The Use of a Silicone Dressing in the Prevention of Pressure Ulcer on the Nose with Children Treated with Non Invasive Ventilation

• Published in: Ostomy/wound management Vol. 58; no. 1; p. 1
• Main Author: Van Capellen, P
• Format: Journal Article
• Language: English
• Published: King of Prussia HMP Communications 01.01.2012
• Subjects: Children & youth; Intensive care; Pediatrics; Pressure ulcers; Wound healing
• ISSN: 2640-5237; 2640-5245

Non invasive ventilation (NIV) is typically used in the pediatric intensive care unit to avoid complications of invasive ventilation. This method uses a nasal- or naso-buccal mask attached with strings around the head of the child. The most common affected location in the development of pressure ulcers is on the bridge of the nose. These are often provoked by an incorrect application of the mask. To prevent this complication of NIV, we used a hydrocolloid dressing. The results with this dressing were not satisfying for two reasons. First of all it was impossible to check the covered skin without replacement of the hydrocolloid, this implicates that often pressure ulcers were only discovered during the dressing change; further, and also very important, these dressing changes are painful for the child. Because of these disappointing results, we had to search for another solution. The dressing we were searching for needed to help prevent pressure ulcers and had to give us the possibility to check on regular base the state of the skin of the nose (covered by the dressing) without traumatizing the child and stripping of the healthy skin. A soft advanced silicone dressing seemed a good replacement. The prophylactic use of a piece of a soft advanced silicone tape, on the full length of the nosebridge to all children treated with NIV was started. This silicone tape, used as dressing, can be lifted up and placed back without need for replacement. It allows the health care professional to do a skin check under the dressing on regular basis without hurting the child and stripping the healthy skin. It also gave them the opportunity to act more accurately according to the condition of the underlying skin. When redness was observed on the nose, a switch was made to a thicker silicone foam dressing (light version, 2 mm), which helped in prevention of pressure ulcer formation. This method was also chosen for children with a previous pressure ulcer scar. We noticed a significant reduction of pressure ulcer formation and appearance of redness on the nose, by using a thin silicone tape. This implicates a decrease in risk for development of a pressure ulcer. The use of a soft advanced silicone dressing, compared to the use of a hydrocolloid dressing, reduces significantly the number of pressure ulcers. This is because these dressings provide the optimal balance of the components necessary to significantly reduce the effects of pressure ulcer formation; redistribution of shear and friction, along with superior management of the microclimate between the dressing and the skin of the patient. It is also time saving for the caregiver and further more it also increases the comfort of the child. Further studies in this area are acquired.