SWM Module 22: Wound Care — Pediatric and Neonatal Considerations Flashcards

Vitamin C deficiency

* Vitamin C, along with vitamins B and D, is essential for collagen synthesis and cellular proliferation. A deficiency in vitamin C directly impairs collagen formation, which delays wound healing.

Primarily affects epithelialization, which helps close and cover a wound. While this delays wound closure, it does not directly impact collagen formation

Hinders overall tissue repair and cell growth, reducing the body’s ability to rebuild tissue. Although protein is important for wound healing, it is not specifically involved in collagen synthesis.

By restricting oxygen and nutrient delivery, which are necessary for all stages of wound healing, but it does not specifically interfere with collagen formation.

Hydrogels if they are in incubator setting

Alignate dressings d/t entering system and compromising bloodstream

Incontinence-associated dermatitis, or diaper dermatitis, has the highest incidence between 7 and 12 months of age (Lund & Singh, 2022).

Use a non-irritating, pH-balanced wipe/cleanser, or tepid tap water to clean the diaper area gently without causing further irritation (Lund & Singh, 2022). Then, apply a zinc oxide or petrolatum-based barrier cream to create a protective layer.

Keeping the damaged skin moist is essential to promoting healing, so do not fully remove the protective cream already applied. Remove only the layers contaminated with stool, and then generously reapply the cream.

a pathogenic yeast, presents as bright red areas of dermatitis with distinct boundaries and surrounding satellite lesions, typically involving the inguinal folds. Treatment for Candida infections requires an antifungal agent, such as nystatin or imidazoles (e.g., miconazole [Lotrimin^®]).

• Applying an antifungal powder
• Applying a skin protectant
• Applying zinc oxide cream

medical adhesive-related skin injury

To treat MARSI, gently clean the area with a pH-balanced cleanser and carefully dry it. Next, apply a silicone-based dressing (e.g., Mepitel^®), as it protects the wound without adhering to it and causes minimal tissue damage during removal.

• Silicone-Based Products Silicone-based products are gentler and safer for sensitive skin.
  • Sensi-Care™ Sting Free Adhesive Releaser does not leave a residue and quickly evaporates.
  • 3M™ Cavilon™ No Sting Barrier Film protects the skin from repeated adhesive removal.

Such as 3M™ Tegaderm™, may be required for a stronger adhesion for critical tubes and are an acceptable alternative to silicone-based products.

Such as DuoDERM^®, act as both an adhesive and barrier, allowing for better adherence to curved surfaces and moisture resistance.

• Liquid barrier film on infants less than 30 days old
• Alcohol-containing and organic-based adhesive due to potential for toxicity, especially to premature infants
• Tackifiers (e.g., tincture of benzoin) because of the strong bond with the epidermis can cause epidermal stripping

occurs when vesicant fluids leak into the surrounding soft tissue from a cannula or vein, leading to blistering, sloughing, and necrosis. Premature infants are at higher risk for more severe skin damage due to the immature skin, less subcutaneous tissue, and small size of their blood vessels (Bryant & Nix, 2024).

Swelling, redness or discoloration, pain, blanching, firmness, and coolness.

1. Stop infusing all medications and fluids through the venous access device. Do not flush.
2. Disconnect the IV tubing.
3. Do not remove the catheter or de-access the site.
4. Attempt to aspirate the vesicant with a 1 to 3 mL syringe.
5. Elevate and immobilize the affected extremity without applying pressure.
6. Notify the provider and obtain further orders (e.g., antidote administration); Follow institutional procedures for extravasation.

• Hyaluronidase (Hydase®)
• Nitroglycerin topical
• Phentolamine (Oraverse®)
• Sodium thiosulfate (Pedmark®)
• Terbutaline (Brethine®)

• Assess the site and outline the area of extravasation.
• Monitor frequently for the development of complications (e.g., blistering, infection, necrosis)
• Document in the patient EHR, including the estimated amount of vesicant infused and aspirated.
• Document within the institutional safety management system.

• Use moist wound healing principles.
• Use moisture-retentive dressings such as hydrocolloids or hydrogels.
• Avoid massaging or applying heat to the site.

• Monitor the IV site hourly.
• Apply a transparent dressing over the IV site.
• Avoid the use of a rigid arm board.
• Secure the arm board tape loosely and distal to the IV site.
• Dilute IV medications to reduce potential irritation.
• Administer dextrose solutions > 12.5% and calcium through central IV catheters only.

occiput

See image for all 4 stages

• Approval for use in neonates and children
• Age of the neonate or child
• Condition of the skin
• Potential for sensitization
• Absorption properties of the product

• Amorphous hydrogels
• Plain or silver hydrofiber dressings
• Thin hydrocolloids
• Medical-grade honey
• Silver-impregnated dressings, although there are concerns about toxicity
• Negative pressure wound therapy (NPWT)

Braden QD Scale

• Intensity and duration of pressure, including mobility and sensory perception.
• Tolerance of the skin and supporting structure, including friction and shear, nutritional status, tissue perfusion and oxygenation.
• Presence of medical devices, including the number of devices and their ability to be repositioned.

• Using pressure redistribution products (e.g., mattresses) specifically designed for neonates and children
• Frequently rotating pulse oximeter probes and blood pressure cuffs
• Repositioning endotracheal tubes
• Applying foam or gel layers between devices and skin
• Using moisture-wicking products around tubes and skin folds
• Ensuring tubing and cables are positioned away from the skin
• Performing a comprehensive nutritional assessment during admission
• Using pressure injury prevention bundles

Stop infusing all medications and fluids

*To prevent further tissue damage. You should NOT remove the IV catheter as it is needed for attempting aspiration of the vesicant and administering an antidote. Disconnecting the IV tubing is important, but it follows the cessation of infusion. Elevating and immobilizing the extremity is a later step aimed at reducing swelling.

Frequent diaper changes

*reduce skin moisture exposure, helping prevent incontinence-associated dermatitis. Talcum powder is not recommended for use in neonates. Topical antiseptics can delay wound healing. Isopropyl alcohol should be avoided on neonatal skin due to its potential for toxicity and irritation

Silicone-based dressings

* The treatment of MARSI includes applying a silicone-based dressing to protect the area such as Mepitel. Acrylic-based dressings are used to secure critical tubes. Silver-impregnated and medical grade honey dressings are used in neonatal and pediatric wound care but are not preferred for MARSI.

Promotes tissue repair

*Protein primarily supports tissue repair and cell growth for wound healing.

Potential toxicity

* Alcohol-containing products are potentially toxic to neonates, as their skin permeability allows higher absorption rates than in adults.

Antifungal powder, skin protectant, zinc oxide cream

The treatment protocol recommended for managing incontinence-associated dermatitis (IAD) complicated by Candida infection is antifungal powder, skin protectant, and zinc oxide cream.