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1. OBJECTIVES
2. MENINGOMYOCELE KIT SUPPLIES
3. TECHNIQUE
4. AUTHORS

OBJECTIVES:

• To protect an intact or ruptured lesion from sources of infection including airborne organisms & meconium, and reduce risk of mechanical trauma and drying.
  
  
• The lesion will be dressed using sterile technique (NON-LATEX gloves and mask) at time of delivery or by transport team.

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MENINGOMYOCELE KIT SUPPLIES:

• 2 rolls 2-1/4" Kerlix (or prepackaged sterilized Kerlix "donut" dressing)
• 1 8FR feeding tube
• 1 2X3" Telfa dressing
• 1 5 mL syringe
• 1 2X2" occlusive dressing
• 5 mL sterile normal saline
• 6" strip #6 Bandnet
• 1 steri drape
• sterile scissors
• 2 pair sterile NON-LATEX gloves

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TECHNIQUE

• Using sterile technique, place supplies on open sterile towel. If prepackaged sterilized Kerlix "donut" dressing is unavailable, unroll the 2-1/4" roll of Kerlix shaping it into a "donut", insuring the center hole will surround the lesion. Cut a 24" strip of Kerlix and reinforce the donut shape.
• Attach feeding tube to the Telfa using small occlusive dressing. Draw 5 mL of saline into syringe, attach to feeding tube, moisten Telfa pad with entire 5 mL saline.
• Place moistened Telfa pad over lesion.

• Place "donut" on the skin surrounding lesion to prevent pressure on the protruding sac.

• Cover dressing with a 4X4 piece of steri drape.

• Secure entire "donut" and occlusive dressing using a 6" piece of #6 Bandnet around infant's midsection.

• Cut and apply steri drape as far caudal to the sac as possible, but cephalad to the anus to keep expelled meconium from irritating lesion.

• Keep sterile dressing moist every 4 hours with 3-5 mL sterile saline via feeding tube port.
• No sterile linens needed in incubator, but sterile NON-LATEX gloves will be worn when entering portholes to handle infant and lesion.
• Cultures and antibiotic administration are unnecessary unless sepsis is suspected (surface culture of the lesion will be obtained at Children's Hospital and Regional Medical Center; then vancomycin and gentamicin will be given immediately preoperatively).
• Infant will be kept in the prone position at all times during delivery of care measures if possible.
• Patient restraint will be at the level of the axilla and thighs.
• Minimize Latex exposure by using non-latex pacifier and supplies.

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AUTHORS

• Patricia J. Jason, RN, BSN, Nurse Manager, Patient Transport
• Dennis E. Mayock, M.D., Medical Director, Patient Transport

For further information, please contact either of the above individuals through the Children' Hospital and Regional Medical Center paging operator at 206-526-2131.

DATE OF APPROVAL: March 1993
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