CPAP and septal necrosis

Gompers, BSN, RN · May 11, 2005

We trialed one of those systems. I liked it because it has a pressure valve that lets the baby exhale through its nose without having to fight against the CPAP flow. We use Vapotherm now, which is wonderful.

When we used the system with the hat and all those straps...we did alternate between the prongs and the mask. Partly to prevent breakdown, and partly to prevent "pig noses" for babies. Basically, every time we did hands-on care of the babies (Q4-6H), we'd switch between the mask and the prongs. Worked very well.

dawngloves, BSN, RN · May 11, 2005

The manufacturer, whose name escapes me at the moment,now reccomends rotating between prongs and masks. It's a real PITA and I don't see how it'll make a difference.

I wish we would use VT more often, but our chief says no way for babies under 1k.

sparkyRN · May 11, 2005

We rotate between the prongs and the mask. Generally, we like the mask better because of the decrease chance of septal breakdown. One of my pet peeves is babies wearing a NCPAP cap that is too small. The hat then rides back on the head and the nurse tightens all the straps up to get a good seal. This in turn causes too much pressure on the nose and ears and breakdown results. :crying2: Make sure your baby has the right size hat and prongs. Once they start growing, babies can outgrow their equipment pretty quickly.

fergus51 · May 11, 2005

I am really anal about this since the hospital I trained in was. We had to rotate between prongs and mask every 3-4h and at that time, we also gave blow by O2 and did a little massage to give them a break. This was required and had to be documented along with vital signs. I have to second Sparky's comment about proper fit too! My biggest pet peeve is seeing a baby hanging by their cpap. The hat should run just above the eyebrows and the straps should not be so tight that your kid gets fish face. If the nurse needs to exert that kind of pressure to get a good peep, something is wrong with the fit.

melissah · May 12, 2005

Thanks to everyone for responding so quickly! Today I went to work and was surprised to find a rep scheduled to meet with me about a new CPAP system that we may be trialling! It is brand new (released for use about one month ago) and so far we are the first institution in Michigan to take a look at it! (This never happens to us!) Anyways, it is called neopap and combines traditional CPAP with Vapotherm humidification. The prongs and mask are the most soft and pliable that I have ever seen. Also, there is no need to create a super tight fit in order to maintain a seal. The machine automatically adjusts flow to maintain pressure if an infant opens thier mouth :). We were so happy to see this machine, and at just the right time. Makes you wonder who gave the rep the heads up! If anyone is thinking about new CPAP machines I would encourge them to take a look at this one. Other bonuses: an attached flow meter for your bag, a battery (one hour reserve) for transports, and it fits on an IV pole. Thanks again for all of your help.

dawngloves, BSN, RN · May 13, 2005

I saw this last month. Isn't it fabulous?!! But our hospital won't spend the $$. :angryfire

SarasotaRN2b · Jun 3, 2005

I saw this last month. Isn't it fabulous?!! But our hospital won't spend the $$. :angryfire

I mean when you consider the cost of a day for a baby in the NICU and the cost of a machine that might lessen the stay, wouldn't it make sense to spend the dough.

I'm not sure about the particulars of the cost, but if you weigh it against just a day less of each baby...it's got to be better financially...wouldn't you say?

Kris

melissah · Jun 4, 2005

It's not only reduction in NICU costs, but reduction in morbidity-- less PICU admissions. Average length of stay decrease, from what I found in the research, is 10 days!!!

NICUpremie · Dec 21, 2010

Recently my institution started to use more CPAP (We are still stuck in the days of intubating everyone). We also switched our prongs from nasal-pharyngeal that had to be taped, to the nasal cannula with the full head gear (Yeah!). While the nurses like these we have had some breakdown despite using nutra-skin on the septum. I have heard that many units switch between the prongs and a mask. Do you do this??? If so does it work well? If you use only the prongs, how do you prevent breakdown? I would really appriciate some advice. Thanks!

As a veteran NICU nurse , I understand your frustration in preventing skin breakdown (nasal necrosis) and also keeping CPAP in place. In the NICU where I work, we also experience the same problems but recently we employed this product called Septal-H. Its a nasal septum saver and a CPAP holder. The beauty of this product is it works with all kinds of CPAP system, including alternating prongs and mask (Bi-Phasic). I am glad to share that since using this product, it significantly reduced nasal injury and made us all very happy in delivering a more satisfying care to our babies, making parents very happy too! I believe the product is available in the market and check their website for more info (http://www.lqproduct.com). I strongly recommend this product!!! :)

Best of luck.