Tuesday, March 26, 2013

The EMT Guide to Rebandaging a Tattoo

I got my first tattoo.


It's a photo-realistic bird on my left shoulder blade. But that's not important. Or at least not the point of this blog.

After lying on my stomach for four hours getting a needle repeatedly stuck in my back the artist cleaned the tattoo, folded a paper towel in half, taped it to my shoulder blade and sent me downstairs to pay and get my "tattoo care sheet." 

It goes like this:


Shower normally
Wash tattoo 2 to 3 times a day with antibacterial soap
Apply just enough ointment to keep tattoo moist
Apply sunscreen to keep tattoo from fading


Soak tattoo in any way (bath, lake, pool…)
Never pick scabs
Do not re-bandage tattoo unless instructed otherwise
Do no sue alcohol or peroxide; soap and water only
While the advice was pretty much what I expected it should be, I was surprised by the recommendation that one should not re-bandage a tattoo.

I'm an EMT. Wound management is kind of important to us and a huge part of that management is covering the wound to keep debris and other nasties out of it. Keeping a wound covered also helps with keeping it moist and promotes healing. It can also help reduce swelling and scarring. These are all GOOD things. 

So, when I got home I went against my medical training and tried to do what the sheet recommended. Except the chaffing of my shirt and sheets on my tattoo was bad. Not to mention I was losing a lot of moisture due to the cold, dry, winter climate and my tattoo was getting tight and uncomfortable. Adding more ointment would help until it rubbed off on my shirt or chairs or couches and I kept thinking about much easier this would be if I could just rebandage my tattoo. So I started to do some googling to determine why it was not considered good to re-bandage a tattoo.

What I found was a lot of opinion based on hear-say that was probably based on misunderstanding, bad hygiene and ignorance. But before we can list the reasons people give about why you shouldn't rebandage a tattoo we have to talk about what a bandage is and what it is not.

What is passed as "bandages" in the tattoo industry are improvised at best and would not go very far in the medical community. These days the "in" thing to do in tattoo parlors is to cover the tattoo with plastic wrap, tape it up and call it a day. In my case, my artist put two pieces of tape over top of a paper towel and called that a bandage. No wonder infection is cited as a fear of re-bandaging. If your idea of a bandage is to cover a wound with a dressing that cannot breathe (plastic wrap) or a non-sterile paper towel you very well may have problems.

There is also a difference between a bandage and a dressing. The dressing is the part of a bandage that makes contact with the wound. The bandage is the part that holds the dressing in place. In a standard bandaid, the white cottony part that you would place over the cut is the dressing, the part with the adhesive is the bandage. To shorten the terminology we all just said bandage to refer to the entire thing. But if your tattoo is 7x12 inches you are not going to find an all-in-one dressing/bandage combo to fit it and so you are going to have to improvise your own dressing and a bandage. 

When I think of a dressing I think of a sterile, permeable (breathable) pad of some sorts. And there are MANY to choose from and cheap. There are even pads that specialize in NOT adhering to wounds. They come in a number of sizes and many of them can be unfolded to cover very large areas or taped together to make the desired size or shape.

Because you do want a tattoo to breathe I would use only medical tape to hold a dressing in place and not worry about any kind of bandage unless I was expecting to get the dressing dirty or wet. For your average tattoo, however, a sterile dressing held in place with tape is more than enough.

So what are some of reasons given for not re-bandaging a tattoo and are they valid? Let's see...

The bandage will adhere to the tattoo and damage it as you attempt to remove it.
I this sort of true. As we all know, a tattoo is damaging to the skin. In terms of the damage it does it is very similar to an abrasion which is a superficial (shallow) area of damage to the surface of the skin. Think skinned knee or elbow. They don't usually bleed a lot but they can produce a clearish liquid called plasma which is the liquid part of blood. It contains clotting factors that will adhere to a dressing or bandage. If any blood or plasma dry to a bandage and are pulled off it can reopen a wound and hinder healing or make a wound worse.

But is it something to worry about? Not really. You can purchase special dressings designed not to adhere to wounds. Also, warm water breaks down the bond of blood and plasma and one can very gently remove a dressing from a tattoo by simply running warm water over it until it falls away from the body. No pulling necessary and no added damage to the skin or tattoo.

