Skin Care

Mithrah · Jun 30, 2003

jeffiner,

I am not an RN yet, but I am thinking of NICU. I'm in the Phoenix area too. What hospital do you work at? Do they need nurse externs?

dawngloves, BSN, RN · Jul 3, 2003

I don't even think we have a skin care policy! I don't mean to highjack you're post, bbut does anyone else use benzoine? I hate it, but sometimes we really need it on ETT.

jeffinerrn · Jul 3, 2003

Dawngloves,

heheh,

don't worry about the thread. as you can see, I haven't gotten much response anyway. but no, we don't use benzoine. our hospital decided long ago not to use it. it just seems to harsh on the babies' skin. I've been in NICU 4 years and I wasn't sure what it was. I'd never seen it in our hospital. then the others told me it was the little betadine stick they have to squeeze and pop to break, like United Blood Services uses when they prep a site to draw blood, then I understood what they were talking about. DUH!

We only use a prepared skin prep pad from Hollister.

fergus51 · Jul 3, 2003

Yes to almost everything. We do use sterile water and try to avoid alcohol, we do put tegederm or duoderm under any taping on the face including our OG/NG tubes and use it as a padding under CPAP on the nose and face where the straps sit, we use limb leads on the smaller babies and rotate the sites frequently. We also have a stretchy tape like fabric that can wrap around the limbs and sticks to itself, not the skin. It works great for sat probes. We use a solution (detachol) to remove tape on the face and on the body of kids with sensitive skin and wipe it off right away. Baths are every second day time permitting.

Mimi2RN, ASN, RN · Jul 4, 2003

I haven't heard about using sterile water, we use little preps that I can't remember the name of, for blood draws, betadine for uac/uvc and LP preps. That all gets washed off afterwards. I like to use tegaderm or thin duoderm on the face, but we are dependent on what has been purchased for general hospital use, and if it's in stock......or "on backorder".

We bathe the babies every other day if they are stable, sometimes they need "butt baths" in between. They get so raw sometimes with the antibiotics etc., sometimes soapy water and a good rinse helps, with an application of Butt Paste, to follow.

We only use benzoin for u-bags.......hate those things, I'd rather cath a baby any time.

What about cord care? Our policy is alcohol q 8 and prn.....not good, from what I have learned.

Good thread jeffiner, and dawngloves hijack...sorry about mine, too, but things seemed to fit.

NICU_Nurse, BSN, RN · Jul 4, 2003

Okay, I have questions!

Fergus, the self-stick tape- how do the sat probes pick up through the tape? We have the bandage-type that has a light shining directly on the skin...? They're supposed to be rotated q shift, but of course people forget and the babies get breakdown on occasion.

Mimi, can you elaborate on the cord care issue?

Also, where do you guys get the statistics that your policies are based on? I would love to present some of these to the higher-up's (we're stuck in the dark ages- it's like vigilante nursing) but have no idea where to find such information, other than doing general searches on Google (and, FYI, I tried looking up the benzoin issue on Google and came up with zilch).

We still have an abundance of alchohol preps, but use sterile water to soften adhesive (or A+D ointment/KY Jelly) when removing things. We use pectin barrier for ostomy bags and the like, but no barriers are used for ETT taping, etc, other than Benzoin to get it to adhere. We don't use anything for the u-bags- do you find that helpful?

As far as bathing, that is a raging issue on our unit at the moment. Some are determined to bathe every single day, full on bath with baby soap and water for those who are able to be bathed (ie, no IV's/Lines/Umb stump present). Others do "full" baths with only water. Others alternate QOD. Others do sponge baths only. Others do crease care only (they call them "Ho" baths- LOL!). Some use lotion, some use A+D afterwards, some use nothing. Each person has an opinion and won't be swayed. Frustrating!

fergus51 · Jul 4, 2003

The self stick tape goes around the probe and just holds it in place (not between the probe and the skin). It's almost like a tensor bandage. It is really helpful on some of our squirmier babies, and much nicer than using tape like I have seen some people do. Tape is my BIGGEST pet peeve. Rather than changing electrodes some people just tape them on, then when they have to be removed there is a nice big red spot that doesn't look comfortable for the baby or impress the parents much. It also works well to give extra stability to IVs instead of only tape.

We don't use alcohol on cords as studies have shown it isn't a good thing. Most of the studies we were shown were from the American Journal of Neonatal Nurses.

Mimi2RN, ASN, RN · Jul 4, 2003

Kristi, I was at a seminar, and went to a session on skin care. Among other things I learned about the cord care studies Fergus mentioned. We were told that the more diligent you are using alcohol, the longer it takes for the cord stump to fall off. One nurse told me 6 weeks for her baby!

My son and his wife were not told to use alcohol on my grandbaby's cord, and it came off quickly.

Fergus-is the self stick tape Coban? We use Finger posies to hold the sat monitor sensors in place. I've used Coban to hold on bili masks.......lately we have been using the mesh Band-net type stuff, to hold them in place. It works better than the straps that comes with the mask.

Tincture of benzoin comes in those breakable ampules, but also in a bottle. We use sterile Q-tips to put it on. It helps to stick down the U-bags, so we don't have to replace them several times. It has to be washed off carefully, when you have the specimen. We seem to do a lot of UDS's around here.

Fergus, I agree about the tape, especially pink tape......it sometimes takes the skin off. I read on one of these threads about using oil to help with tape removal, scalp IV's in particular. I told people at work about this, and a couple of nurses tried it, said it did make a difference. It needs to be left on for a few minutes for best results, sometimes needs reapplication.

Any more ideas?

mimi

nurseiam · Jul 5, 2003

Our policy is similar to NANN guidelines. Bathing......when the baby is so funky no one can stand it! But I love to swaddle the baby when I give a bath! They are so much happier. There is a great video on childmed.com.

prmenrs, RN · Jul 5, 2003

Apparently, the alcohol kills beneficial bacteria that help the umbi detach. I usually stress keeping the diaper below the umbi, and the signs of oomphalitis in my d/c teaching.

NICU_Nurse, BSN, RN · Jul 5, 2003

Oh, thank you all! I will stop doing this immediately, and I'm going to try to get my hands on some copies of this information to hand around the unit.