- Dab (do not rub!) with alcohol prior to blood drawing and injections.
-Lubricate all tubes that come into contact with the patient.
- Never apply tape of any kind to the skin. It may be helpful to use strips of Mepitac or Mepiform (Molnlycke Health Care) to secure the IV cannulae or monitoring devices. If tape or another adhesive accidentally finds its way to the skin, saturate it with Vaseline, mineral or baby oil and gently soak off.
- If blood pressure cuffs must be used, apply gauze underneath cuff to disperse pressure caused by edges of the cuff.
- Mepilex Transfer may be used beneath pulse oximetry pads.
- Hydrogel dressings (Vigilon) may be used beneath electrodes or Mepilex Transfer may be used to secure electrodes.
- Soak off any bandage, dressing or other product which may be stuck to the skin or to a wound.
Any questions regarding this material may be directed
to the DebRA office at
212-868-1573
Please note that all medical information given by DebRA is for informational purposes only, and is not intended to substitute the care and guidance given by a qualified physician. Always consult with physician prior to starting any treatment regimens. DebRA does not endorse any products or treatments
1. General Measures: Avoid any friction or shear forces to skin. Move by lifting (not sliding), on to the OR bed. Cut off adhesive portion of EKG leads and pulse oximeter probes. Secure leads, probes etc. with webril/gauze. Always use gloves that are slippery (with Vaseline or hydrocortisone cream) prior to handling patient. BP cuff is OK with webril padding underneath.
2. Intravenous Lines: Peripheral IV’s can be secured with a wrap only, no tape. Note: tape can be used to secure the IV lines to the gauze / webril wrap, just not directly to the skin. Remember to pad the tourniquet if one is used.
3. No tape or adhesives on skin!!
4. Eye Care: EB can involve the corneal epithelium. Drying or abrasion can result in corneal bullae. On speaking with ophthalmology, ophthalmic ointment is recommended for G/A or deep sedation. Eyes can not be taped shut, so please be careful to avoid accidental corneal contact. Also, if “blow by” oxygen is used, avoid having it blow across eyes as this may cause excessive drying.
5. Airway management: If at all possible avoid intraoral manipulation. Many patients have been done under deep IV sedation (propofol + ketamine) for minor but lengthy cases such as fecal disimpaction. If mask ventilation is required, lubricate mask with Vaseline or hydrocortisone cream. Do not use an oral airway unless absolutely necessary. Avoid pressure with fingertips on mandible.
If intubation is required, to help avoid intraoral bullae, lubricate the ETT and the laryngoscope blade prior to use (water based lubricant) and use your most gentle technique. Downsize the ETT you plan to use by a half size. Once in place, secure with beard holder and place vasoline gauze under the straps to avoid skin contact. An LMA would probably be a bad alternative for airway management as the intraoral (vs. tracheal mucosa) is more likely to form bullae. Use caution with oral suctioning. Suction only if necessary and lubricate suction catheter prior to use.
Please refer to the section on Epidermolysis Bullosa from Katz and Steward’s Anesthesia and Uncommon Pediatric Diseases, 2nd edition, W.B. Saunders Publishing.
This protocol was developed by Dr. Robert Valley at the University of North Carolina at Chapel Hill. It was developed for the treatment of a particular patient. Please adapt these guidelines for the specific needs of your patient.
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