The tattoo will be unable to breathe. 
This is only true if you are using an occlusive (water and air-tight) dressing such as plastic wrap. If you are using a sterile, permeable dressing this is not an issue.

The tattoo will get infected.
Again, this is only an issue if you are using a non-sterile dressing and not washing the tattoo properly. Slapping on a paper towel and leaving it for a couple of days so that your sweat and bacteria can fester an grow can very much cause an infection. Carefully washing the tattoo and putting a clean, sterile dressing on once in a while can actually help prevent infection.

The dressing will pull the color from the tattoo. 
I have searched and searched and searched and have not found a single reliable source for this claim. The ink of a tattoo is inserted under the outer layer of the skin called the dermis into the lower layer of skin known as the epidermis. This is where your sweat glads live and below where new skin is formed (so that you simply don't slough off your new tattoo). It is not easily extracted from your skin. If it were, we would all be losing our tattoos in our sleep on our pillows and bed sheets. If your cotton shirt will not pull out your color a sterile dressing won't either.

That being said, you WILL bleed color from your tattoo for a few days. Your skin and body were not made to hold ink and just like your skin will attempt to expel a sliver, it will attempt to expel the foreign substance known as ink from itself. This is completely normal and should not be taken as a sign that your ink is being "drawn out."

It will slow the healing process.
There is no evidence to suggest this is true. At least not if the tattoo is bandaged properly. In fact, it goes against what we known to be true about wound management which is that a covered wound heals faster.

So, should you or should you not re-bandage a tattoo?

It's totally up to you!

One account I read from a medical doctor suggested treating the tattoo like a sunburn. Keep it clean, keep it moist and if it feels better to bandage it then bandage it. Just bandage it properly and change the dressing frequently, especially if you are still seeping blood or plasma, working in a dirty environment or sweating.

Below is what I would recommend to anyone getting a tattoo as far as aftercare is concerned:

1. Remove the initial bandage within the two-hour time frame recommended by most artists. Do so by running warm water over the bandage to loosen any clots or dry blood so as not to open a wound.

2. After properly washing your hands (at least 60-seconds or good scrubbing with soap and hot water) wash the tattoo with soap and warm water. Do not use peroxide or rubbing alcohol as these products can damage and dry out your skin and tattoo.

3. Apply a thin coat (thin enough to barely make the tattoo shine (for a tattoo that covers my entire shoulder blade I use only a pea-size)) of some kind of ointment. A favorite is A&D. If you can keep it open, then do so, making sure to protect against sun exposure or soaking in pools and baths (where bacteria live).

4. Shower like normal.

5. There are plenty of reasons to bandage a tattoo. You need to work and don't want to get it dirty. It is in a location where clothing will chaff. You want to sleep and not get ink and blood on your sheets. Your skin is sensitive and looses moisture fast and you need help keeping the tattoo moisturized. If you can keep from having to bandage the tattoo, great! Leave it alone. But if you feel you need to rebandage the tattoo do the following:
    a. Pick up a package of non-stick, sterile dressing pads in an appropriate size.
    b. After properly washing your hands and tattoo, apply a thin layer of ointment to the tattoo (this will help with both the moisture and with keeping the tattoo from sticking to the bandage).
    c. Unfold or tape the pads together with clean medical tape until you have a dressing that will cover all sides of your tattoo.
    d. Being careful not to touch the part of the dressing that will touch your tattoo, apply the dressing to the tattoo and tape on all sides to clean, non-tattooed skin (avoid putting tape on any parts of the tattoo).
    e. To remove the dressing, remove the tape and then run the entire area under warm water to dissolve any potential blood or plasma clots that may be adhering to the dressing. Keep running water over the dressing and tattoo until the dressing falls away. Do not pull or forcefully remove.
    f. Change the dressing at least once a day, more if sweating or it gets soiled.

6. Do not pick any scabs or dry skin and be careful to keep the area moist.

7. After a few days, switch from ointment to a non-dyed and non-perfumed moisturizer.