2001 OPEN FORUM Abstracts
NASOPHARYNGEALPRONGS FOR INFANTS LESS THAN 2 KILOGRAMS, A DEVICE EVALUATION
Jodi Jackson,MD; Judy Vellucci, RN; Tom Rose, RRT; Howard Kilbride, MD Children?s Mercy Hospital, KansasCity, Missouri
Background: Binasal Nasopharyngeal(NP) prongs are often used for the delivery of nasal continuous positive airwaypressure (NCPAP). These types of prongs are inserted through the nares and nasalcavity and past the choana into the nasopharynx. An alternative method of providingNCPAP is with the use of nasal prongs, which are secured in the nares only.NP prongs offer some advantage over the nasal prongs in that the longer lengthallows the nasal anatomy to assist in the security of placement. Previously,NP prongs were only available in lengths of 4 cm and 9 cm. When inserted atfull length, these prongs would clearly be too long for small infants, and wouldpass the desired placement in the nasopharynx and deliver positive pressureto the esophagus. Attempts to secure these prongs at a length appropriate forinfant size resulted in cutting the prongs or leaving a section of the prongsoutside the nares. Recently, NP prongs have been developed specifically foruse in premature infants (Neotech Products, Inc), providing varying lengthsat the same unit cost as standard NP prongs. By providing a more appropriatelength for infant size, these prongs have less dead space to obstruct CPAP flow.The purpose of this report is to detail recent experience with the new ?premieNP prongs.?
Methods:Over a 4-month period, infants <2 kg were extubated to the standard 4cm NP prongs used in our nursery. Those infants perceived as having clinicalproblems on NCPAP were switched to the ?premie NP prongs?: length 2.5 cm, diameter2.5-3.0 mm depending on size of infant. Data were collected retrospectivelyconcerning number of apneas, carbon dioxide level, and feeding tolerance beforeand after the change in binasal prongs. During the 4-month period, questionnaireswere distributed to nursing and respiratory therapy personnel to assess comfortand satisfaction with the two types of binasal prongs, using a 1-10 rating scale.
Results: During this 4-monthperiod, 12 infants (weight 0.700-1.5 kg) were switched to the ?premie NP prongs?due to perceived less than optimal clinical status using the standard NP prongs.Four of the 12 infants had previously failed an attempt of extubation usingthe standard NP prongs. Within 24 hours, all 4 infants were successfully extubatedusing the ?premie NP prongs.? Of the remaining 8 patients, there was a trendfor less apneic episodes, lower carbon dioxide level, and better feeding toleranceon the ?premie NP prongs.? Caregiver satisfaction was significantly higher inthe 5 areas assessed: irritation (p<0.001), stability (p=0.05), patency (p<0.007),positioning (p<0.001), and comfort level (p=0.001). Under the comments sectionof the questionnaire, 12 of the 40 caregivers surveyed independently made statementsconcerning improved air movement and breath sounds on auscultation when usingthe ?premie NP prongs? compared to the standard NP prongs.
Conclusion: Nursing and respiratorycaregiver comfort level in caring for infants on NCPAP was improved with the?premie NP prongs.? In comparison to standard 4 cm NP prongs, ?premie NP prongs?were easier to position, were less irritating to the nose, and more easily secured.Moreover, 33% of the infants supported by NCPAP using the standard NP prongsfailed extubation, but went on to be successfully extubated when using the ?premieNP prongs.? All infants appeared clinically improved with properly positionedNP prongs. Proper sized prongs appear to improve clinical respiratory conditionand result in less NCPAP failure than standard length prongs. The unit costof the ?premie NP prongs? is the same as that of standard NP prongs, but itseems they are easier to use and provide improved support.