Skin Care

fergus51 · Jul 5, 2003

Mimi, I don't know the name of the self stick tape, I'll look on my next shift. We do have a solution for helping to remove the tape (detachol), but even that isn't enough on our really young babes. I don't mind using tape on ETT tubes and IVs for obvious reasons (they need to stay on!!!), I just hate it when nurses are too lazy to replace electrodes so they tape them on.

Mira · Jul 5, 2003

:) Swaddling while bathing apparently is part of developmental care.stable temp and enough fats to protect the baby from cold stress is our policy for bathing,how often will depend on the nurse-I bath my CLD babies every day I`m on.Infant hygiene if bathing is not applicable is once a day.No tape over ECG leads,we wet the gel part to make it stick again.Any solution should be rinsed off with sterile water-had a superficial burn case recently on a 23weeker after a doc left the babe post UAC insertion.We use miconozole gel/cream(mouth/bum) for babe on antibiotics.we leave the cord stump to dry(take 2-3days),and make sure that the willy is down before we close the diaper(boys),when cord is smelly we clean it with alcowipe and leave to dry,sometimes we use starsac(similar to talcum powder).we use posey wrap for saturation probe,and change the site every care time(6-8h).Our policy is about 7 years old,I would be interested to know the latest evidence-based practice.

magRN · Jul 6, 2003

As far as the bottoms go: NOTHING but water.

Mimi2RN, ASN, RN · Jul 6, 2003

Same for us, we use wet non-sterile 4x4's for cleaning. Sometimes a rinse under the faucet works wonders when they are poop to the gills. They do smell better!

NurseAmy · Jul 17, 2003

We use benzoin for ET holders on kids over 1000 grams. Silk tape usually for IVs and cannulas and umbi lines, some times with duoderm underneath the tape. Also we try to always double back the tape for armboards. Pulse ox probes rotated q hands on assessment, usually every 3 to 4 hours. Triple dye to cords if needed, but no alcohol. We use skin prep for ostomy bags as well as for ET holders and such on our micro preemies in order to protect the skin and help secure things.

When we revamped the skincare policy there was some study that suggested that alcohol was absorbed thru the skin at an unacceptable level on preemies, so we try to limit alcohol wipe use. Also, detachol is a big no no because of the skin care police in our unit-I have a bottle hidden for emergencies

Are your units using high humidity in your isolettes for VLBW babies? It seems to be better for the skin than aquaphor that we were using.

jeffinerrn · Jul 24, 2003

thank you everyone for your replies, I have been checking in, I just haven't been typing much, I have a bum thumb and haven't been able to type much lately. I have been reading your input though and find it helpful. I do find it interesting that everyone has their own way of doing things, but that the general theme seems to be that there is little to no research to back up what we are doing. hmmm. other than NANN Guidelines, which aren't terribly specific what are we to do? there is little consistency between facilities. no wonder we all seem to wander and differ in our opinions. how can we expect to stick together when we have little guidance?

Everyone's input has proved helpful and l hope you all continue to share your practices. perhaps we can come up with some solutions together.

fergus51 · Jul 24, 2003

I think it's also that there are more than one way to skin a cat. I don't think there is only one right way, but more research is definitely needed!

NicuGal, MSN, RN · Jul 25, 2003

Working for a county hospital puts restraints on us getting the "nice" stuff, so we improvise a lot.

Bathing....we don't have a specific guideline...for the sloppy feeders and the chronics a good scrub is in order. Teeny tinies...minimal wash. We use Aquafor on them to keep their skin nice. Most of us don't us baby lotion...it seems to dry them out more sometimes. On kids under a kilo...we create the rainforest in their isolettes...although 2 of our attendings feel that this contributes to fungal growth..not to sure about that.

Taping OETs....use white adhesive tape with benzoin. We don't use Detachol anymore....some study said that it can be absorbed into the little ones if not washed off really well. We use mineral oil to unstick things.

IV's....clear tape or paper tape. No bandaids on the little ones, just some cotton stuck on heelsticks.

We also use eggcrate on the beds and the occasional gel pillow.

Betadine gets washed off immediately.

Cord care...we are in the midst of redoing out protocol, so for now we are "supposed" to be using the alcohol.

Ostomy care...skin prep under the bag. GT's we keep open to air as much as possible until it is completely healed.

CatRN · Aug 2, 2003

Hi everyone.....

Each NICU is different in their policies and practices. I worked at places that bathed and weighed daily, some bathed and weighed Mon & Thurs, some bathed prn and weighed daily...etc. I have picked up a few things, and held onto my favorites. As far as skin care guidelines, the Association of Women's Health, Obstetric and Neonatal Nurses has Neonatal skincare evidence based practice guidelines....quickly here are a few recommendations...

Cord care: initially a neutral pH cleanser or sterile water, nothing after unless soiled and only sterile water if soiled. Alcohol delays separation at the stump, and can cause a blood alcohol level in very premature infants.

First baths only to be given to remove EXCESS vernix and only when necessary. Preterm infants should not have a bath as vernix is an emollient as well as offers antibacterial protection. For those hulk-like green children....we just can't help ourselves! We make them rosey pink!

