questions on my patient

[rockabye]

Ok I recently took care of a premie and noticed 2 odd things. First, he was on a biliblanket, but there was a thin regular blanket between him and the biliblanket. I thought babies were supposed to be directly on the biliblanket to get the full phototherapy coverage? I couldn't find the manual for the biliblanket to confirm this, just always seen the baby directly on the biliblanket. I went ahead and put him directly on the biliblanket since that is what I was taught.

Second, his PIV was in his arm and taped securely to an arm board, but there was no tegraderm at the insertion site; it was completely opened to the air. Isn't that an infection risk? When I asked about this, people told me that's just how the nurse tapes her PIVs! I cut a strip of tegraderm to cover the insertion site because I was not comfortable with this.

Any other NICU nurses have comments on this or can enlighten me?

[NicuGal, MSN, RN]

We have covers for our bili blankets, or we cut a chux and stick in there.

I would guess that most institutions use an occlusive dressing over the site, look up the policy. If this person isn't and it is policy, it should be written up. That is just kind of gross and lazy.

[rockabye]

Thanks for your answers Nicugal. I should have mentioned that there was a disposable cover on the biliblanket too. I looked up the manufacturer website for the biliblanket and it did say it recommends nothing but the biliblanket cover to be between the patient's skin and the lights. I guess the baby would still receive some phototherapy with a a thin blanket in between, but not get the full coverage.

I also looked for policy about PIVs and I didn't read anything specifically mentioning an occlusive dressing. However doing an internet search, all of the PIVs mentioned having an occlusive dressing over the insertion site. Fortunately that was the first time I have ever seen a PIV taped without one and hopefully it won't continue. Usually I have the opposite problem with PIVs and retape them because there is too much tape to properly see the site!

[twinkletoes53]

We placed our babies directly on the biliblanket, which was covered by a thin disposable cover. We actually had a radiometer that could measure biliblanket readings. Also, although we were told that babies' eyes don't need to be covered when on a biliblanket, we always shielded their eyes when turning them prone if they were premature.

Re: the IV. We always place a sterile occlusive dressing (Tegaderm) over the IV insertion site. That is just common sense to me. Why would you leave the IV site completely unprotected? Any line in the infant is a potential port of entry for infections. We also had a policy that stated that you should be able to see the infant's extremity below and above the IV insertion site. That was to detect possible infiltrations more quickly.

[rockabye]

We also had a policy that stated that you should be able to see the infant's extremity below and above the IV insertion site. That was to detect possible infiltrations more quickly.

That's great you actually have a policy on taping the IVs. Fortunately, most of the PIVs I encounter are taped pretty good, but there have been some that are so difficult to see because they are just covered in tape. I usually try to retape them if they are particularly bad, but I have also lost a couple PIVs due to trying to retape them too. Would be much easier if people just taped them right to begin with!

[NICU_babyRN, BSN, RN]

Yes, any insertion site regardless of PIV, PICC/PCVC or CVL MUST have an occlusive dressing over the site.

And no, there shouldn't be a blanket between the light and the infant. Just the manuactured bili cover which is almost paper like. Also, if the infant still has fragile skin, they should have over head bili. Never lay a 23-29wkr on a bili blanket during the first two weeks of life, that's how they get skin tears.