UACs and tegaderm use

[NICU_Nurse_3986]

I am a new NICU nurse, and I have a concern about a current practice at my hospital. We do not cover our UACs and UVCs with tegaderms. Instead we leave them open to the air and just tape the catheter above the insertion site to prevent unintentional removal. Does this sound like an unsafe practice to anyone else? I mean in the adult world they try to keep all central lines as sterile as possible. I was always taught they were covered with tegaderms and had sterile dressing changes. Why should a UAC be any different? It seems like we are putting our babies at risk for an infection. What are the current practices at other hospitals? And does anyone have any research to support or disprove my concerns? I would appreciate any help. Thank you.

[texas2007, BSN, RN]

We tape our UAC's to the abdomen with tegaderm but not the area right at the opening. If anything, the tegaderm is used to just secure it from coming out. I think the reasoning behind not doing so is that the belly button stub dries out and becomes kinda like a scab. I can see your concern but I don't think it's necessary to cover the actual insertion site. We do do all of our central line changes (PICC, UAC, UVC, Broviac etc) sterile, which has really made a dent in our catheter infection rate.

[elizabells, BSN, RN]

We don't cover either, just bridge. Our cardiacs often come back from the OR with tegaderm over the stump itself, and if you don't get it off soon enough the stump gets really gooey and stinky. I feel like that's worse than letting it dry out. Our CLABSI rate is really, really low. We run our UVC fluids sterile...ly, like a PICC, but not the UACs.

[Mimi2RN, ASN, RN]

We used to use bridges, but now tegaderm only over a coiled loop of the lines. Never over the umbilicus, as others have said, it wouldn't dry.

[NANSNURSE]

Same here. Every NICU I have ever worked in just does the bridge with the loops to prevent pulling out, but never cover the insertion site.

[kitty29]

We tape our UAC's to the abdomen with tegaderm but not the area right at the opening. If anything, the tegaderm is used to just secure it from coming out. I think the reasoning behind not doing so is that the belly button stub dries out and becomes kinda like a scab. I can see your concern but I don't think it's necessary to cover the actual insertion site. We do do all of our central line changes (PICC, UAC, UVC, Broviac etc) sterile, which has really made a dent in our catheter infection rate.

Same here...you don't cover the stump.

[MegNeoNurse]

I thought it was strange at first as well that the umbilicus is left open to air in our unit as well, per policy. We place duoderm on each side of the stump to protect the skin, secure the UAC on one side with a stress loop and tegaderm over, then UVC on the other side in the same fashion.

Now I can't imagine putting anything over the insertion site. Although the catheters are generally sutured in place, putting tegaderm on top of the stump, esp. with a UAC, and needing to change the dressing runs the risk of pulling the UAC back or out, and that would be NO BUENO.

[Sweeper933]

Same here. Every NICU I have ever worked in just does the bridge with the loops to prevent pulling out, but never cover the insertion site.

Same here

[NicuGal, MSN, RN]

Yuk...we don't cover the stumps...I hate when even a little piece of it gets caught under there....

[PICNICRN, BSN, RN]

Tegaderm secures the cath- same as those who use the bridge method- never cover the stump... you want that dry! If you cover it with the tegaderm, it could get moist and "the yuckies" will grow! EEEEWWWW

[ilstu99]

No...no covering. The stump dries, and the access spots kind of shrivel around the lines. Nature's little Tegaderm. We don't even bridge, or tape the lines down. We put tape around the line, and suture that.

[NICU_babyRN, BSN, RN]

Never cover the stump! Not only does gross stuff grow under that tegaderm if you cover the stump, but it also prevents the stump from drying and with that, the catheter can actually migrate in and/or out of the umbilicus!!!!