SKIN ASSESSMENT - IN IN THE HE NEWBORN INF INFANT August, D L - - PowerPoint PPT Presentation

▶
skin assessment
SMART_READER_LITE
LIVE PREVIEW

SKIN ASSESSMENT - IN IN THE HE NEWBORN INF INFANT August, D L - - PowerPoint PPT Presentation

Apr 18, 2023 212 likes •549 views

SKIN ASSESSMENT - IN IN THE HE NEWBORN INF INFANT August, D L PhD Ca Candid idate NNCA CA, October 2016 Th The Townsvi vill lle Hosp spit ital l and Healt lth Se Servic vice 1 ACKNOWLEDGMENTS Patients/Families, Neonatal Unit

slide-1
SLIDE 1

IN IN THE HE NEWBORN INF INFANT

SKIN ASSESSMENT -

1

August, D L PhD Ca Candid idate NNCA CA, October 2016 Th The Townsvi vill lle Hosp spit ital l and Healt lth Se Servic vice

slide-2
SLIDE 2

2

FUNDING

  • Mona Kendall Association
  • Parker Health Care & Australian College of Neonatal Nurses
  • The Townsville Research Trust Fund
  • Graduate Research School of James Cook University

Karen New, Robin Ray, Yoga Kandasamy & Liza Edmonds Patients/Families, Neonatal Unit Staff, Health & Wellbeing Service Group

ACKNOWLEDGMENTS

slide-3
SLIDE 3

Perip ipheral l in intr travenous catheter inse sertion & se securement with ithin in Australia ian & Ne New Zeala land neonatal l unit its: s: a a cr cross-sectional l su survey.

Red Envelope or Registration Desk :

Your name & & Phone number Pri rize drawn 28 28th

th of

f October.

slide-4
SLIDE 4

4

Objectives

Neonate/newb

  • rn outcomes

Measurements

  • f skin health
slide-5
SLIDE 5

5

THE GOAL

slide-6
SLIDE 6
slide-7
SLIDE 7

HEALTH, FUNCTIONALITY & MATURITY

7

Evaluate

Kidneys Lungs Heart

Minute/Tidal volumes Oxygenation Heart rate, Perfusion

Echocardiogram, Electrocardiogram

Visual assessment Trans Epidermal Water Loss, pH

Skin

Creatinine Urine output

slide-8
SLIDE 8

EVALUATION OF HEALTH

8

Visual assessment TEWL-Trans Epidermal Water Loss

Skin

TEWL Hey, Wu, Farnroff (1970) Rutter and Hull (1979)

  • g/m2 of water loss various gestational ages
  • 4hours, 4 days, 3 weeks of life
  • 18 anatomical sites
  • Abdomen highest water loss <30 weeks
  • Thermoregulation & volume of fluid losses

Harpin & Rutter (1983), Kalia et al. (1998)

  • TEWL, term ≤ adult  mature

Lund & Kuller (1997)

  • Tape removal sites
  •  TEWL (pectin & plastic)
slide-9
SLIDE 9

EVALUATION OF HEALTH

9

Visual assessment TEWL & More

Skin

Skin health Hoeger et al. (2002)

  • pH, skin desquamation, stratum corneum hydration,

surface texture (n=202, term)

  • 3 day, 4 weeks, 12 weeks , 4 anatomical sites
  • Differences in skin apparent in first 3 months

Nikolovski & Stamatas (2008)

  • 124 infants (3-12 months)
  • water holding properties & transport differed

Fluhr et al. (2010)

  • Doppler measure for perfusion
  • TEWL term ≠ preterm ≠ < 25 weeks
  • < 25 weeks (longer development)
  • (2014) electron microscope
  • Low surface acid  stratum corneum cohesion
slide-10
SLIDE 10

10

Visual assessment

Skin

TEWL, pH

Lund et al. (1986)

Intact Dry/flaky Reddened Excoriated

Lund et al. (2001, 2004) NSCS – Neonatal Skin Condition Score

Dryness- 1- normal, no dry skin 2- dry skin, visible scaling 3- very dry, cracking/fissures Erythema- 1- no erythema 2- visible erythema < 50% of body surface 3- visible erythema > 50% of body surface Breakdown/excoriation 1- none evident 2- small localized areas 3- extensive

