Published Sep 30, 2003
We're revamping our skin care policy to be more thorough and up-to-date. Anyone care to throw in little tricks or things you do to save that delicate skin?
Do all preemies have standing orders for some sort of moisture barrier (ie, Aquaphor or cream vs. gel/vaseline type products)?
Do you have set rules for bathing (qod or q72) or does your policy leave it completely up to the nurses' judgement?
Do all babies get diaper-area protection automatically, or do you wait until something shows up and then prescribe a particular item (ie, regular A+D vs. Aquaphor vs. Desitin vs. Aquaphor with Questran vs. Boudreaux's Butt Paste, etc.)?
Anything else you can think of? I'd love to help make this policy as thorough as possible!
As an aside, do any of you routinely use Duoderm (or a similar product) as a barrier between the skin and the pulse-ox probe? Do you know of a different brand transparent or semi-transparent wafer (other than Duoderm) that would do the same thing?
NICU_Nurse, BSN, RN
Another one: When securing OG/NG/NJ tubes, do you use a particular kind of tape, or a semi-occlusive dsg (ie, Tegaderm/Op-Site/etc.), or both? What's your rationale for your choice?
Wow... Duoderm used under sat probes! I haven't even seen this on our unit. Isn't it rather thick?? Does the monitor pick up through it even though it's not really transparent?? We use a lot of tegaderm.. well some people do. However so much is left to the individual RN's preference... which makes it difficult to be a newbie. I would love to learn more about this topic.
Do you often see injury resulting from sat probes??
I know! I admit, that was new to me until last night! Once I saw it in action, I couldn't believe I hadn't thought of it before!!! I tried it on two preemies- put a slice on both feet and then put the pulse ox over it and it picked up all night.
One of the other nurses had done this before- that's where I heard of it. I don't know how she thought of it, honestly. Will someone else try this and let me know if it was just a fluke? :)
I do see, unfortunately, too many reddened (stage 1) sores from pulse ox probes. I wish I didn't see ANY. One is too many for me.
In addition to the duoderm, there is another new gel-thing out; it's totally clear, not flesh-clear. If anyone out there has this (I think 3M makes it), let me know if this works for you.
I thought it was rather thick, but the probes picked up with no apparant problems. The ABG's matched the sats all night. When the babies dipped, so did the ABG's.
This might be a dumb question... but would tegaderm work just as well??? Tab
dawngloves, BSN, RN
I would think the Tegaderm too thin. It is more of a moisture barrier than a heat and friction barrier.
We change the POX site Q6. I think I've only seen one breakdown on the top of a foot.
Wait until the butt gets read for an order. I prefer triple paste. Might as well knock that rash out !
I usually give a "whore bath" if the baby is still on ISC, but if they are weaning to a crib I'll give them the works.
We use Aquaphor on micro preemies. It's in the admission orders.
We have used Tegaderm under POX sites, but it isn't a policy and so most babies don't have it, but there is a policy to change the site every 4 to 8 hours depending on the size of the baby
Baths are 3 times a week and PRN. They used to be every night until someone realized that every night was probably too much and most of the babies don't get that dirty. Although some of the older/chronic babies may get a bath every night and the chronics usually need it.
We wait until the butt gets red as well before applying anything. Usually start with A&D then go to Desitin and then Butt Paste. I really don't think we have a policy on this.
Securing OG/NG tubes is nurse's preference. I personally like Tegaderm because it looks nicer (not a very scientific rationale)
Okay, this is the other product (transparent vs. slightly opaque) I mentioned:
Neobond, by NeoTech-
This is clear, vs. skin-colored like the Duoderm, and I'm going to try this when I get back to work and see how effective it is. If the Duoderm worked as well as it did, I'm thinking this stuff will work even better since it's completely transparent. Not to mention, this doesn't stick to the skin- to be used just as a barrier, not to secure the probe.
Like I said, anyone who is willing to give this a whirl while at work, I'd LOVE to hear your thoughts.
My thing is, I know that we all have policies stating that they need to be changed qwhenever, but we also know that they AREN'T always changed, and I'm seeing this (so far!) as a viable solution to that. I'm not faulting anyone for not changing it or forgetting, merely looking for a way to ensure that even if it DOESN'T get changed, the baby doesn't pay the price with a sore. Know what I mean? :)
Also, thanks for sharing your routines! I really appreciate it. The babies do to! I'm assuming. I mean, babies don't talk. You knew that, right?
I have newer tried duoderm under POX sites but now I will defenetly try one day.
We are also trying to make a skin care policy.
We dont use any kind of moisturisers on our small ones and never any kind of soap.
We bathe 2x a week. We dont use anything on the butt unless it is red, our favorite is AD with Zink.
Yes, please do try it and let me know. I'm dying to hear another opinion. :)
I used the duoderm on time for a Micro preemie whose skin was so easily broken done nothing else worked, it was the first time i tried it and a bit of an experiment but it worked very well and protedted the skin better than tegederm
Mimi2RN, ASN, RN
We bathe the babes every other night, when they are stable. We use Neutrogena soap, it's good for their skin, and they smell so nice afterwards.
Mec babies sometimes get a washcloth bath to clean of the worst of the green before they get treated. Sometimes it's just the arms and legs, though.
We use more Butt paste and less Desitin these days.
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