Securing/Dressing Umbilical Lines

We secure our lines using products from Neotech. Also prepping the cord site and abdomen with chlorahexidine is what we do. It has become the standard of care. It's important to remember to wipe off the chlorahexidine with water, otherwise you get a chemical burn. Do you triple dye the cord stump? We do this also. We have no CVL infections.

Christine, RNC, BSN

Hi all,

I am involved in a Performance Improvement group in our LIII NICU. Our project is to research ways to decrease our central line infection rate. I have only worked in NICU for a few months as a new grad, and have seen several things that don't make sense. One of them is that we bridge tape our UAC's UVC's. This technique leaves the cord stump with the lines exposed to air/diaper/god knows what else. I have suggested prepping the abdomen with betadine/chlorhexidine, looping the lines flat against the abdomen, taping them flat, and covering the whole site with a transparent dressing, eg Tegaderm. My rationale behind this idea is that once everything is covered, the lines will be secure, and bacteria won't be able to track down the lines into the bloodstream. Let me know what you all do at your NICU's. Any rationale would be helpful. The nurses on my unit said that's a good idea, but noone else seems interested in changing the way we do things.

Thanks in advance for your input!

SteveRN21 ~ NICU

Hi all,

I am involved in a Performance Improvement group in our LIII NICU. Our project is to research ways to decrease our central line infection rate. I have only worked in NICU for a few months as a new grad, and have seen several things that don't make sense. One of them is that we bridge tape our UAC's UVC's. This technique leaves the cord stump with the lines exposed to air/diaper/god knows what else. I have suggested prepping the abdomen with betadine/chlorhexidine, looping the lines flat against the abdomen, taping them flat, and covering the whole site with a transparent dressing, eg Tegaderm. My rationale behind this idea is that once everything is covered, the lines will be secure, and bacteria won't be able to track down the lines into the bloodstream. Let me know what you all do at your NICU's. Any rationale would be helpful. The nurses on my unit said that's a good idea, but noone else seems interested in changing the way we do things.

Thanks in advance for your input!

SteveRN21 ~ NICU

Hi Steve,

I've worked in units that secured umbilical lines in both of the ways you mention. I've seen greater sucess with the "bridge" method. First of all, it is a more secure method of taping the line. I've never seen one pull loose from the tape or "migrate". Secondly, because the cord stump is exposed, it usually dries out, and can be easily accessed for cord care. With the "loop method", it is my experience that the line is not held as securely in place, and there always seems to be moisture under the Tegaderm, necessitating frequent Tegaderm changes. This places the baby at risk for skin irritation, and accidental dislodgment of the line.

Just my experience.

Have you checked Neonatal Network for research-based articles?

in our unit....typically, we use the t-bar method for the tiny ones, mostly because the tegaderm/duoderm could remove very fragile skin when removed, whereas, the t-bar method is very effective at preventing migration and allows access to the umbilical stump for cord care. For our older, bigger kids, we always use the tegaderm/duoderm solution, their skin is not as fragile AND they tend to be much more active and likely to grab a line and tug. We do x-rays daily on our kids with lines (typically they are also intubated, but not always), and if the line has migrated and needs to be pulled back, the NNP will usually come do it.

Jamie

Wow! Daily xrays for infants with lines. I'm surprised. We do xrays on a prn basis for those that are intubated and with lines....usually one the day of and the next day are standard. After that, they are prn.

Hydrocolloid products are recommended for neonatal patients. We have not had any issues with hydrocolloid removing any of the patient's skin.

Christine, RNC, BSN

in our unit....typically, we use the t-bar method for the tiny ones, mostly because the tegaderm/duoderm could remove very fragile skin when removed, whereas, the t-bar method is very effective at preventing migration and allows access to the umbilical stump for cord care. For our older, bigger kids, we always use the tegaderm/duoderm solution, their skin is not as fragile AND they tend to be much more active and likely to grab a line and tug. We do x-rays daily on our kids with lines (typically they are also intubated, but not always), and if the line has migrated and needs to be pulled back, the NNP will usually come do it.

Jamie

We use both methods...depends on the kid. I don't think that there is anymore sepsis from the umbilicus being exposed...if you cover it up it gets all yucky and gross and I am sure it will breed some nasty thing.

Wow...if I were a parent I would not be happy at all about daily xray's on my kid for lines. That is why you look at the numbers and make sure they haven't moved! Just my 2 cents!

We use the bridge method as well. It's good to have the cord stump exposed - it dries out and the lines get "stuck" so they don't slide out as easily as when it's a brand-new line. If we do use tegaderm (usually on a highly active big baby), we will tegaderm the line down above the umbilicus, so the stump is exposed and can dry out.

I've seen quite a few kids get nasty umbilical stump infections because the whole line was tegadermed down and the stump stayed moist. We've also had lines slip out when the stump was covered in tegaderm as well, because it was still so wet and slippery, and the lines never got "stuck" in the stump.

Is anyone using the NeoBridge from Neotech? We trialled it and loved it but never ordered any. Maybe a money issue?

http://www.neotechproducts.com/store/detail.php?sku=NT-6&session=af273c5

I agree with Jolie. Do you swab the umbilicus with betadine q shift? We stopped using triple dye on cords a couple of years ago. I can't think of infections from UA/UV lines. Only PICCs and even that is few and far between.

And along the lines of non acessed ublilical cords, we don't even swab with alchohol and instruct parents to let it dry out on it's own.

Also with the betadine...you can't leave that one the little ones...they will absorb the iodine in it as their skin is so thin. It will also cause a nasty burn, esp if they are under lites. Your best bet is to let it dry out on its own.