Hi -

as you know , most bacteremia in NICU related to staph.epidermidis , which lives on baby skin and of course improper hygienic measures at time of invasive procedure lead to to such a complications.

what i want to know : 1st - do we have to cover the catheterized umbilicus or leav it to air ? is there any study adressing the difference in colonization and infection between two practices (cover or donr cover ) .

2nd question : what is the daily care to uvc ?  clean or wipe with N/S - Alcohol or bethidine ? 

 

any information

 

thanks  

Hi Aymen,

We do not cover the umbi site. I have checked w/ a few others who have experience in other parts of the country & they agree that the practice is to not cover. This allows for monitoring of site & insertion depth. 

Our practice is to secure down loops of the catheter onto the abdomen w/ Tegaderm (op-site). After prepping the skin & then washing off the prep w/ sterile saline, you will be securing & covering the extra catheter onto very clean skin. No daily care is needed. We cut a small half circle out of the Tegaderm to allow it to sit very close to to the umbi without going over the site.

Regards, Gayle

@Aymen Eshene We do not cover the umbilicus at all either. We stitch the catheter with a suture that is resorbable (Vicryl) and make a bridge with tape (like Steristrip) to secure it. I am not aware of research into this area. We do not clean the catheter, just leave it as is for the (few) days we keep it.

@gayle omansky The securing technique you use seems very interesting to me - would you be able to share photos? 

Stefan,

Sure thing, I will look for photos for you. We moved from bridges such as yours to the op-site/ Tegaderm method a while ago. We feel it is very safe & allows for more confident handling/ holding by parents because the securing does not get caught in blankets.

i will get back to you soon,

gayle

Stefan,

Here are a couple of pics using our SimBaby illustrating securing a catheter down to the abdomen. We also suture first (not in pic), & decided on 2 loops because we had traditionally secured 2 loops into our bridge. It seems to work best to have the tail coming out the bottom to the side. This keeps the catheter away from fingers & legs. We also try to catch as much of the catheter at the umbi as possible for safety. If both UA & UVCs we use a bigger op-site looping each a little to the side.

Some folks use a skin protectant product such as Duo Derm in addition. The caution with this method is that the Duo Derm holds moisture against the skin which is exaggerated when covered by the op-site, & this has revealed problems when removed. 

We find the op-site adheres well as long as it is put onto dry skin. It has not caused damage when removed as long as we use the "stretching to break the adhesive" method.

I hope this is clear enough. I can get over to the Sim Lab this week for more pics if need be & apologize for the missing cap in the line set up.

Best, Gayle

@gayle omansky Thanks for posting pictures, they are very illustrating, and the whole set up looks clearly better than our "tape bridge" method. Do you use the Tegaderm for all infants regardless of gestational age  / BW?

Stefan, 

Good point, we use the Tegaderm for all our babies > 27-28 weeks. We still use bridges for under that age.

We use a premade product called umbilical catheter anchor, which is foam & adhesive. Because it is very adhesive we trim down the "legs" that go on the baby's abdomen & use thin strips of the Duo Derm under the legs. It is all watched carefully because of fungal infection issues under the Duo Derm & skin damage when removing.

What we do here is open the cord as well, but we tied it with no 1 or 2 silk (which is kind of rough, so it would not move). Without any stitches, just tied it firmly it.. We made flags to stick and stitch the silks, without bridge.. Just a small tape to fix it at abdominal wall.. It works all along.. [emoji4]