Tape in the NICU

The Neobond is SPECTACULAR. I don't know about ETT's but I now use this on all my preemies as an under-layer beneath the pulse ox probes- I even tested it on myself by placing some on my arm and ripping it off very quickly to see how much it bonds. It pulled a little hair out, but was NOTHING like your typical silk or threaded tape. The probes shine right through a single layer of thi and pick up beautifully. It is similar to the electrode gel on your EKG probes, and will "melt" and disinegrate after a while, so it just rolls off of the skin and you don't have to work to get it off (it's easy to unwrap, too, to let the area breathe, which I do with every switch). Because of the melting, I don't think this would be appropriate for ETT's, but it is WONDERFUL for pulse ox probes. Two thumbs up from me.

The 3M Transpore tape is extremely flimsy- and it stretches a bit if you pull from oppoite sides. The only time I use this is for either securing over a pulse ox probe (ie, if it's slightly losing it's stickiness but I don't want to charge the baby for a brand new one just yet), or for securing cotton/gauze over, say, a heelstick (instead of using bandaids, which I hate and never use). I do not stretch it out *before* applying- leaving it unstretched will give it more room to breathe so it will be even less constricting (for instance, if I have to use it to wrap in a circular/spiral way over a limb or foot, etc.). It is also good if you HAVE to have tape touching the baby's skin, because it sticks a bit less, but I don't like to do this and avoid this whenever possible (which is pretty much always). When I say less, I mean a *bit* less- it's really pretty sticky, but not so sticky that I would feel comfortable using it to secure an ETT. Good tape to have, clear so you can still assess whatever is under it (ie, a dressing that was bleeding- you can see if there is drainage from your site beneath the tape, vs. a cloth or paper tape that blocks the gauze under it from being visible.

Love, love, love the Neobond, and also use Duoderm for similar purposes now. Just FYI, if you're in a pinch, even though it's opaque, you can still get perfectly accurate readings from a pulse ox probe with Duoderm.

For OG/NG tubes, I will either use only a small piece of transparent dressing (ie, Tegaderm/Op-Site) or will secure it with a teensy, as-small-as-possible and VERY thin piece of silk tape in a butterfly over the tube, and then a piece of transparent dressing over a larger area to secure it. I like the transparent dressing, because not only does it stick to the tube, but it can be pinched at either end to sort of close it off and reduce pulling/displacement. If a baby is active or actively pulling at the tube, I will use the silk tape- the trans. dsg alone usually isn't enough to hold it in place with your more active babies- it curls up around the edges and becomes less secure.

We have those little packaged tape remover pads, and those are just mineral oil and fragrance (thus the alchohol-y/gasoline smell; who thought that up?). I don't like the idea of introducing fragrance on the baby's skin (especially if they're under 30 weeks or so) so I don't like these (though they work well). I usually use either water or vaseline. The mineral oil pads are just that- oily, and so is the vaseline; you get a residue, but I usually just wash with warm water (and sometimes a tiny smidgen of soap if it's a thick layer) and it comes right off, leaving clean, dry skin.

I have used both Argyle and Bard gastric tubes, and these were changed q24 and q48 respectively; don't know if that's a manufacturer's suggestion or just hospital policy. At least the Bard tubes can be changed out every 2 days instead of q24- that's a slight improvement.

Going back to the tape/dressing thing, I really like using the breatheable transparent dressings whenever possible, vs. tape, which doesn't breathe. The dressings we use, if pulled in the opposite direction (ie, pulling it outwards by the corners and stretching it) basically come off the skin on their own with very little chafing (you get some flakiness, but no huge patches of skin coming off with them like you do with the tape occasionally). It seems to be less harsh to the babies (although sometimes, depending on where you use it- ie, facial contours vs. an arm or leg- you have to secure it well in order to get it to un-stick the way it's designed to).

We are not allowed to use Benzoin on skin. We do use it on the tape however. Gawd, I hate the smell of it!

Just wondering what kinds of tape/adhesives your NICU uses and what you use them for.

For example, how do you secure ET tubes?

We use benzoin and tape. Just my opinion, but we have used many other things and the tape works the best. We don't have a problem with tube placements and such. The ET holders aren't in the budget, so we make do with the tape :)

Also, what do you use to secure OG/NG tubes?

We use silastics...we will butterfly them or use a small piece of pulseox tape if OG and if NG we put tegaderm and then opsite.

When securing UVC/UAC lines, what do you use?

Plain old plastic tape in a bridge...although if it is a bigger kid and needs to be on the belly more for oxygenation issues, etc we will lay them flat on the belly and use opsite.

What do you use to remove tape and other things stuck to your patient?

We use detatchol very sparingly. There is some substance in it that the VLBW kids can absorb. Once we use it we wash the area well.

Here are some web sites showing tape/dressings I'm familair with as well as one showing some hydrocolloid tape which looks fascinating to me. Anyone familair with it?

Just wondering what kinds of tape/adhesives your NICU uses and what you use them for.

For example, how do you secure ET tubes?

My last hospital had specially manufactured ET tube holders which were great. My new place uses benzoin then applies silk tape. I really don't like not being able to see the tube well and the potential for displacing the tube too much when having to withdraw it after an x-ray shows its too low...

Does anyone place clear occlusive dressings or another product on the baby's face before placing the tape on it? Does that seem to help?

Also, what do you use to secure OG/NG tubes?

My last hospital used clear occlusive dressings or pink tape (Hy-Tape) and they both worked very well. My new place uses silk tape for everything and the babies constantly pull the tubes out, sometimes multiple times each day. (How awful for them that we must reinsert them so often! My last hopsital had the type of tubes that could stay in place for 7 days before having to be changed... they were made of a special type of plastic. Sure was nice for the babies!) I really loved using the clear occlusive dressings but I don't think they'd work so great at my new place since we change our OG tubes every 24 hours as a policy. (I'd sure like to get that changed... do you know of any manufacturers who make OG tubes that can be left in place longer than 24 hours? It's been 3 years since I worked at my previous NICU but I'm thinking about calling them and asking them the brand they use and if they are still using the longer term tubes.)

When securing UVC/UAC lines, what do you use?

My last hospital used either pink tape bridges we made ourselves, or these wonderful manufactured bridges made with a duoderm-type substance touching the skin and a clear two-sided piece that we could see through and could be pulled apart and reclosed when we needed to do so. Oh how I loved them!!!!

What do you use to remove tape and other things stuck to your patient?

My previous hospital had some things packaged like alcohol preps that we used only when we had to. I don't remember their name but they smelled almost like gasoline or something. My new place has these little ampules (like triple dye ampules) called "detachohol" or something like that but I've not used it yet. Has anyone ever used mineral oil or olive oil? I can't remember where but I remember hearing of it being used... Sounds incredibly natural, doesn't it?

Any suggestions you have for the best tape for securing things yet being the most skin and baby friendly would be greatly appreciated! I'm all about learning the best way to do things and sharing them with my co-workers. Experience and evidence-based knowledge are at the top of my list for learning the best ways to care for our little patients. Thanks in advance for any posts you make to this thread!!!

Here are some web sites showing tape/dressings I'm familair with as well as one showing some hydrocolloid tape which looks fascinating to me. Anyone familair with it?

We have used the hydrocolloid tapes on the SIMV sensors on our vents and for NGs, but it expensive and we only get it if the rep happens by.