Perfect score = 3, worst score =9 68.7%-85.4% (intrarater) and 65.9%- 89% (interrater)

slide-11
SLIDE 11

11

Visual assessment

Skin

TEWL Vi Visscher M. . A Practic ical l Meth thod for

  • r Ra

Rapid Measurement of

  • f Skin

Skin Con Condit

  • ition. Newborn and

and Inf Infant Nurs ursing Revie iews. . 12// 12//2014;14(4):147-152. 152.

slide-12
SLIDE 12

12

SKIN INTEGRITY INTERVENTIONS

Moisture Agents Humidity Prevention

  • f harm

Cleansing

slide-13
SLIDE 13

13

SKIN INTEGRITY INTERVENTIONS

Moisture Agents

Oils Emollients

  • Low alcohol %
  •  Povidone-

iodine

  • Chlorhexdine

(antimicrobial)

  •  Contact time

Cleansing

  • ‘Gentle’
  • Odorless/colorless
  • Amount

Lund et al. (2001)

Prospective evaluation of skin care bundle &

  • utcomes
  • No increased rates of infection

Conner et al. (2003)- Cochrane Review

Ointment & Emollients for preterm skin

  • Aquaphor and Eucerin
  • Paraffin - TEWL
  • Skin conditions improved (TEWL)
  • Coagulase Negative Staph increased

Darmstadt et al. (2005)

Aquaphor  Sunflower seed oil

  • Nosocomial infection

Bangladesh

Cooke (2011)

Infant Massage & Oil for skin care

  • (2014) Protocol for trial >37 weeks

UK

Danby et al. (2013)

Olive oil  Sunflower seed oil

  • Adults, 4 weeks
  • TEWL loss = tape stripping
  •  Stratum C. thickness

UK

Salam et al. (2015) RCT Nangia et al. (2015) RCT Coconut oil and control for colonization

  • 751gm- 1499g
  • TEWL, skin swabs, skin condition score

without  infection Pakistan India

slide-14
SLIDE 14

14

SKIN INTEGRITY INTERVENTIONS

Moisture Agents

Emollients

<30 weeks 60-80 %

Humidity

Prevention of harm

Cleansing

Length of Time Example Text

Wean day 7 & stop at day14 Born <25 weeks keep 4 weeks

slide-15
SLIDE 15

Iatrogenic

Pressure Epidermal Stripping Dermatitis Burn Extravasation Delivery/Birth Injuries

Dermatologic

Collodion Infection Scalded Skin Genetic Epidermolysis bullosa Benign Erythema Toxicum

slide-16
SLIDE 16

16

Frequency & Severity

slide-17
SLIDE 17

DEPTH REDNESS

slide-18
SLIDE 18

Skin Injuries

Pressure Epidermal Stripping Dermatitis Burn Extravasation Delivery/Birth Injuries

SKIN INJURIES

slide-19
SLIDE 19

Skin Injuries

Pressure Epidermal Stripping Dermatitis Burn Extravasation Delivery/Birth Injuries

SKIN INJURIES DERMATITIS BURNS

slide-20
SLIDE 20

Skin Injuries

Pressure Epidermal Stripping Dermatitis Burn Extravasation Delivery/Birth Injuries

slide-21
SLIDE 21

21

OUTCOMES

Walk lker et t al.

  • l. (2

(2009) n= 43, extremely preterm infants n= 44, matched term controls Follow up at 11 years 20 mild scaring 11 Moderate procedural investigation 12 Scars from surgery Differences in thermal sensitively but not mechanical sensitivity Li Li et t al.

