The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts


Marlene Riggle, April Fields, Crystal Greene; Respiratory Care, Saint Joseph Hospital, Lexington, KY

The major driving influence behind the increasing use of Noninvasive Positive Pressure Ventilation (NPPV) has been to avoid the complications of invasive ventilation. Overall, NPPV is very safe, however it is not without potential complications, including necrosis of the skin. Pressure sores on the face are unique. Typically for all other pressure wounds the treatment and goal is to remove the pressure (i.e.: keep heels off bed, etc.) During NPPV the pressure exerted on the patient's face from the standard interface impairs capillary blood flow causing injury to the skin on the nasal bridge. Facial pressure sores were not included in the hospital wide skin care/wound care algorithm. A study was conducted to evaluate skin breakdown during NPPV use. The baseline data was collected randomly throughout the NPPV patient population with forty patients observed. A skin injury was observed in nineteen patients (48%). Prevention of skin break down was key. Documentation and pressure ulcer scoring guidelines were reviewed with an updated NPPV flow sheet implemented to reflect this documentation. Wound care consult documentation was added to the revised flow sheet. The therapists would assess the skin integrity on the cheeks and the bridge of the nose and document staging according to guidelines in the staging key located at the bottom of the NPPV flow sheet. If skin break down was noted, the therapist would enter a wound care team consult located on the hospital intranet and note the consult request at the top of the flow sheet. Pressure ulcers were treated with a silver antimicrobial wound gel along with a barrier pad to the bridge of the nasal area of the NPPV mask. It was observed that after the cushion barrier was placed on the mask, break down was only seen minimally with rare occurences of redness. The implementation of the new process made respiratory therapists, nurses and the wound care team aware of the pressure ulcers caused by long term NPPV use. The treatment and wound care consults have resulted in meeting our goal of improving or eliminating these hospital acquired pressure ulcers during consistent or long term NPPV use.
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