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Wound Care inSpecial Populations: PediatricsTucson Nurses Week ConferenceMay 16, 2014Victoria Beall RN, BSN, CWOCN
Newborn Skin Functions Microbiome Skin Barrier.
The Uniqueness ofNeonatal Skin
Stratum CorneumPremature2-3 layersFull Term: 10-20layers :30% thinnerthan adults for thefirst year of lifeAdult: 10-20 layersVisscher M. Update on the use of topical agents in neonates. 2009 .Newborn and Infant Reviews
Touch: the first sense to developDiallo A., Newman K., McGrath J. Helping families understand the importance of their infant’ s skin. 2010.Newborn & Infant Nursing Reviews.
Skin CareGoals: Preventiatrogenic injury Avoid potentialtoxins fromtopical agents Reduce exposureto sensitizingagents Promote normalskin developmentAssociation of Women’ s Health, Obstetric and Neonatal Nurses, AWHONN (2007) Neonatal skin care: Evidence -basedclinical practice guidelines (2nd ed.)
Most Common Pediatric Wounds Epidermal strippingExtravasation injuriesSurgical wounds (open/incision)Incontinence-associated dermatitisChemical and thermal injuriesPressure ulcersBaharestani M., An overview of neonatal and pediatric wound care knowledge and considerations. 2007.Ostomy Wound Management.
Iatrogenic InjuryAn injury inducedinadvertently by aphysician or surgeon ormedical treatment ordiagnostic procedures.Merriam-Webster Online Medical Dictionary 2013
Hospitalized ChildrenImad I., Murphy T., Nylander-Hosholder L., Ranft A. A new approach to management of intravenous infiltration in pediatricpatients. Journal of Infusion Nursing 2011.Visscher M., Recent advances in diaper dermatitis: etiology and treatment. 2009 Pediatric Health.Baharestani M., Ratliff C., Pressure ulcers in neonates and children: an NPUAP white paper. 2008 Advances in Skin &Wound Care.
Identified Problems Treatment: traditions vs. EBP Unreported alterations of skin integrity Lacking or absent:– Standardized care– Protocols– Clinical guidelines/algorithms
Our Process for Problem Solving Multidisciplinary task forcesKnowledge & evidence action Product evaluation Algorithm, protocol & work placereminders Promote EBP staff development
Guidelines, Best Practices & Resources
Product Evaluation
Pressure Ulcers
Who is at risk for P.U. ?
Diaper Dermatitis
Who is at risk?
Prevention
Diaper Dermatitis AlgorithmAlgorithm courtesy of Diamond Children’ s at the University of Arizona.
Peripheral Intravenous (PIV)Therapy
Infiltration ComplicationBaharestani M. An overview of neonatal and pediatric wound care knowledge and considerations.(2007)Ostomy, Wound Management.
Neonatal Extravasation
Who is at risk forextravasation injury?.
Early Detection Rapid TreatmentAlgorithm courtesy of Diamond Children’ s at the University of Arizona. Algorithm adapted from: Sawatzky-Dickson andcolleagues , Neonatal intravenous extravasation injuries:: evaluation of a wound care protocol. 2006 Neonatal Network
Pediatric Wound Care Clean the wound Protect the wound & surrounding skin Facilitate atraumatic dressing removal and applicationthat do not require frequent changes Commonly used products:– Silicone dressings and silicone adhesive removers– Transparent films and liquid barrier films– Hydrogels (sheets and aqueous gel)– Hydrocolloid dressingsBaharestani M. An overview of neonatal and pediatric wound care knowledge and considerations. 2007.Ostomy Wound Management.
Promote EBP & Safety Culture Nurse, physician & pharmacistinservice Unit-skin care teams/champions Mini root cause analysis withfeedback to staff
SummaryMake it:Easyto understandEasyto rememberEasyto practice
References Association of Women’s Health, Obstetric and NeonatalNurses, AWHONN 2007 Neonatal skin care: Evidence -basedclinical practice guidelines (2nd ed.)Baharestani M., An overview of neonatal and pediatric woundcare knowledge and considerations. 2007. OstomyWoundManagement.Baharestani M., Ratliff C., Pressure ulcers in neonates andchildren: an NPUAP white paper. 2008 Advances in Skin &Wound Care.Diallo A., Newman K., McGrath J. Helping familiesunderstand the importance of their infant’s skin. 2010.Newborn & Infant Nursing Reviews.Imad I., Murphy T., Nylander-Hosholder L., Ranft A. A newapproach to management of intravenous infiltration inpediatric patients. 2011. Journal of Infusion NursingMerriam-Webster Online Medical Dictionary 2013Sawatzky-Dickson and colleagues , Neonatal intravenousextravasation injuries: evaluation of a wound care protocol.2006 Neonatal NetworkVisscher M., Recent advances in diaper dermatitis: etiologyand treatment. 2009 Pediatric Health.Visscher M. Update on the use of topical agents in neonates.2009 .Newborn and Infant Reviews
Merriam-Webster Online Medical Dictionary 2013 Sawatzky-Dickson and colleagues , Neonatal intravenous extravasation injuries: evaluation of a wound care protocol. 2006 Neonatal Network Visscher M., Recent advances in diaper d