Humidity seems to be the rage for all the real little ones.....the newer isolettes...the Giraffes & Versalettes....seem to be better at preventing the rainout effect...the dripping, moist walls inside the isolette. Some doc's argue the moist environment promotes fungal and yeast growth....but no evidence supports that. I know that it's a pain to get leads to stick as well as a temp probe...and that the smell of Hyperal urine when you open the portholes can smack you in the face. Humidity also helps keep the nares moist for the baby on NCPAP.....less suctioning needed. I like thin duoderm under OG's & NG's.....thick duoderm in an upside down "T" under NCPAP prongs (INCA, Hudson, & Aladdin Prongs) Arabella's come with foam for their prongs.....I don't usually use an armboard for PIV's unless it's in a spot that requires no bending (AC's, foot) and I try not to use those areas...I like the scalp....parent's usually don't....but their is an armboard that uses soft stretchy straps to secure the board, and no tape necessary except a tegaderm and a chevron. I stole a few and keep a private stash. Don't like pink tape for ETT's or Umbilical lines. One company makes a nice white bridge for umbilical lines....a little expensive...have a stash of those too ;-).....I like the white tape or silk tape for ETT's and still like tincture of benzoin.....I feel it helps white tape stay on longer. Less retaping of ETT's...I've seen some nasty skin tears from ripping the tape off. Hope this helps....Oh, love water beds and gel mattress's...they work great for overall skin care. I like sheepskin too. They even have oscillating water beds now....kind of like the clinitron beds they use on adults!

kids · Aug 3, 2003

I know what Fergus is talking about, a brand name is Coban ("coheisive bandage"). We used it a lot in home care to hold sat probes on (also comes as a latex free).

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Gompers, BSN, RN · Nov 23, 2003

Just wanted to bump this topic up, as I wanted to ask some questions as well as comment on the thread. I'm on our skincare committee and we're really trying to iron out some new guidelines, so if anyone sees anything fishy about what WE do please let me know and give me some advice! THANKS!!!

First of all, questions:

1. We are currently using Baby Magic soap but hope to change to a low or non-alkaline soap like Cetaphil or Neutrogena to limit changes in the skin's natural pH balance. Are any of your units using these kinds of soaps? Help us find one to order!!!

2. Is anyone using the sterile saline preps instead of alcohol for IV starts and lab draw sites?

3. We just ordered the NeoTech NeoBridges for umbilical catheters - hydrocolloid base with adhesive flaps to hold lines in place. Does anyone have experience with these? I'm wondering if they fall off if there is too much humidity in the isolette?

Now, for what my unit does currently for skin care:

1. For ETTs, we use a duoderm-like hydrocolloid product called Coloplast to protect the cheeks, then use two layers of the 1/2 inch white fabric tape on top of that to secure the tube. We leave the Coloplast on the cheeks until it is no longer needed or starts peeling off on its own and then we change it - in the meantime we can just change the white tape when necessary for reintubation, cleanliness, etc. without hurting the skin. For the bigger babies who have a lot of oral secretions while sedated we sometimes use waterproof Hytape (pink tape) for ETT (directly on skin as no need to protect cheeks first - the zinc in the tape is actually good for the skin and it's less stripping than the Coloplast). Just make sure to check ETT placement first as it's really hard to retape with this sticky stuff!

2. For NGs and Nasal cannulas - we use a strip of Coloplast on the cheeks for protection and cushioning, then use Tegaderm to hold the tubes on top of that. For bigger kids with healthy chubby cheeks we sometimes just use Tegaderm so the kids look cuter - pure vanity!!! We are starting to use Hytape alone to hold these tubes in place since they're usually long term.

3. For ostomy bags we use Hollister brand newborn and preemie pouches. They're wonderful! They come with a hydrocolloid duoderm-type wafer that is really sticky on it's own.

4. For bathing, we are trying to do 3 times/week. For 1kg we use plain water for at least that first week. This is a really hard transition as some nurses still love to scrub every tiny baby with a washcloth and Baby Magic EVERY NIGHT!!!

5. We use 50-60% humidity for the first few weeks for

6. Pulse oximeters are changed at least every 8 hours. We cut some "fur" off the synthetic sheepskin to "unsticky" them for the ELBW kids, and usually use a Posey foam ID band to hold in place for all kids. Leads and temp probe sites are changed every day, replacing with new ones if they aren't sticky anymore. Limb leads available for ELBW kids, and all leads are hydrogel. Ordering Hydrogel temp probe covers as well.

7. We use alcohol for IVs and heelsticks, betadine for arterial draws and line placements, washing off ASAP. We don't use bandaids, but instead gauze and tape - trying to wrap the site with gauze and place tape over that so no tape touches the skin. For IVs we use clear tape and Tegaderm, double-backing tape or using gauze under it if possible for securing on boards.

Are we doing anything wrong that you can see? Sorry so long but we really want this to be a good set of guidelines!!!

prmenrs, RN · Nov 23, 2003

I really prefer Johnson's to Baby Magic--less perfume, which they really don't need! We get little sample size bottles of baby bath and shampoo--definitely need shampoo to avoid cradle cap.

Thanks for that vey comprehensive list, Gompers.