elee

With significant transepidermal water loss due to poor skin integrity of 22-23 week gestation, I was wonder if there is any ideas to: 1) secure line access (when tegaderm /occusive dressing does not adhere)? We currently use tegaderm to secure UAC/UVC line along with PICC lines/PIV. But with tegaderm not adhering the first few days of life, difficulty in securing PICC lines. UAC/UVC we can secure in pace with tighter suture. 2) have anyone have experience with No-Sting and if so recommendations and experience? Since the company does not recommend its use. 3) any measures to decrease transepidermal water loss besides: keeping humidified isolette closed. Thanks Edward Lee, MD Winchester Medical Center NICU Winchester, Virginia

In preparation form potential Covid+ or PUI in the delivery and NICU setting, viral filters are suggested while using self inflated resuscitators, NIV (high flow cannula, NIPPV, bubble CPAP, SiPAP, CPAP), and ventilators. Pediatric Viral filters are on back order and we have only adult viral filters of various specs depending on manufacturer (min 200 ml VT or > 125 ml VT for others). The representatives for Drager have stated that many are using their ventilators at the expiratory limb at the exhalation valve which we can do in the Bunnel Jet ventilator. We are awaiting feedback from Sensormedics for Oscillator. We are going to like going to a tent set up if patient is on High flow, bCPAP and SiPAP unless can of the distinguished colleagues can help in determining if there is another work around or experience with using adult viral filter for the NIV. We are planning on placing respiratory supported patient in negative pressure room with full PPE but if there is limitations in space and if overwhelmed will need to place in regular patient room in isolette (single bed rooms unless overwhelmed will cluster.) The second issue is adaption of neonatal self inflator bags or T-piece resuscitator for adult viral filter and is there any experience adapting this. Thanks for any assistance. Edward Lee, MD Winchester Medical Center, NICU Winchester, VA, USA