neonatal skin - neocon2019 · the skin as an organ •largest organ of the body •appearance and...
TRANSCRIPT
Neonatal Skin
NEOCON Hyderabad 2019
Eszter Jozsa RN, IBCLC, CNE
The skin as an organ
• Largest organ of the body
• Appearance and condition provides information about
–nutritional status, hydration, tissue oxygenation, diseases and dysfunctions, gestational age and emotions
Physiology and structure
• Three morphologically different layers
Function of the skin
The immature skin
• pink-red, transparent, shiny
• visible veins close to the surface
• water retention and tissue edema due to
collagen instability
• thin epidermis, dermis, hypodermis
• density of Stratum Corneum
• fragility
• permeability
• adherence between dermis and epidermis
• minimal elastin and collagen fibres
• pH after birth
• potential for absorption of topical agents
Skin injuries of the neonates
• Trauma to the skin = serious consequences
• Promoting skin integrity is one of the most important aspect of care
– Minimise irritation
– Prevent skin breakdown and epidermal stripping
Concepts of securing devices
on neonatal skin
• Decide the best possible device to use
• Decide the best possible place
• Use the right adhesive tape
• Use correct application techniques
• Use appropriate removal techniques
• Use barriers between skin and tape
Interventions
• Assess the skin for color, perfusion,
appearance and temperature
Interventions
• Keep skin clean and dry
Interventions
• Use protective barrier between the skin and adhesive tape
Interventions
• Alternate electrode placement
Interventions
• Apply safe removal technique
Interventions
• Limit the use of chemicals on skin
• 15 seconds drying time after application of
cleaning solution
Interventions
• Maintain body temperature
Interventions
• Prevent extravasations
Interventions
• Deliver optimal CPAP and High Flow therapy
Interventions
• Preventing pressure damage
– Comfortable, but fitting hat
• Check ears
– Correct size interface
– Chin strap or dummy
– Correct size mask and prongs
– Correct position
Complications
Necrosis of the forehead Transection
Interventions
• Provide adequate nutrition
– Promotes wound healing.
– Enhances the maturation of the skin.
• Practice minimal handling
– Reduces the possibility of mechanical skin
trauma.
Interventions
• Minimal use of adhesive and tape– Assess the need for adhesive tape used
– Chose the appropriate adhesive tape
– Use sterile products and technique to decrease the risk of infection
– Appropriate taping technique reduces mechanical injuries
– Assess skin condition regularly
Common taping problems and
their prevention
• Tension mechanical injury
– Stretching or pulling the tape as applied
– Failing to reposition or replace tape as swelling
indicates
Common taping problems and
their prevention
• Non-tension mechanical injury
– Skin irritation due to incorrect tape applied
– Improper tape removal technique
Common taping problems and
their prevention
• Skin stripping
– Removal of the epidermis with adhesive tape
– Repeated application of tape over the same site
Common taping problems and
their prevention
• Chemical injury
– Irritating chemical entrapped between the skin
and the tape
Know your products!
Products used
• Comfeel Plus Transparent
– semi-permeable
– semi-transparent
– waterproof
– oxygen and water vapour permeable
– hydrocolloid adhesive
Products used
• Tegaderm
– water and bacteria proof
– transparent polyurethane film backing
– polyacrylate adhesive
– hypoallergenic
Products used
• Leukoplast elastic
– aggressive zinc oxide adhesive
– flexible tape
– residue after removal
Products used
• Durapore
– Bidirectional tear
– Hypoallergenic
– Latex free
– Silk-like cloth
– No-strech
– Solvent based adhesive
Products used
• Surgistrip
– polyamid backing
– polyacrylate adhesive
– sterile
Products used
• Cavilon
– breathable, transparent coating
– acrylate polymere
– pH7
Products used
• Melolite
– nylon coated
– absorbent
– non-adherent
Products used
• Mefix
– Skin friendly water based,
– Latex free
– Solvent free
– Polyacrylate adhesive
– Non-absorbent, non-woven fabric made of
spunlace polyester
– Water repellent
Products used
• Mepitec
– Silicon based, gentle adhesive
– Reusable for the same baby
– Conforms well to body contours
– Waterproof
– Breathable to prevent maceration of the skin
– Leaves no residues on the skin after it’s removed
Thank You
Any questions?