgical first aid. Treatment of specific types of accidents are given below.

Skin Adhesion

First immerse the bonded surfaces in warm soapy water. Peel or roll the surfaces apart with the aid of a blunt edge e.g. a spatula or a teaspoon handle; then remove adhesive from the skin with soap and water. Do not try and pull surfaces apart with a direct opposing action.

Eyelid to Eyelid or Eyeball Adhesion

In the event that eyelids are stuck together or bonded to the eyeball, wash thoroughly with warm water and apply a gauze patch. The eye will open without further action, typically 1-4 days. There will be no residual damage. Do not try to open the eyes by manipulation.

Adhesive on the Eyeball

Cyanoacrylate introduced into the eyes will attach itself to the eye protein, and will dissociate from it, generally covering several hours. During the period of contamination double vision may be experienced together with a lachrymatory effect, and it is important to understand the cause and realise that dissociation will normally occur within a matter of hours, even with gross contamination.

Mouth

If lips are accidentally stuck together, apply lots of warm water to the lips and encourage maximum wetting and pressure from saliva inside the mouth. Peel or roll lips apart. Do not try and pull the lips with direct opposing action.

It is almost impossible to swallow cyanoacrylate. The adhesive solidifies and adheres in the mouth. Saliva will lift the adhesive in ½ to 2 days. In case a lump forms in the mouth, position the patient to prevent ingestion of the lump when it detaches.

Burns

Cyanoacrylate gives off heat on solidification. In rare cases a large drop will increase in temperature enough to cause a burn. Burns should be treated normally after the lump of cyanoacrylate is released from the tissue as described above.

Surgery

It should never be necessary to use such a drastic method to separate accidentally bonded skin.