How does your unit secure IVs? (and feeding tubes, cannulas, etc)

[elle_RN]

I am really surprised at the amount of tape our Level III RNICU puts on our babies. I can barely assess peripheral IVs (forget seeing the catheter insertion site) because there is just SO much tape. Just recently a baby's IV went bad and they have a burn...barely visible before all the tape came off. I worked in adult med/surg for almost 2 years and I am used to seeing everything nicely under tegaderm. To make matters worse our unit makes its own armboards with tongue depressors and gauze. So it's a mess of coton balls, wood, and oh-so-much of that horrible thick clear tape. With half of a tegaderm right over the insertion site. Everyone there is used to it. We also use tegaderm to secure nasal cannulas and NG/OGs to the babies.

They're collecting ideas to improve the unit and I want to suggest reducing the amount of tape we put on the babies' skin. I don't even like using that much on adults and here we are putting it all over babies...it can take days for the redness to go away.

How does your unit secure these items? Do you have pictures? What products/brands does your unit use?

[katierobin23]

For IVs, it depends on the nurse. If the nurse starting it likes tegaderm, that's what's used along with tape and a small piece of cotton under the hub. If the nurse doesn't like tegaderm, we can use a small piece of tape over the hub and then tape it like normal around. Our arm boards aren't homemade...I can't imagine using tongue depressors and cotton! I don't find that the tape obscures the site, but it sounds like you're seeing a lot of it being used, maybe we just use less.? I personally like tegaderm but find that it makes the sure look more puffy than it actually is. For OG/NGs, we use strips of Neobond next to the skin and pink tape on top of that to secure the tube. That's our policy, but tegaderm can be used if the Neobond and pink tape doesn't stick.

[imaginations]

Depends on how desperate the insertion process is, usually. If the IV can be secured/the baby held still while the IV is taped then we use two, thin ster-strips looped underneath and over the cannula, one across the top and then a clear tegaderm over the top. We have neonatal and baby size, soft foam arm boards, which are malleable (they are wire instilled on the inside).

All that said, give me a central line any day!

NG tubes are secured with a piece of comfeel on the check, tube over the top and then brown tape or clear tegaderm sticking the tube to the comfeel.

[Preemienurse23]

We always use tegaderm over the insertion site. Then we use silk tape to secure the hub. We try to avoid covering the insertion site. I personally don't like arm boards, I have lost more IV's because of them than without. But our arm boards are cotton lined with the wire in them. Most of us use cotton directly under the hub to provide some skin protection from the plastic. We also use tegaderm to secure feeding tubes, sometimes duoderm is placed under the tube with the tegaderm over, but usually it's just the tegaderm.

[NicuGal, MSN, RN]

We use regards over the site and Cather and tape and armboards. I always teach

People to keep tape to minimum! I had one really horrible infiltrate that I found after I peeled off 4 pieces of tape and a hunk of flesh came off with that last piece

[TiffyRN, BSN, PhD]

I'm not that great with IVs or their taping but I think I am decent at NG/OG and oxygen taping methods. I have searched for pictures that can go with a couple of these. Let me first emphasize that the one picture of an actual child with this was from a public google search, I don't know this child, have no healthcare provider relationship with them and therefore there are no HIPAA violations here.

For NG tubes, I like the method of laying a layer of duoderm and covering it with tegaderm. Some infants are sensitive to the tegaderm so keeping the tegaderm only on the duoderm can be a good thing. (scroll down to the first actual picture of the child's face)

http://agirlandhertube.blogspot.com/2011/11/adhesives-part-1-adhesives-taping.html

For oxygen, I like the round neotech EZ holder best.

http://www.neotechproducts.com/files/ez-hold-marketing-materials-and-images

When the infant has both a NC and NG, I like to tape the NG to the cannula right at the insertion site and maybe once more further out.

[prmenrs, RN]

On numerous occassions, I've considered staple guns, but, that is frowned upon.

[TiffyRN, BSN, PhD]

Prmenrs:

I know exactly where you are coming from. Just a couple of days ago (at the end of the shift) there were 3 of us wresting a tube back into a big ole chronic that knew all the tricks. When I finished I had to rush over to do withdrawal scoring on an infant with NAS. I almost scored him an extra point until I figured out that I was the one with the tremors.

Oh and I meant to add this, though we may joke about staple guns, I found this link for a securement system that involves looping umbilical tape around the back of the patient's vomer bone (at the back of the nose). Seems a bit drastic and dangerous even for a full-grown adult.

http://www.amtinnovation.com/bridle_how-to-place.html

[umcRN, BSN, RN]

We use hypafix for oxygen and feeding tubes. Its a cloth like tape that works pretty well if the kid isn't too sweaty or goobery. For IVs we have iv start kits that come with everything we need. Small strips of silk tape, foam skin protectors, and tegaderm bordered by the hypafix type tape with a clear center so you can see your site really well

[Fall.out.nerd]

For IVs we use a stat lock which just fits over the hub and holds it in place, then we use tape to hold the arm to the board.

For NG/OG and O2 we use hypafix which works well unless there's a lot of droll or moisture for the most part it does the job

[Mimi2RN, ASN, RN]

We use Tegaderm or Veniguards, with or without armboards. I get very irritated when I find an IV with the insertion site covered with tape!

[Katie71275]

Im an NT in the NICU and we use tegaderms to secure NG/OG tubes to the face. As for IVs, nope you can't see the insertion site at all!! I wondered about that too. They use tegaderm over the site and then wrap it with pink tape(hi-tape)and gauze(and arm boards).

In PICU/Peds, we did the IV with a tegaderm then used arm boards and kerflix with thick strips of tape, but it was made so that usually only the tegaderm touched the skin and the tape was laid over the gauze and secured.