Iatrogenic skin injury in hospitalised babies is common. Most babies who are admitted to a Neonatal Intensive Care Unit require a peripheral intravenous catheter (PIVC) for fluids, medication and nutrition. PIVCs (drips) are placed inside a vein and are the most used device in unwell babies, with many babies requiring multiple drips.
Skin injuries are the most common iatrogenic injuries in hospitalised babies, which increases the risk of infection (local and systemic) and can lead to fluid and electrolyte imbalance and temperature instability. The skin injury can cause complications which prolong hospitalisation and can result in permanent scarring.
Following a traumatic event experienced by a baby, staff within the NICU unit at Waikato hospital engaged MWDesign to develop a product to reduce this type of harm.
The Pépi splint is designed to allow simple application and removal while providing rigid limb isolation, a gentle but firm skin grip without causing irritation to delicate skin. The Pépi splint secures the PIVC without direct adhesive contact to baby's skin. The Pépi splint is reusable, Ambidextrous in both hands and feet, can be sterilized in an autoclave, reducing unnecessary waste. The Pépi splint can be trimmed to suit baby's needs and 100% eliminates tape to skin contact.
There are approximately 60,000 births annually within New Zealand. Of these babies, 4,500 (8%) are born prematurely and 3,500 (6%) are born smaller than expected.
Reducing harm to those requiring health care is a global health priority.
New-born and premature babies often require intensive medical care which can encompass delivery of medications and fluids intravenously.
Veins often collapse, requiring the cannula to be changed (every 24 - 72 hrs). The tape that holds the tubing on will often remove up to 75% of the skin, de-laminating the skin exposing the baby to infection.
?In extreme cases the tiny fingers and toes have been known to be amputated during tape removal >5/year in New Zealand. It is this kind of event that triggered Waikato hospital NICU unit to contact MWDesign to begin design work to investigate and discover a potential solution to this very distressing problem.
?We collaborated with nursing staff, family, iwi and clinical specialists throughout the development, often trying the device on ourselves before testing in NICU.
?New mums (and dads) despair watching the procedure as their child screams with pain at the skin injury despite the nursing staff's best efforts to remove the tape, then reapply to another arm or leg. Our own MWDesgin staff member went through this exact scenario with their new son barley 6 months prior to stating this project. Having lived through the experience we were on board 100% from the outset.?
There were several important insights during the ideation phase.
#1 Primarily was that tape to nurses is like hammer and nails are to a carpenter
#2 A 24-week-old baby is so tiny, physical less size then a pound of butter. The skill to get a lure into a tiny vein in that tiny limb is not to be underestimated so retaining that lure in place is paramount
#3 There are so many invasive objects/ skills/ techniques being applied to save the baby's life that as a parent, you feel helpless. Anything that reduces harm is positively embraced
#4 Premature babies skin has a very different makeup to children and adults, specifically they don't sweet.
#5 versatility is key. No two children behave the same or have the same needs.
#6 100% of the time the current method causes harm through skin damage. At best causing potential secondary infection at worst accidental digit amputation.
The Pépi Splint is a soft and flexible silicone splint that allows the nurses to wrap the tape over the silicone tabs instead of directly onto the baby. The splint can be used for both left and right arms and feet.
The splint can be reserialised and reused until the baby grows out of that size or is discharged. Thus, reducing waste by reuse up to 5 months per splint
With a thin aluminum splint encased in the silicone, the splint can be bent into the appropriate angle needed for the baby. The splints come in three sizes for varying weights of premature babies and tab length can be trimmed to suit.
The Pépi splint currently in clinical trials at Waikato hospital NICU unit and Wellington hospital NICU unit with 0 skin injury's, 0 near misses with 100 % relieved parents.