Toddle Wrap for Biopsies Excisions

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Slide 1 : Toddler Wrap for Abdominal Biopsy or Excision Valerie B. Lyon, M.D. & Christine M. Palmer Dept. of Dermatology, Medical College of Wisconsin, Milwaukee, WI Annette M. Wagner, M.D. Dept. of Pediatrics & Dermatology, Northwestern University’s Feinberg School of Medicine, Chicago, IL Bari B. Cunningham, M.D. Dept. of Pediatrics and Medicine (Dermatology), University of California, San Diego School of Medicine, San Diego, CA
Slide 2 : Abstract Young children, especially toddlers, are anxious and uncooperative during skin procedures. Wrapping a sheet or blanket around the child is an effective way to restrain the child to maintain a sterile field. The wrap can be used for skin biopsies and small excisions on the midsection of the body, arms, and legs.
Slide 3 : Introduction During skin biopsies and excisions (where only local anesthetic is used), it is common for young children to be anxious and uncooperative. The toddler stage is often the least cooperative age for procedures. Because they do not lie still, restraints are used. The restraints prevent the children from disrupting the surgeon and the sterile field. For abdominal procedures, we have found that wrapping a sheet or blanket around the child’s upper body (arms and shoulders) and another around his or her legs aids in restraining the child. A sheet or blanket is used because it is a familiar object to children, and it is less obtrusive than typical patient restraints. Similar wraps have been reported as useful1,2,3,4,5,6.
Slide 4 : Methods We wrap toddlers for abdominal biopsies and excisions with the following steps: 1.) Lay the sheet across the exam table with the long length perpendicular to length of the exam table. 2.) Lay the child on the sheet. 3.) Wrap one side of the sheet around one arm and then tuck the end of the sheet underneath the child’s torso (Figure 1). 4.) Wrap the other side of the sheet circumferentially around the child’s upper body (arms and shoulders) and then tuck the end underneath the child (Figure 2). 5.) Wrap a second sheet circumferentially around the child’s legs (Figure 3).
Slide 5 : Figure 1. Sheet wrapped around one arm and tucked underneath torso.
Slide 6 : Figure 2. Sheet wrapped circumferentially around upper body.
Slide 7 : Figure 3. Sheet wrapped circumferentially around upper body and legs.
Slide 8 : Methods continued Nurses or other assistants then hold the patient above and below the procedure site. Parents do not help hold the patient down but are encouraged to hold one of the patient’s hands for comfort and to offer emotional support and distraction. The wrap and assistants allow the surgeon’s hands to be free to perform the biopsies and excisions efficiently (Figure 4). We only use this wrap for biopsies or small excisions, however, because children this age are not able to tolerate procedures lasting longer than a few minutes.
Slide 9 : Figure 4. Surgeon performing abdominal biopsy while implementing toddler wrap.
Slide 10 : Methods continued The wrap described above can be adapted for skin biopsies and excisions anywhere on the midsection of the patient’s body. Also, one arm can be left out of the wrap for a procedure on the arm. The wrap can be modified for procedures on the legs as well, by simply wrapping the sheet circumferentially around the child’s waist and upper body (Figure 5). The assistants then firmly hold the extremity above and below the lesion for stabilization. The wrap can be easily adapted for infants without wrapping the arms separately.
Slide 11 : Figure 5. Toddler wrap for small excision of leg lesion.
Slide 12 : Video Demonstration of Wrap Technique toddler wrap 1.mov
Slide 13 : References 1. Cunningham B & Wagner A. Surgical Techniques. In L. Schachner & R. Hansen (Eds.), Pediatric Dermatology. 3rd ed. New York, NY: Mosby; 2003:191-192. 2. Raskin BI. A simple pediatric restraint. Cutis 2000;66(5): 335-336. 3. Wong DL. Pediatric Nursing. St. Louis, MO: CV Mosby; 1997:702-703. 4. Betz CL. Nursing Care of Children. 2nd ed. Philadelphia, PA: WB Saunders Co; 1994:827-828. 5. Leifer G. Principles and Techniques in Pediatric Nursing. 4th ed. Philadelphia, PA; WB Saunders Co; 1982:77-83. 6. Whitson BJ. The Pediatric Nursing Skills Manual. New York, NY; John Wiley & Sons; 1980:189-201.

 


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