Skin care in the NICU

[Pajefferson16]

Hello all! I am currently working on a unit improvement project regarding skin care for neonates- specifically diaper rashes. I am curious to see what everyone else is doing!

Is there anything that you guys do in your units as far as preventing diaper rashes? I am currently thinking of implementing a procedure where we automatically start using A&D on babies who are more susceptible to getting diaper rashes (for example, babies on antibiotics, NAS babies, etc.). Does anyone have anything else they do, or any articles they would like to share?

Also, what do you guys do for those babies who already have diaper rash? Our unit is split; some nurses use desitin for diaper rashes, and some nurses will continue to use A&D.

Thanks in advance for the input!

[NICU Guy, BSN, RN]

We use Critic-Aid (black cap).

Critic-Aid® Skin Paste

[jennylee321]

When the sudacream/zinc oxide isn't working, mixing some stoma powder with it seems to help.

[NICU Guy, BSN, RN]

My favorite name of skin cream "Anti Monkey Butt Cream". A patient was transferred to our NICU with this in their supplies.

Anti Monkey Butt Baby Cream - Anti Monkey Butt

[adventure_rn, MSN, NP]

I've worked on a few different units, and the unit with the best perineal outcomes used the following:

1) All kids get cream of some kind with every single diaper (default was A&D/vaseline for every baby, every time).

2) Kids at high risk for breakdown (i.e. NAS) automatically get a higher quality zinc-based barrier cream, like Desitin.

3) Any time erythema is noted, babies receive higher quality zinc-based barrier cream, like Desitin; basically anybody with diaper rash, even a mild one, gets the strong stuff.

4) Once excoriation and/or open sores are noted, we start using stoma powder in addition to Desitin.

That unit also had a specific diaper rash protocol printed at every bedside so that every nurse was on the same page about peri-care expectations.

The units with the worst outcomes have been the ones that didn't use cream prophylactically as standard practice (which was surprisingly common in retrospect).

[Luckyyou, BSN, RN]

I love a combo of triple paste and A&D.

[rnkaytee]

We use a combo of all that has been mentioned, but I will usually order time open to air - it helps immensely!

[vintage_RN, BSN, RN]

We use zinc prophylacticly with each diaper change. At any sign of redness or breakdown we use Prosheild. I also find we see Medihoney a lot with our really badly excoriated bums (it looks and smells like literal honey)

[adventure_rn, MSN, NP]

We use a combo of all that has been mentioned, but I will usually order time open to air - it helps immensely!

Lol, every time I've done this (always prone), the babies look up at me with an expression like "What the heck are you doing to me?" I've also learned the hard way that you have to use chux pads to build up a splash guard around the entire end of the bed/isolette...

In a similar vein, I've seen people put a cannula in the diaper to blow O2 onto the site to keep it dry, though that definitely wasn't unit policy.

[NICU Guy, BSN, RN]

I've also learned the hard way that you have to use chux pads to build up a splash guard around the entire end of the bed/isolette...

Reminds me of our myleo kids and making a "mud flap" for their butt.

[adventure_rn, MSN, NP]

Reminds me of our myleo kids and making a "mud flap" for their butt.

[Julius Seizure]

Reminds me of our myleo kids and making a "mud flap" for their butt.

we do this on femoral CVLs and sometimes UVCs/UACs