How to deal with Nasal CPAP - page 2

I am wondering how ya'll deal with a kid on NCPAP. I am a GN an just started working in NICU a couple of weeks ago. Are all kids on NCPAP so crabby? The little one I had yesterday was just... Read More

  1. by   Heather333
    I feel very comfortable as a new grad in the NICU. I have a wonderful preceptor and very supportive staff. Also, out neonatologist is a great teacher and enjoys new grad.

    Now that I have been in NICU, I can't imagine doing anything else.
  2. by   NicuGal
    I despise CPAP, but at least they aren't on the vent! We nest and swaddle, give a pacifier with glucose on it. We don't sedate our kids on CPAP, we will beg to change to a high flow cannula and then PD/C them to keep them open! We have gone as high as 2 1/2 L! Also...we sink an og to keep their tummy from getting full of air. If they are feeding we close it for about an hour and then vent it. Also, put some duodurm on their septum and upper lip...it helps keep the prongs in place and helps cut down rubbing
  3. by   dawngloves
    NICU gal, what is PD/C? Thanks! And yes, it is better than a vent.But man! Those long termers can yell!
  4. by   NicuGal
    Postural Drainage and Clapping We also will do vibrating
  5. by   chrispy
    We use a ncpap driver and yes we get the pig nose syndrome as well. But it is the lesser of two evils.

    Your dammed if you do and dammed if you dont.

    chrispy nicu nurse from Darwin NT (Australia.)
  6. by   nell
    We don't give Tylenol to kids less than 2 months because of liver immmaturity. Also no sedatives unless intubated. We use Lidocaine gel lightly in their nares - I notice no ne else suggested this - is there a reason we shouldn't be using it that I don't know about???
  7. by   karenelizabeth
    it was Cpap on a long prong I hated the most the babies allways seemed to be trying to get away from it and ended up lying like bananas.

    Thank god for those little nasal masks and short prongs we only use a long prong infrequently now
  8. by   Brownbetty
    I am a new RN in the NICU and had a patient today on CPAP. I must say she was fighting that tube all day. She was getting Versed. Anyone use that?
  9. by   dawngloves
    Haven't seen it used for CPAP, yet.
  10. by   VBallKris
    A few people mentioned placing the baby prone, but our NICU no longer accepts that in our policy, due to babies getting necrotic nasal septums. When the baby is prone they are morelikely to have the CPAP nasal prongs press their nasal septum and cause pressure which increases the chances of necrosis of the nasal septum. We have a policy to now only let the babies lie supine and the respiratory therapists must check the nasal septum every two hours. I definitely recommend swaddling the baby tight and using a pacifier.
  11. by   lovemyjob
    We also switch back and forth b/t prongs and the nose cover thing... cant think of what it is calld.
    Also, I thought that pignoses were a result of the prongs being placed wrong. We really dont have too much of a problem with breakdown. I really think it has a lot to do with the fact that we dont use the prongs all of the time. The kids really seem to like the cover better.
  12. by   Gompers
    I'm wondering if the units that still use CPAP have started using Vapotherm or Fisher Paykal's high flow heated humidified nasal cannulas? We haven't used CPAP at all since we got these cannulas and even the micropreemies are tolerating extubation. They're actually doing better because there is less nasal secretions with the cannulas, so less suctioning, and also because the cannula stays taped to their faces, they don't have that "down time" like they do when you're doing CPAP care and switching between masks/prongs. I remember when we used CPAP we had the long prongs and had to suction Q4-6H. Those few minutes were horrible - babies desatting, bradying, etc. Not to mention their swollen, bloody nasal passages! It's been shocking how much better our babies are doing on these cannulas and we're successfully extubating much earlier than we were before. Have your units trialed these systems yet?
  13. by   RainDreamer
    Quote from Gompers
    I'm wondering if the units that still use CPAP have started using Vapotherm or Fisher Paykal's high flow heated humidified nasal cannulas? We haven't used CPAP at all since we got these cannulas and even the micropreemies are tolerating extubation. They're actually doing better because there is less nasal secretions with the cannulas, so less suctioning, and also because the cannula stays taped to their faces, they don't have that "down time" like they do when you're doing CPAP care and switching between masks/prongs. I remember when we used CPAP we had the long prongs and had to suction Q4-6H. Those few minutes were horrible - babies desatting, bradying, etc. Not to mention their swollen, bloody nasal passages! It's been shocking how much better our babies are doing on these cannulas and we're successfully extubating much earlier than we were before. Have your units trialed these systems yet?
    Are we the only place that doesn't use the Vapotherm or Fisher Paykal? I have never even heard of those except on this forum. I wonder why we don't use those. We do have heated humidified nasal cannula, but I don't think it's the same as what you're describing?

    We do wean aggressively as tolerated and extubate as early as we can. I would love it if we were able to just put them on a high flow NC like you describe, because the CPAP is so hard on their nose, but what if they need the extra back-up rate that the CPAP can provide?

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