Dealing with cpap machines and skin damage

[tinkerbell419]

ANyone here who has looked after a baby on nasal cpap who ended up getting skin and nasal damage. What are the main reasons why this happens. Im feeling rubbish about myself although the baby i looked after had abrasions under his nose before i looked after him but the nurse who took over from me say the skin is now really broken. I put a bit of vaseline on the skin but have been told to not use vaseline. Now im worrying that i had the mask and prong on too tight but i did provide nasal relief to the nose every 3-4 hours.

It worries me now to look after a cpap baby. I am worried that i will be blamed but i dont know at what point his skin started to break down. According to notes skin was noted to be abrased about 2-3 days before and baby doesnt like the prongs.

Is this a common problem with cpap babies?

[Baby Wrangler]

I think this is definitely a common problem! You shouldn't feel bad because sometimes it is not preventable. We had one baby that had such bad skin breakdown over the nose bridge that she had to be reintubated just to give her nose a break. Babies that are 23-24 weeks have really sensitive skin.

I find that it's really important to switch between the mask and prongs. Even if the baby doesn't like them (e.g. crying), unless they're really spelling or desating, it's good to give them at least a couple of hours off the mask. We also use special cpap cannulaide that we put over the pressure points. We tried using some foam stuff too we got off adult ICU but that can interfere with the seal sometimes.

It's also important to keep an eye on the breakdown and bring it up during rounds so that the team can address it otherwise it will just get worse.

[NicuGal, MSN, RN]

We put duoderm under the nose and on the septum. It also depends on the setup you use. We use the RAM cannula and it is easier on them.

Vaseline can break down the plastics of the prongs and make them stiff. Sometimes we put a little bacitracin inside the nose if there is breakdown from the prongs.

Now you know and will take some knowledge from it! Sometimes it happens, but you have to be on top if it from the start. Don't feel

bas!

[artisticmind]

Vaseline is also a petroleum-base which can not be used with any amount of oxygen as it is a fire hazard. With adult patients we used to take a mepilex foam and cut it in a Y-shape and place it on their face in an upside down position to protect the bridge and sides of their nose.

[Here.I.Stand, BSN, RN]

I'm not a NICU nurse, but even young adults with healthy skin can get pressure ulcers from BiPAP masks. We get them here and there at my work, and a friend's husband with severe OSA has gotten them from his home mask. I'm sure a preemie with very delicate skin would be at even higher risk.

Our RRTs have these gel pads for the nasal bridge to help with that. The Duoderm suggestion sounds like a good one, too. Like any other pressure ulcer, they need to have that pressure alleviated, or the wound is just going to get worse. So time off the mask if possible, or padding like mentioned with the gel or Duoderm or Mepilex. Your RRTs and the hospital's WOCNs are great resources; communicate with them at the first sign of skin breakdown. Maybe even before it gets to that point, if the baby is on the mask for a prolonged period and/or has delicate skin.

Don't beat yourself up, though. These things sometimes happen. My preceptor had to tell me that during orientation a couple years ago for me; my patient in a cervical collar had intact skin with our 0800 assessment, and then three hours later had a SDTI under her chin.