For neonates what dressings would you avoid?

Hydrogels if they are in incubator setting

Alignate dressings d/t entering system and compromising bloodstream

What does IAD stand for in wound mgt.

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

IAD Treatment

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.

Candida albicans,

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^®]).

The recommended treatment protocol for Candida infection with skin denuding includes:

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

(MARSI)

medical adhesive-related skin injury

MARSI Treatment

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.

MARSI Prevention

The prevention of MARSI includes the preferred use of the following:

• 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.

Acrylic-based dressings

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

Hydrocolloid Dressings

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

Precautions

Avoid the following:

• 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

Intravenous Extravasation

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).

Common first signs of extravasation include

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

Extravasation Treatment

The initial steps for managing IV extravasation are as follows (Lippincott Williams & Wilkins, 2022; Tarpey, 2023):

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.

Antidotes can be administered either through the catheter or directly into the extravasation site with a small-gauge needle (e.g., tuberculin syringe). The choice of antidote and the application of cool/warm compresses is complex and dependent on the properties of the extravasated drug, with antidotes including (Tarpey et al., 2023):

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

After antidote administration and venous access removal:

• 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.

Extravasation Wound Treatment

To treat extravasation wounds:

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

Extravasation Prevention

The following strategies help prevent intravenous extravasation (Lund & Singh, 2022):

• 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.

In neonates and children, the _____ is the most common area for development of PIs (Caillouette & Quigley, 2020). Other high-risk areas include the ear and nose, with older children and adolescents having PI patterns more similar to those of adults (e.g., sacrum and heels).

occiput

Staging for PIs in neonates and children follows the National Pressure Injury Advisory Panel (NPIAP).

See image for all 4 stages

PI Treatment

The selection of products used for PI treatment in neonates and children must take into consideration the following:

• 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

PI Treatment

Commonly used commercial products include (Caillouette & Quigley, 2020):

• 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)

The ___ ____ is the preferred PI risk assessment tool for pediatric patients (Caillouette & Quigley, 2020).

Braden QD Scale

The Braden QD Scale assesses:

• 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.

Best practices in the prevention of PI in neonates and children include:

• 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

What is the FIRST step to take when IV extravasation is suspected?.

Elevate and immobilize the extremity

Disconnect the IV tubing

Stop infusing all medications and fluids

Remove the IV catheter

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.

Which intervention is recommended to prevent incontinence-associated dermatitis (IAD) in neonates?

Applying antiseptic creams

Daily application of talcum powder

Cleaning with isopropyl alcohol

Frequent diaper changes

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

Which dressing type is preferred for treating medical adhesive-related skin injuries (MARSI) in neonates?

Acrylic-based dressings

Silicone-based dressings

Silver-impregnated dressings

Medical grade honey

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.

Why is protein intake crucial for pediatric wound healing?

Enhances fluid balance

Aids in collagen synthesis

Increases vascularity

Promotes tissue repair

Promotes tissue repair

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

Why should products containing alcohol be avoided when treating neonatal wounds?

Increases wound drainage

Causes pH imbalance

Potential toxicity

Promotes epidermal thickening

Potential toxicity

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

Which treatment protocol is recommended for managing incontinence-associated dermatitis (IAD) complicated by Candida infection?

Antifungal powder, skin protectant, zinc oxide cream

Antifungal powder, zinc oxide cream, skin protectant

Zinc oxide cream, antifungal powder, skin protectant

Zinc oxide cream, skin protectant, antifungal powder

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.