tub bathing in the NICU

Specialties NICU

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What are your guidelines for tub bathing premature infants? Do you tub bath babies requiring isolettes?

Specializes in Level II & III NICU, Mother-Baby Unit.

We occasionally give swaddled tub baths to our older babies who are in open bassinets and have healed umbilical cords. They are generally about ready to be discharged. We don't give tub baths to babies in isolettes because they are mainly in there because they need help with temperature control and bathing in a tub could be too much cold stress for them; they get good sponge baths if they can tolerate it. Sometimes we have big babies in isolettes simply because they have a uvc line but they still only get sponge baths because of their line...

please explain what a swaddled tub bath is how do you wash them if theyre swaddled in something?

Specializes in Level II & III NICU, Mother-Baby Unit.

I will try to post a link here to a video of a swaddled bath. Children's Medical Ventures is a wonderful company full of information and supplies to help give babies appropriate developmental care as they grow. The swaddled bath is a shining example. The video used to be on their web site but I couldn't find it quickly so I googled "swaddled bath" and it was the second item that came up and it is now on youtube. I highly recommend this company's products and their educational products for nurses as well!!! Can't say enough good things about them really. After bathing the tub needs to be cleaned very well and dried thoroughly to avoid bacteria growth and cleaned as well before bathing again just to be sure....

Hopefully this link will take yo to the video...

Specializes in L/D 4 yrs & Level 3 NICU 22 yrs.

We teach parents a swaddled tub bath for babies over 1800g and stable resp status with healed umbis and circ (if done). They are bathed under a radiant warmer and have to be at least 98.0 before a bath. Babies in incubators are bathed if they meet those criteria. We try to give baths Q 3 days as the workload allows! Also can't say enough good things about Children's Medical Ventures as well.

Specializes in NICU Level III.

I wish we did, especially with our older kids.

that is so great-wish I had known about that with my own babies at home!

Specializes in NICU.

We do swaddled baths in my unit, also, and after we give the parents a demo of one, they are then free to bathe their baby 2-3 times a week. My unit does not pay for the Tiny Tub from CMV and it really is too small for older chronics. We have 6-8 rectangular rubbermaid clear tubs and then purchase the mesh support separately ( I think from Target in their infant section for around $8.) These baths are so much less stressful for infants and such a pleasureable experience that we say the infant "is going to the preemie spa." We want them to enjoy baths, so if they are having a fretful day at home, the parent can soothe them with a swaddled bath. Another trick to pull out of their parenting bag. With the blanket around them containing them and the warm water, we're sure they feel like they've returned to the womb. One parent keeps them warm by pouring warm water on the blanket, and the other just uncovers the body part they are washing. We have infants who fall asleep in the tub! A sponge bath can be chilling and scary, esp when I see nurses giving them on a wobbly scale at bedside as the baby screams and gets mottled. I wouldn't enjoy this and neither do they. We initiate after 1900 grams which is about when they are weaning from or out of the isolette. We do not use an overhead heater. Baby is kept covered as he is undressed and then placed in the warm water. When it is time to remove him from the water, a warm blanket from our blanket warmer is placed on the parent's chest and he is lifted out to his/her chest, quickly covered with the nice warm blanket and patted dry in the security of the parent's arms. These baths can often be done with nary a peep from the infant. Be advised that if a swaddled bath is done before a nipple feeding, they can be so relaxed that they may not nipple well! I have bathed trached kiddos this way, and if the picc is in an extremity which a coworker will keep out of the water, it is still possible. I have worked in a unit where even an intubated older chronic received a swaddled bath, because it was so relaxing for him. You just need RT assistance to stablize the ET. Once you get used to doing baths this way, the only thing that takes longer is filling the tub. It is nice to do one when you can leave the baby in the water relaxing as the parents video, just because they look sooo peaceful and content. Lavendar baby wash adds to the spa feeling,too. :)

Specializes in NICU, Post-partum.

If an infant has an IV or a PICC line, they cannot be bathed in the tub.

We actually use our scales to bathe the bigger babies.

I prepare my water, fresh linens for the bed, and squeeze the water over the infants right into the bedding they are on. I do this as quickly as possible...removing all leads with adhesive remover before I start...our vent kids or super tee-tiny ones are never removed from the leads, so you just have to wring out a washcloth and do the best you can.

Once they are clean, I get them out with a dry towel and hold them while I get out the wet bedding, dry off the pad, and then replace with fresh bedding. I have a diaper laid out, put that on first, then new leads and then swaddle with warm blankets.

Our policy is that if a baby doesn't have a pre-bath temp of 98 or higher, they cannot be bathed.

Our Isolettes are Omnicells and have a feature to where we can blow more heat into the isolette during bathing, which also works to get the infant's temp back up.

Specializes in NICU, Infection Control.

I have used the bath basins that come on an adult "care kit" (w/the pitcher, cup, etc) to give baths. I like to do it on an open warmer, and have mom dry 'em off. Older premies really need it sometimes. I swaddle them and put a blanket in the "tub" to limit slippage.

To keep the bathtub clean, stick it inside a plastic trash bag. I still wash and disinfect it, but this way, I'm pretty sure that tub is clean when I put my customer in it.

Parents do love this, by the way, it's kind of a "graduation" of sorts. There are lots of videos out there of me giving premies tub baths.

Does anyone have a standard of care policy on developmental care in the NICU or Bathing in the NICU?

Specializes in ICN.

Like several others have said, we give swaddled bathes to even some ventilated babies as long as they are stable, Even with a PICC line, although most of the babies using the tiny tubs from CMV are over 30 weeks (I think). Our developmental specialist comes around to teach the parents this technique, as well as giving massages afterward with aquaphor and or doing Kangaroo holding. (we do kangaroo holding on vented and non vented babies.)

The smallest babies really seem to relax in the warm water with the swaddling cloth around them. The little tubs look like clear tupperware containers with a small cloth covered support for the baby to lie on. Of course, they are held so they don't slide and the parent or nurse only uncovers one limb at a time to wash, then recovering that section before moving on to the next limb.

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