I love my job, but....

  1. I have been in the NICU for going on 13 years now, and I absolutely love everything about my job, but....
    I HATE NASAL CPAP!!!!!!!!!!!!!
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  2. 11 Comments

  3. by   iceNICUnurse
    Quote from cswain12000
    I HATE NASAL CPAP!!!!!!!!!!!!!
    I really do agree with you....the babies hate it as well I think :angryfire
  4. by   dawngloves
    I hear ya! I'd rather have an intubated baby than CPAP. We've been using mask (when we have them )and the kiddos are still miserable! Scoot all over, cry and cry, set off the alarms.
  5. by   fergus51
    I don't think anyone does like CPAP. It was invented by the devil
  6. by   mermom
    Could you please elaborate for a preemie mom? I've often wondered why it is so miserable for the babies...I know the prongs are murder on their little noses, and they're always falling out and having to be repositioned, but what exactly is it that causes the babies to be so agitated? Many of my fellow preemie moms are always so excited when their babies graduate from vent to c-pap, but I thought it was brutal. That's why this thread really caught my attention. I find your opinions and experience very enlightening.

    Wen
    preemie mom and NICU nurse fan
  7. by   BittyBabyGrower
    I'm sure those prongs hurt! They wear off the septum of the nose, the inside of their poor little noses get raw and bleed and get swollen. It is a step forward, but a brutal step forward! I have been letting parents hold kids on CPAP for 30" off with a nasal cannula as long as they are stable. We have had to have so many plastics consults on kids noses in the past year :angryfire
  8. by   fergus51
    They are just uncomfortable mermom. We have found most babies noses will come out just fine if cared for properly (with tegasorb, massage, alternating mask and prongs and rest periods). The worst cases usually involve poorly fitting caps and prongs with no protection. And I HATE it when nurses seem to hang the baby from the CPAP in the isolettes.
  9. by   Gompers
    We use the C-pap that has the 2-4cm long prongs threaded down the nares, connected to vent tubing, taped like an ETT. Anyone know what I'm talking about? I don't even think they make it anymore!!! Our kiddo's noses get so swollen and gooky with these things, but at least there is no pressure or moisture on the nose, so we never have breakdown issues other than the irritation inside the nares themselves. We trialed the one with the bonnet and the soft, short prongs that you alternate with the soft nose mask - while the babies liked it, we had the hardest time keeping it on! I did love that there was the one-way valve so they were able to exhale against the flow.

    We're currently trialling two kinds that are basically nasal cannulas hooked up to warmed high humidity at up to 6 LPM flow. We've had a great response to these and they are sooooo easy to work with. You just need to make sure the cannula is taped really snug against the nares so that they get the full flow and it doesn't go blowing all over their faces. The only issue I have with it...6 LPM sure is LOUD! I wonder how they can sleep with such hissing all the time!!!
  10. by   crankyasanoldma
    I'm not in neo, but do agree about the CPAP. My son (6) has a pretty big hole in his septum from the CPAP. I took him to a plastic surgeon to see about correction and was advised against it as the hole is relatively high on the septum. The Doc said if the hole were lower he would recommend repair as the nose can collapse. He did offer me a silastic plug, but it needs to be removed and cleaned regularly (6 years old? ha).

    I guess I shouldn't gripe about a small cosmetic problem when we escaped the whole alphabet soup of potential problems, but it IS hard to keep his fingers out of that hole!!
  11. by   dawngloves
    Gompers, we're trialing Vapor Therm too. Do you have a problem with water shooting out the prongs and up the babies nose?
  12. by   Gompers
    Quote from dawngloves
    Gompers, we're trialing Vapor Therm too. Do you have a problem with water shooting out the prongs and up the babies nose?

    We're trialing the VapoTherm and a very similar set-up from Fisher Prikel (sp.) as well. We prefer the VapoTherm as the tubing is just like a larger nasal cannula setup (very long and flexible), while with the Fisher one the cannula is only like 2 feet long and then it attaches to short, thick vent tubing. (Of course, word has it we're buying the Fisher ones, go figure.)

    YES, once in awhile we have gotten a rush of water out of these cannulas. We've found a couple of solutions for this. First, we'll determine if the baby can tolerate a slower flow, as the faster the flow, the more humidity builds up. Second, we'll try to move the baby to a bedspace away from any air vents or drafts, as the cooler temperature in parts of the unit causes a lot more condensation inside that hot tubing. As a last resort, we'll decrease the temperature of the humidity, from 37 degrees to maybe 35. If the baby's temp is stable like this, it often does the trick and is still warmer than what the kids get from a regular cannula.
  13. by   dawngloves
    Thanks Gompers, I'll keep those in mind. I don't think we had it at less than 6L and the AC is so cold on the unit! Guess we'll have to play around some more.

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