2012 OPEN FORUM Abstracts
DOES THE RAM CANNULA REDUCE THE NEED FOR INTERMITTENT INTERVENTION TO PROVIDE CPAP TO THE PREMATURE INFANT?
Matt McNally, Scott Slogic; Respiratory Care, Dartmouth Hitchcock Medical Center, Lebanon, NH
Background: In 2011 our intensive care nursery made the decision to transition to the RAM cannula as the primary interface for non-invasive ventilation on neonates. The anticipated benefits of these prongs were that they would be easier to manage device than our previous prongs, the Hudson prongs. In addition to bench testing the device, we also surveyed the number of times that the patient needed to be intervened with due to prongs being misplaced with the Hudson prongs versus with the RAM cannula. The proposed benefits of fewer interventions may include fewer opportunities to break the hand hygiene chain, loss of FRC, skin breakdown and neural developmental care of the infant. Methods: Nurses and Respiratory Therapists working in the Intensive Care Nursery kept track of how many times that they had to intervene with a patient on nasal CPAP. An intervention was defined as intentionally adjusting the prongs to assess the nares as per standard on the unit every 4 hours or because the prongs were misplaced. Totals were collected in twenty four hour periods. Results: The average number of interventions for the Hudson prong group was 12.08 (n 13, SD 7.9) in twenty four hours. The average number of interventions for the RAM cannula was 6.89(n 57, SD 3.26). Conclusion: Maintaining the RAM cannula in optimal position is easier than with the Hudson prongs, resulting in forty seven percent fewer interventions in a twenty four hour period. The benefits of these prongs may include maintenance of FRC, fewer opportunities for infection, less skin breakdown due to misplaced prongs and neural-developmental benefits from fewer noxious stimuli of prong misplacement and readjustment. The main limitation of this observation was the small number of days on Hudson prongs versus the RAM. Sponsored Research - None