Securing lines

From ShortGut - Wiki

Tips

• Securing the line is essential. Specific techniques are described under Recipes below.

• Children can have or develop allergies to dressing products, which can make them more likely to scratch at them and dislodge the line. A number of different dressing products are available, including:
  • tegaderm
  • sorbaview
  • opsite IV 3000 (this may be the most breathable, which helps to prevent the buildup of bacteria)
  • VenaSet: a new product being tested at the Mayo clinic and other centers as of an April 2008 post on the yahoo short bowel syndrome group. Made from the same material burn victims get treated with and supposed to be easier on the skin, more secure, and better for preventing infections.

• It helps to keep at least one secured layer of clothing between lines and grabby hands. Options include:
  • Onesies (and turtleneck onesies during the winter)
  • Onesy extenders, which add a few inches of length to the shirt
  • BandNet or X-span: These mesh netting products come in tubes of different diameters that can be cut at any length and worn over the torso (to make it harder for kids to access lines, g-tube, stoma bag), or the thigh (for femoral broviacs), etc.
  • Straps that you can attach to a regular t-shirt to keep it down (if you have trouble finding these, you can buy mattress sheet straps -- these are meant to keep the corners of sheets under the mattress, but work to keep shirts under the butt as well -- they are a piece of elastic with an old-fashioned slip hook on each end)
  • Body tights
  • Custom-cut spandex wraps (preferable to ace wraps, since those may sensitize kids to latex)

• See Products for additional options (clothing, tubing protection, etc.) that people have found helpful in dealing with lines.

Specific Recipes

• I have found that attaching a safety pin to the line and pinning it to the inside of the clothes really helps the strain on the CVL site and the G-tube site. My daughter is 10 months old and walking everywhere, I have also started pinning the G-tube to the outside of her clothes near her butt to keep her from stepping on it. Note of caution: Some parents don't encourage this technique because the safety pin might pierce something it shouldn't (see the next tip for a pin-less alternative), or because of what might happen if someone else tries to take off the shirt or if the child pulls too hard.

• Alternatively, make a loop not far from the end of the TPN tubing, and tape the loop so it stays. Then clip the loop, using a keychain clip, onto the child's shirt (less scary than safety pins).

• For a child who pulls at or plays with the line, some parents have found it useful to tape the line over the shoulder or up the back -- anywhere out of reach.

• Some parents have had good luck securing lines using statlocks or related products (e.g., the Bone? not quite sure what this is). Others have had better luck with a combination of tegaderm, tape, mesh vest, etc. (e.g., see next recipe)

• From the yahoo tpnsupport group for lines unused lines that hang out really far: Some people will sew a 'pocket' inside of undershirts and put the unused line in there. Another option is to get shoulder pads from the fabric store and some adhesive velcro dots and put them on the corners of the shoulder pad and fold it in half around the line. Then use a bulldog clamp on the pad to secure it to the child's clothing. No one ever touched it and it was really secure.

• Inspired from the two immediately abovementioned methods, we thread Bo's catheter up over the shoulder and secure the line to the shoulder of his tank-top style undershirt with a onesie extender wrapped around the line and the shoulder "strap." We also include a pink tape anchor as the line exits the dressing.

• MaxMunakata -- we wrap paper tape around the line several times and tape it down, followed by an extra piece of tape over the top, and have found that it holds up to lots of strong tugging. See here for pics of the procedure: BroviacTapeWrapProcedure.