Commentary by Shannon Stone McCord

Securing tubes and lines is one of the great challenges in caring for pediatric patients. In infants and small children there is a loose bond between the dermis and epidermis. 1,2 This makes this population more susceptible to loss of skin integrity from removal of tape or dressings and from shear injuries created by children sliding down in the bed from a raised head position. A recent study by McLane 3 found that the pressure ulcer rate in children was relatively low, 0.4%, as compared to the rate of skin breakdown, 14.8%, thus further illustrating the problem of securing tube and lines in children. Problems that can result include loss of skin integrity and contact dermatitis, both of which can be painful. Additionally, infants and toddlers tend to pull at inanimate objects attached to their bodies. At this age, infants and toddlers cannot comprehend that pulling out the tube will hurt and lead to another invasive painful procedure, increased cost, and parental anxiety when the tube or line is replaced.

In this article, the authors discuss the use of a catheter-securement device (StatLock) to prevent dislodgement of the tube, loss of skin integrity, infection, and pain. Any product that can meet those criteria would be an appropriate product to evaluate. The product should be evaluated for the following qualities: availability of neonatal and pediatric sizes, type of adhesive, recommended wear time, availability in latex-free material, ease of use, and ability to effectively stabilize the tube. In addition, use of any device should include ongoing monitoring for evidence of contact dermatitis and loss of skin integrity. In the author's institution, she uses both vertical and horizontal tube holders (Hollister, Inc., Libertyville, Ill) to secure chest tubes and gastrostomy tubes with excellent results. These holders have a barrier wafer that adheres to and protects the skin and a plastic tab that wraps around the tube and is pulled tight to secure the tube in the appropriate position. Sometimes in infants, the wafer must be cut down slightly to avoid the umbilicus or other areas. A baby nipple can also be used to stabilize tubes in infants and children; a barrier wafer or hydrocolloid dressing is placed around the tube, and the baby nipple is cut up one side, placed around the tube, and taped to the barrier wafer or hydrocolloid dressing. 4 In addition, she uses stretchy bandages (Spandage, Medi-Tech International) or self-adhering wrap (Coflex, Andover Coated Products, Salisbury, Mass) to secure dressings, tubes, lines, and IV boards and to eliminate or reduce the use of tape in children.

In conclusion, more securement devices need to be designed with the size of infants and children in mind to reduce complications and safely secure tubes and lines in this population.

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