2005 OPEN FORUM Abstracts
THE SAFETY OF INOMAX NITRIC OXIDE DELIVERED THROUGH A NEONATAL TRACHEOSTOMY MASK.
Steven T. Polston RRT, Norton Healthcare inc., Kosair Childrens Hospital ,Louisville Kentucky.
BACKGROUND: A patient in our neonatal intensive care unit became a long term user of INOmax nitric oxide. After a prolonged stay the patient was weaning from the ventilator but was unable to wean from the INOmax. The physicians plan was to eventually complete the ventilator wean, go to supplemental O2 and humidity by tracheotomy collar, and move the patient to our in-unit long term care area. An INOvent had never been used outside of acute care. The nursing staff of the long term care area asked what, if any, exposure they might have to the gas. The care given in this specialty unit involves more handling of the patients than the acute area.
METHOD: A Fisher/Paykel MR730 heater with a MR290 chamber was set up the INOvent injector on the dry side. Patient inspired gas was supplied by a blender/flowmeter and set to 40%. 5 PPM INOmax was use for the test. A single limb heated wire 22mm tube was adapted for the INOvent sample line and a tracheotomy mask was placed on the end. The mask was placed on a baby mannequin to simulate a patient. Oxygen (O2), nitrogen dioxide (NO2), and nitric oxide (NO) concentrations were measured using the INOvent sample line. Measurements were made with the mannequin in the two major positions patient and caregiver would interact: on its back in bed and held in the caregivers' arms. The mannequin was put on a flat surface and measurements were made from the tracheotomy to points that define two half spheres with a radius of 6 inches and 24 inches. Measurements were also made on the flat surface below the tracheotomy (an offset of 3 inches) to the same radii. While the mannequin was held in the crook of and arm, measurements were made at the holders' nose and the mannequin's umbilicus. This was 12 inches and 6 inches from the tracheotomy mask
RESULTS: With the mannequin on a flat surface, measurements at the mask were 40% O2, 0 ppm NO2, and 4.6 ppm NO. At both 6 and 24 inches the measurements were 21% O2, 0 ppm NO2, and 0 ppm NO. Below the mannequin on the surface itself the measurements were 34% O2, 0 ppm NO2, and 3.4 ppm. At 6 inches the measurements were 27% O2, 0 ppm NO2, and 1.7 ppm NO. At 24 inches they were 21% O2, 0 ppm NO2, and 0.1 ppm NO. While the mannequin was held, the mask measured 40% O2, 0 ppm NO2, and 4.6 NO. At the caregivers' nose and the mannequins' umbilicus the measurements were 21% O2, 0ppm NO2, and 0 ppm NO.
CONCLUSIONS: Even though NO was detectable across the flat surface it was not detectable at 6, 12 and 24 inches from the source. This defines a large area around the patient that poses little risk to caregivers and shows where action can be taken to improve dissipation of the NO. Room air exchange rates provide good dilution of excess gas but can be hampered by obstructions such as bed linen. Use of INOmax gas and the INOvent shouldn't be a barrier to the interaction babies need for proper development.