So up until a few months ago my only experience has been in the ED so frequent incontinence clean ups weren't a common occurrence until I started working in step down.
So to me it just makes sense that if someone's incontinent they get a brief and everyone on my unit must feel the same way because we ALL use briefs along with creams and all the pads under the pt and all that. However whenever I float to the ICU I can NEVER find briefs and when I ask other nurses always get the same response of something like "we don't really use those here" now I know habits can sometimes dominate a unit and become part of the culture for that unit but I'm starting to wonder is this just an ICU thing?
Two regular ICU agency nurses come to our unit they have the same feeling towards briefs. But why? I feel like it significantly reduces the risk of skin breakdown because the poop is more contained and less likely to spread up their back and down their legs, also it makes clean up faster. So why????? If anyone can find research on this that'd be great if not I'd like to hear all opinions as well.
Briefs are thought to promote skin breakdown, that's why they're not really used in the ICU. I have used them on very rare occasions when the incontinence was so bad the patient so compromised from a respiratory standpoint that constant bed changes were more of a risk than skin breakdown from a brief. In those cases, however, an external rectal pouch was tried without success and an indwelling bowel management system was contraindicated.
Years ago I worked in an LTC that didn't allow briefs while in bed. I recall a few cases where either d/t special situations or family request it was care planned to wear briefs in bed. We also had fabric pads for the beds (vs. disposable).
I remember being really surprised but there was not a problem at all with skin breakdown in the facility. We were educated that this allowed for better air circulation.
I think it also had to do with the expectation that proper peri-care be performed w/ every episode of incontinence:)
In the SICU, We use chux pads (not the tiny blue ones but the huge white ones that hold a lot) easier to manage/ easier to change because we fecal management systems and flexi seals all manage to leave with time..
Thing I remember about briefs was that sizing was critical. The CNAs freq had a habit of picking a larger than nec brief size. (Bigger briefs mean less # to the bag, and hence more expensive.) For some reason, they felt that the bigger brief would hold more urine (for the 'heavy wetters'). No amt of inservice could change the system. It also gave the CNAs a false sense of dryness so that they were 'safe' between incont changes, so rounds could be spaced apart farther. We wound up having to indicate the correct size to be used on the care plan/CNA record --- a pt in the wrong size would cause the CNA to be disciplined.
Another thing about wrong size was that the elastic panty leg could chafe/cut into the groin fold or upper inner thigh area and leave an abrasion or laceration.
And they DID LEAK outside the looser elastic.
False sense of security!
Now this was in LTC, but many staff still have similar expectations of briefs. This thinking also applied to the use of the adult diapers.
A brief on somebody holds the feces/urine against the skin. I can't imagine how they would wick away moisture, really, if you think about it. If a patient is totally immobile and laying on his back, where exactly is the moisture going to go? It's still in the brief. I would think if moisture wicked anywhere, it would wick around more of the skin than if a person is just laying on a pad because more of the skin would be in contact with the brief than would just be in contact with a pad.
I also think it's just flat out easier to tell if someone has been incontinent if there is no brief. Either the smell or sight will give it away very quickly... and if you're rushed and in a hurry, a patient with a brief might sit in incontinence longer if it's not immediately obvious from a distance that he/she has pooped.
This is exactly what I was thinking. I'm on step down, and we're not really supposed to use chux, either, although in some patients, an exception might be made. I'll add, though, as some advice - if you note skin breakdown on an incontinent patient and your facility allows it per protocol, an order for a foley may be helpful.
Makes total sence to me. If the patient isn't mobile, its much better for skin integrity. I've seen some pretty harsh skin issues due to briefs and they always clear up when they can be left open to air. We used to mix calamazine with nystatin powder and it worked wonders.
I agree that a brief should only be used in an ambulatory patient. I work in an ED and unfortunately briefs are used primarily even in bedridden patients because our department only has the cheap blue chux that are practically useless.
This has been a trend for many years in pretty much every setting. The use of briefs is usually only recommended while ambulating or other situations where an underpad can't be utilized. The general reason is that briefs give staff an excuse to not change the patient when soiled, and also that they result in more skin contact with stool and/or urine.
I often find that with loose stool in particular, briefs tend to push it up into the peri area, where as with just a pad it will...flow... Better. Skipping the brief makes an easier clean-up, and maybe lower risk for a UTI (sorry I don't have any EBP to back that claim).
VANurse2010
1,526 Posts
Briefs are thought to promote skin breakdown, that's why they're not really used in the ICU. I have used them on very rare occasions when the incontinence was so bad the patient so compromised from a respiratory standpoint that constant bed changes were more of a risk than skin breakdown from a brief. In those cases, however, an external rectal pouch was tried without success and an indwelling bowel management system was contraindicated.