Published Oct 17, 2003
dawngloves, BSN, RN
What problems are you having with Betadine?
WE WERE HAVING PROBLEMS WITH BURNS ALSO. SO OUR UNIT SWITCHED TO CHLORHEXADINE. WHAT IS YOUR INCIDENCE OF BURNS WITH BETADINE? IS THIS WHAT YOU USE FOR PUTTING IN LINES?
We use Betadine. I've never seen burns with it, even with 24 weekers.
When I started in the NICU in 1986 (I'm showing my age!), we used 1/4 strength Betadine, followed by alcohol to prep for umbilical line placement. It was believed that full-strength Betadine would burn the neonate's skin, hence the dilution. These solutions were placed in sterile med cups on the surgical tray, and the residents would sponge them onto the abdomen with gauze. As soon as the baby was prepped, the nurse was to remove the diaper or chux beneath the baby to prevent the child from laying in a pool of Betadine and alcohol during the procedure.
One time, a nurse and resident forgot to remove the diaper from under the baby (a fairly stable preemie, about 30 weeks). When the procedure was finished some 45 minutes later, and the baby was being positioned for an X-ray, it became apparent that the baby had suffered a massive chemical burn on her back. What was so tragic was that her respiratory disease turned out to be fairly mild, but the burn and its subsequent complications kept her in the hospital for a long time.
Sorry, didn't mean to hit send quite yet. When she was DC'd, she faced future surgeries for skin grafting.
I have since worked at a number of other hospitals and have never seen anything like this happen anywhere else. What I believe to be the critical difference is the use of Betadine and alcohol swab sticks rather than the use of gauze to sponge on these solutions. With the swabsticks (used full strength), there is virtually no "run-off" which can pool out of sight under the baby's back.
The use of chlorohexadine concerns me. Isn't this the stuff that caused neuro toxicity years ago when used to bathe newborns to prevent spread of infections in the nursery?
I Believe you are correct Jolie about the neurotoxicity of chlorhexadine. We have only ever used Betadine followed by alcohol to prep sites and I have never seen a chemical burn yet. P.S. I'm going to show my age too. I also started NICU in1986!
we use a betadine solution..........
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