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.
Depends! If my patient is awake and incontinent then he/she can have a brief. If they are tubed/sedated/obtunded then no brief. I am in my rooms every hour and if there is poop I clean it up.
I work in a large urban hospital that has completely overhauled their policies on skin prevention/management over the past couple years, and briefs aren't considered "best practice" and aren't used on any unit - ICU or med-surg. The material briefs are made out of don't have "moisture wicking properties," and therefore don't absorb any of the moisture d/t incontinence. The only thing briefs accomplish is increasing the amount of skin in contact with urine/stool, and thus increasing the risk of skin breakdown, UTIs, etc. We have these big blue and white pads that are capable of absorbing large amounts of moisture and are strong enough to be used to pull pts up in bed without tearing. Seriously, they're amazing.
And a previous poster mentioned, "if you note skin breakdown on an incontinent patient and your facility allows it per protocol, an order for a foley may be helpful."
At my hospital, incontinence is not a indication for a foley even if the pt has skin breakdown. Per the "CAUTI police," the risk of a UTI outweighs the risk for skin breakdown, and that pt's incontinent of urine should have their toileting needs frequently assessed. Also, we have a skin cream that acts as a barrier to prevent urine/stool from just sitting on the skin, and that this cream (along with freq. assessments for incontinence) can be used for incontinent pt's with noted excoriation or other skin breakdown. Not sure if this is practiced everywhere, but it seems to be successful.
Several years ago we got new beds/mattresses that were supposed to reduce pressure ulcers. We were told in product training that we should only use 1 sheet and 1 chuck on the mattress for it to be effective. A few years later, our beds are covered in a fitted sheet, a draw sheet, a chuck, and a lift sheet routinely! People have amnesia sometimes. First thing I do when I turn my patient is remove all unnecessary layers of bedding. I rarely use briefs, for the reasons already stated, but this thread made me laugh.
we don't use briefs either. We use dry flow pads (the big blue and white paper pads that can absorb elephant pee!) What we will do to save the sheets is to place an extra pad between the legs and tuck it up under the gown - acts as an extra layer and is much easier to change than a full bed change.
I did a little research on Liveanew.com and it seems like there are a lot of different products which absorb at different rates. On one hand the pads are great because they keep the stool and such away from the skin when a patient can't tell they are incontinent or leaking, on another hand the ease of briefs are probably preferred by a lot of people.
No briefs at all...we take them off as soon as they come up to ICU. We use the big blue disposable pads for patients on specialty beds, and blue washable pads for others. We can also put a condom cath on a man. That is a nursing decision and doesn't need a provider order. Example is a man who is going to be sedated for less than 24h.
briefs can hold moisture up against the skin and cause skin breakdown leading to pressure ulcers. with chux at least there can be more air movement and drying of the skin, depends on the brand and absorbancy of the chux as well, and if the patient is just lying there chux are way easier to clean up than trying to get briefs off a person who is laying and cannot help as much. An ambulatory patient is one thing but try to get a pull up off without making a mess on someone on bedrest....no way.
briefs can hold moisture up against the skin and cause skin breakdown leading to pressure ulcers. with chux at least there can be more air movement and drying of the skin, depends on the brand and absorbancy of the chux as well, and if the patient is just lying there chux are way easier to clean up than trying to get briefs off a person who is laying and cannot help as much. An ambulatory patient is one thing but try to get a pull up off without making a mess on someone on bedrest....no way.
We do it all the time in the ER. We use the type of brief with the closure like a baby diaper, but if they come in with a pull up type on, you just rip the sides. It's usually not hard to keep it contained. Just unfasten, tuck between the legs, then roll.
Salter444
64 Posts
Depends! If my patient is awake and incontinent then he/she can have a brief. If they are tubed/sedated/obtunded then no brief. I am in my rooms every hour and if there is poop I clean it up.