The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

PREVENTION OF NASAL SKIN BREAKDOWN DURNING CPAP USE

Karen R. Morelock1, Carol Baraks1



Background: Neonatal patients requiring nasopharyngeal continuous positive airway pressure(CPAP)prongs may experience adverse effects with the use of the CPAP equipment. This study pursues techniqies to prevent the skin breakdown noted with the use of CPAP in neonates.

Symptoms of skin breakdown include erythema and irritation to local skin on the bridge and nasal septum, bloody nose, and necrotic or sever damage to the nares or septum, which may ultimately require plastic surgery.

This research study incorporated and evaluation and change in humidifcation, suctioning and positioning of the CPAP equipment in an effort to minimize skin breakdown.

Methods: Humidifcation: Changes in humidification and suction procedures were used to minimize adverse affects of CPAP, Temperature in the CPAP tubing was increased to be equivent to body temperature. Enviromental temps were contolled. Proper humidity with a light mist in the NCPAP tubing and without a moisture pool on the tubing was accomplished.

Suction: Deep suctioning practice was changed to as necressaty (PRN)to clear secretions, taking care not to suction vigorously. In order to reduce trama to the nasal passages the use of a nasal aspiratir was adopted and suction gauges were routinely dialed to a range of 80-100 mmHg pressure. Staff was educated on the alternative suction devices and suction pressure.

Positioning CPAP: Correctley sized nasal prongs and ventilator tubing were adjusted to alleviate pressure on the nasal septum, nares and upper lip. CPAP hats were tied to promote patient comfort and deliver of pressure. CPAP prongs were adjusted with a slight space between the prongs and the nose. Patients in isolettes/open warmers were positioned flat to minimize stress on the tubing. Adjustments for developmental needs and gastroesophogeal reflux were implemented. Patient were sedated only if inconsolable.

Results: No skin breaksown noted during the study except one case where protocol was not properly implemented.

Conclusion: Evaluation of data over 2 year period demonstrated a reduction in trauma to skin and nasal mucosa in infants treated with the NCPAP methods described.