  • l. (2

(2015) n=11 13.9 ± 4.6 years (born 25.6 ± 1.6 weeks) Nasal deformities:

  • Nostril asymmetry
  • Collumellar asymmetry (septum)
  • Nasal tip deviation
  • Airway obstruction
slide-22
SLIDE 22

Nasal Prongs vs. Masks & role of layers

22

Yon

  • ng (200

(2005) n=89 (28.7 ±2.3- 29.7 ± 2.5 weeks) n=12/41 (29%) mask n= 17/48 (35%) prongs

  • Length of time of CPAP

(adjusted odds ratio 1.04; 95% Cl 1.01- 1.07; p = 0.003)

  • No statistical

difference between gestational age or use

  • f mask/ prongs

Fi Fischer (200 (2005) n=420/989 Pressure Ulcer Advisory Panel Staging- 3 stages (stage 4 not used)

  • Born < 1500grams (OR

2.28, 95% CI 1.43 to 3.64)

  • Nasal CPAP was used >

5 days (OR 5.36, 95% CI 3.82 to 7.52)

  • Unit was >14 days (OR

1.67, 95% CI 1.22 to 2.28) Günlemez (2014) n= 179 n= 87 Silicone gel n= 92 control Injury control– 13 (14.9%) Injury gel- 4 (4.3%) Necrosis higher in control Bleeding Crusting Excoriated Necrosis Collins (2014) n= 132 (<32 weeks) n= 67 HHF + whiskers n= 65 NCPAP n= 32 whiskers n= 33 cannualaide 0-Normal 1-Pink/ red 2- bleeding/ulcer/scab 3-skin tear

  • HHF + whiskers= less

injury in 7 days post extubation

  • No difference in

trauma scores

  • Trauma score 2.8 (SD

5.7) or 11.7 (SD 12.5), p <0.001

  • Wiskers 14.4 (SD

12.5) or Cannualaide 9.5 (SD 7.3), p=0.006 Newman (201 (2014) n=78 (<1500 gm) n= 35, mask n= 21, prong n= 22, rotation NSCS- Lund (2004)

  • Rotation group had

best skin scores

  • Risks included days on

CPAP (p<0.001)

  • Current gestational

age (p=0.006)

slide-23
SLIDE 23

Fischer et al. (2010)

Janata et al. (2010)

slide-24
SLIDE 24

Doll Dollis ison an and Bec Beckstr trand 1995 1995 Case control- pectin vs. adhesive 4/20 R pectin vs. 13/20 R tape 3/20 E tape 20 neonates (28-33 weeks) I- intact/moist D- dry R- red intact E- excoriated

Lund et al 1986

Lu Lund et al al. 1997 1997 Control site vs. 3 adhesives: plastic, pectin, gel Pectin and plastic significantly worse measurements 30 neonates (26- 40 weeks) Irritation/Stripping scales +TDWL and colorimeter measurements

slide-25
SLIDE 25

DEPTH REDNESS

slide-26
SLIDE 26

26

NEONATAL SKIN AUDIT 2010-2012

slide-27
SLIDE 27

27

Neonatal Skin audit cohort 2 years: 247 patients

Inju Injuries occ

  • ccurred

n= n= 77 77 (10 (107 inj njurie ies) St Stage 1 n= n=32 St Stage 2 n= n= 41 41 St Stage 3 n= n= 15 15 St Stage 4 n= n= 3 St Strippin ing n= n= 16 16

No injury occurred n=170

n=24 Vascular catheters n=19 Airway devices n=18 Temperature & saturation probes n= 34 Unknown

Mean birth weight : 1155g 1155g (r (range e 445-2678g, SD SD 620g) g) Gestation: 28 28 wee eeks (r (range 22-41 weeks, SD D 4.1 .1)

slide-28
SLIDE 28

PROSPECTIVE (DAILY REPORTS OVER 9 MONTHS)

28

Birth weight & Gestational Age Observational

1960 g

(60 600-4460g)

32 32 weeks (23 (23- 41. 41.4) Media ian 32 32 [28 28- 36] 36] wee eeks

46.1 .1% 39 39 In Injuries 33.9 .9%

115

Injury Information

Multiple Injury Rate

slide-29
SLIDE 29

PILOT OUTCOMES

29

Weeks of

  • f Age

1st Week 2nd Week Older Stages 1-4 16 2 9 Stripping 6 4 1 2nd Injury 9 2 7

slide-30
SLIDE 30

3

https://catatoniccomic.wordpress.com/tag/cartoon/

Skin Assessment for measureable

  • utcomes
slide-31
SLIDE 31

31

OUTCOMES

slide-32
SLIDE 32