ECG leads for micropreemies

[NICURN29]

Hello!

I am looking for some product information and/or care information regarding the use of ECG leads on micropreemies. We have recently had several 23-weekers, and even using the limb leads has resulted in burns to their skin. We have been moving the leads every 3 hours with cares, and still there is sometimes skin integrity issues from their use. I am looking for information (A) on what brand leads you use in your NICU, especially on babies with very immature skin, and (B) any "modifications" you may make in your lead use (for example, we place Coban over the sensor on our pulseox probes for micros so that they don't have the light backed right up to their skin) that you may utilize to help protect skin.

Thanks for any help you can offer!

[katierobin23]

We have a policy that says we can choose not to use leads on micropreemies with significant skin integrity issues. Those babies almost always have a UAC which we use in conjunction with the pulse ox to monitor their heart rate until the skin matures enough to use leads.

In my experience, coban is much more abrasive to skin than the pulse ox sensor, we cover it with clear tegaderm to keep the adhesive off the skin, and wrap it gently with a posey wrap.

[Coffee Nurse, BSN, RN]

Same here, we use sats probe and UAC for monitoring micropreemies until they're better keratinized and weaned off of humidity, around day 8-9 per our protocol. In my old unit we used to put a bit of Jelonet between limb and probe; in my current one, we just use those white, less-sticky Masimo probes (not the brown ones that are a little more like Coban -- and can't imagine putting actual Coban on a microprem!).

[Luckyyou, BSN, RN]

We have the same problem with limb leads. Sometimes I cut the long part off and stick them on the chest and abdomen and have better luck with skin integrity. People tighten the limb bands WAY too tight. I always put mepitel one under leads and pulse ox on the itty bitties (Wound contact layers – Mepitel One | Mölnlycke Health Care). I change the leads completely at least once a shift and have pretty much accepted that nothing is going to stick in giraffes at 70-90% humidity.

[danielle2000, MSN, RN]

When they are that tiny we opted to not use those leads till their skin can tolerate them. The UAC is what we utilize. Technology has to catch up now since we are saving these very small preemies!!!!

[rnkaytee]

We don't use leads in any baby less than 1000 grams - I can't imagine changing the leads every 3 hours - seems like you'd be taking off layers every time. We rely on the pulse ox, which we put tegaderm on so it's not sticky and the UAC BP.

[HyperSaurus, RN, BSN]

We do usually use leads, we cut off the wrap-around on limb band leads and place those on the chest.