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Prevention
of Blister
Blister Care and
Prevention of Infection
Nutrition
Nurturing
Click
here for a PDF Document "Care of the New Baby with EB-Initial
Information"
by Jacqueline Denyer
Handle gently!
Avoid lifting babies or children from under the arms;
instead, place one hand beneath the bottom and another beneath the
head/neck to lift. A pillow, egg-crate (foam) pad or sheepskin may be used
beneath the baby to prevent friction against the skin while lifting and
holding.
Do not rub skin!
Since blisters can be caused by friction, the skin should
be patted rather than rubbed. Before blood tests or immunizations, the
area can be cleansed by gently pressing or patting the alcohol pad against
the skin.
Dress in loose-fitting clothes!
Clothing that rubs the skin may cause blisters. Avoid or alter
clothing with binding elastic. Avoid harsh buttons, snaps and zippers.
Non-binding diapers or cloth diapers may be used. Elastic may be cut from
the legs of disposable diapers to help minimize blistering.
Avoid excessive heat!
Overheating tends to increase skin fragility. Maintain a moderate
environmental temperature (including your car) and do not over-dress.
Do not use adhesives on the skin!
Tape or bandaids should not be applied to the skin because they
may cause blistering.
Lubricate the skin!
Aquaphor or Vaseline will help decrease friction.
Pad Bony Prominences!
Gauze sponges, secured by rolled gauze, may be used to pad
elbows, heels and knees if infant get blisters from kicking against the
sheet in the crib. Soft socks may be placed over lubricated hands and feet
to prevent blisters.
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Blister
Care and Prevention of Infection
Wash hands before administering skin care!
Hand washing is the most effective measure to control infection.
Do not remove clothing or dressings that are stuck to the skin!
Materials that are stuck to the skin should be soaked until they
can be removed easily. This can be done at bath time (in the tub) or by
applying room temperature water or a soaked compress directly to the
bandage.
Cleanse skin daily!
Skin may be cleaned with a very mild soap such as Dove.
Drain blisters!
Blisters tend to increase in size if they are allowed to remain
intact. For this reason, most blisters should be drained when they are
about the size of a dime or if they appear tense. Sterile needles or
lancets may be used to puncture the side of the blister roof. A tiny
pinhole may re-seal and allow the blister to refill, so take care to open
the blister roof adequately. The blister roof should be left intact to
facilitate healing and comfort. A mild antibiotic ointment may be applied
to the area to aid in the prevention of infection.
Apply topical antibiotics to lesion!
Mild, over-the-counter antibiotics (Polysporin, Bacitracin) are
effective in preventing infection and may be rotated every month or two to
discourage bacterial resistance. Bactroban, like all antibiotics, should be
used only when infection is present. (Signs of infection include increased
redness, swelling, pain and warmth). Prolonged
use of Bactroban has been associated with the development of resistant
Staph infections.
Apply non-adherent dressings!
After application of topical antibiotics, a non-stick dressing
such as Mepitel, Vaseline Gauze or Telfa should be applied to denuded or
unprotected areas. Next, rolled gauze is wrapped around the non-adherent
dressing and is then secured with a tubular dressing retainer. The
dressing retainer will prevent the occurrence of tape accidents.
Change dressing daily!
Daily dressing changes are recommended and can be co-ordinated
with a bath or cleansing of the skin. Some contact layer dressings, such
as Mepitel (Mölnlycke Health Care) may be left in place for several days,
although the secondary or outer dressing should be changed and the wound
assessed daily.
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Breast Feeding!
While “breast is best” for most babies, breast feeding presents a
special challenge for infants with EB. Infants with blisters and lesions
in the mouth may have difficulty nursing or sucking from a regular baby
bottle. Mothers may decide to provide expressed breast milk to their
infants. The Haberman feeder is a cleft palate nipple which incorporates a
valve that facilitates easy delivery of the formula without the need to
suck hard. This works well for babies with a fragile oral mucosa.
- Infant mouth care may include gentle cleansing with a spongy
toothette.
- A dry nipple will stick to lips and blistered areas, causing more
damage. You may moisten the nipple with water or Vaseline prior to
feeding.
Keep Growth Charts!
It is important to chart the growth of an infant/child with EB.
Such charts provide essential information for evaluating the adequacy of
the diet. A nutritionist should be consulted about the nutritional status
of an infant with EB if there are questions or concerns about weight gain.
Many infants with EB require fortified formula to meet their increased
caloric and protein needs.
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It is not unusual for nursing staff and parents to avoid handling a
baby with EB, with the hopes of minimizing blisters. Learning the correct
way to hold the baby will instill confidence in the caregivers and allow
the baby to receive the emotional support and closeness he/she needs.
It’s a good idea to use the crib as a "Safe Place". All
dressing changes and other unpleasant activities should be performed at
places other than the crib (for example, on the changing table). The
infant should learn to connect the crib with comfort.
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