How to deal with Nasal CPAP

  1. 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 miserable. I was trying my hardest to get him comfortable, keep his nose for breaking down anymore, and keep his pressures up. He wouldn't tolerate any other position than prone which just kept squishing his nose on the mask.
    He was a 31 weeker who HATED to be touched. It just seemed like a struggle all day long to keep him comfortable and properly maintained.

    Any advice would be wonderful!

    Heather
    •  
  2. 36 Comments

  3. by   Sleepyeyes
    oopsie, wrong button... :imbar:
    Last edit by Sleepyeyes on Jul 19, '02
  4. by   dawngloves
    Sometimes we use the covers that go over the nose, likr the adults have. But they have leaks sometimes and the alarm is always going off.
    Yeah, I have the CPAP. They are crabby and have a piggy nose.
  5. by   prmenrs
    Hard to problem solve w/o actually seeing the kid, but..

    Suction his nose, and apply hydro cortisone cream to his nares and upper lip.

    Swaddling--tight!

    You can try putting him prone if you use a wedge and tucker sling and slide him up to the top of the wedge. I've used stuffed toys to rest his head so that there is a space between the top of the wedge and the toy for the cpap device.

    Prop a pacifier in; cut off one side of it to accomodate the cpap. If you usse the "wee thumbies" from children's medical ventures, the bottom part slides right around the cpap thing, and actually helps hold it in place.

    Try holding him for a few minutes to comfort him--mom can do that, too. Keep him as vertical as possible against your chest. Hum--it's supposed to be comforting.

    He may be trying to tell you that he's ready for Nasal cannula--you could try that w/ hi-flow (~250-500cc/min) NC for the pressure, if necessary.

    That's all I can come up w/on the spur of the momment. Could try some tylenol, too, might help him rest.
  6. by   prmenrs
    I used to feel like you, Dawn, but, I've gradually converted--I am now a big believer in intubation and respirator as a last resort. Non-invasive respiratory support is better for the baby than baro-trauma. Plastic surgery vs chronic lung disease? I've seen too many bronchopulmonary dysplasia kids--they're even MORE miserable for MUCH longer than CPAP nose. And they die.

    That being pontificated, , it's up to us to make them as comfortable as possible will having their nose rearranged.
  7. by   Heather333
    Thank prmenrs!

    Did the suctioning, hydrocortisone, pacifier, the works......
    Everytime I would turn any other way than prone, he would drop his sats. I think he needed the pressure on his chest when his was prone. Had some decent substernal and intercostal retractions. He was only on 22% O2, he just needed the PEEP. Gave him some Ativan to chill him out so he wouldn't fight so hard.

    I'm really new at this but I guess as time goes on, it will get better.

    Thanks for the advice
  8. by   prmenrs
    You may be new, but you're doing some great problem-solving!!
  9. by   Heather333
    Thanks.

    It's scary at first, but the more I do it, the better it gets. I ABSOLUTELY LOVE MY JOB. It's very rewarding.

    Heather
  10. by   KRVRN
    Wow, we only allow ativan if they are intubated on a rate high enough that we're not close to extubation in the next 12 hrs or so.

    Regarding CPAP, we also do proning, tight swaddling, and pacifiers. Also maybe be careful when moving the baby when the CPAP is in... Sometimes the tubing is situated such that when moving the baby the tubing doesn't move appropriately with the baby and kind of "drags" or presses the prongs across the nose. (if that makes any sense...) That can further hurt an already sore nose.
  11. by   KRVRN
    As Prmenrs said, we also sometimes put an inconsolable baby on high flow NC. We go as high as 1 or 2L flow. I've been told 2L can give as much as 2 or 3 PEEP.
  12. by   prmenrs
    I'd recommend Tylenol before ativan, but at least we're making the effort to do something. They can be held, too.
  13. by   karenelizabeth
    One we have ruled out rising or high co2 levels.

    We ofren alternate between nasal mask and prongs can help a bit.

    Also tried low flow if only for 1-2 hrs to give the nose a rest this is especially nice if baby Kangarooed by Mum at same time.

    Kangarooing on its own can sometimes help as can what I've heard discribed as "facilitated tucking" ie Supporting babies in in-utero position with hands on head and bottem and legs.

    As a last resort I had seen and used mild sedation on a very old premi with very chromic lung disease.
    Last edit by karenelizabeth on Jul 16, '02
  14. by   NICUNURSE
    Heather 333, looking back, how do you feel about being a new grad RN in the NICU. I just graduated an am about to embark on the same journey and am getting a little anxious. If anyone has any advice for a new RN in the NICU, it would be greaty appreiciated.

close