CPAP positioning

Specialties NICU

Published

Specializes in Telemetry, EMS.

I am a new NICU nurse and am having a time with the positioning of the CPAP. These poor babies with their molded little heads and little piggy noses. Any helpful tips on placment to help minimize the effects of the cannula's for these little guys? Thank you.:banghead:

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Specializes in Neonatal ICU (Cardiothoracic).

It depends on the type of device. We use the Hudson prongs here, which is a bar that sits below the nose. I find that if I angle the prongs down and back as I insert them, i get a better seal without having to "smash" them in so far.

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Specializes in Telemetry, EMS.

Not sure of the name of the device but they need to go around the head and the babies get molded heads. They have little blue sponges to help with it but it is still hard to hold them in place without making them so tight that they indent...:cry:

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Specializes in Neonatal ICU (Cardiothoracic).

I HATE CPAP. Give me back the Vapotherms we had at my last unit.

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Specializes in NICU.
I HATE CPAP. Give me back the Vapotherms we had at my last unit.

But Steve... it's MAGIC, remember? Sensei said so!!!

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Specializes in PICU, ICU, Transplant, Trauma, Surgical.

Vapotherms :) Are they kosher again? The babies

PS - we still have our user manuals and some vapotherm supplies tucked in the back of one of our storage rooms, wishful thinking I believe.

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Specializes in NICU.

I ditto the hate for CPAP.

I don't know if it's vapotherm, but we recently started using a high flow nasal cannula that works really well. Definitely much better on the noses than CPAP and the babes are happier.

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Specializes in Nurse Scientist-Research.

They started being used again a year or two ago. But nobody is supposed to like them. And about time they came back is when our hospital went nuts about bubble CPAP. It's supposed to be the miracle cure. And though way off-topic, we have had tremendous success with it though we aren't nuts about it (just something new to get used to).

With the positioning; we have had SOME success with using those z-flow pillows for the kids on BCPAP. Truthfully in the end those kids spend a lot of time on their backs. So for those kids who spend many weeks on BCPAP they wind up with these characteristic flat in the front and back heads and dilated nostrils. Not attractive. It does go away though, thankfully.

As for Vapotherm, many of us still have an affection for it. The docs don't want to use it as they say there isn't much research supporting it's use over other modalities. That may be true, but what we've found is that it does sometimes work when other things don't. Right now we have a little lady who is really just buying time until she has to be trached/GB/Fundo'd. She can maintain CO2's in the mid to high 60's on Vapotherm of 3. She did no better on BCPAP but was very agitated and keeping that stuff stuck to her face was an absolute nightmare. Also she's really getting way past her due date (I think her adjusted age is something like 44-48 weeks) and she now really needs play time, swing time, mat time and that's extremely difficult to do with BCPAP.

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Specializes in NICU, CVICU.

Why hasn't anyone invented canula tubing with prongs/masks that will work with CPAP??

One thing that I have found to work is to use a beanbag under the head. If the baby is on his/her tummy, lay the head on the beanbag to see where the tubing falls and then use your hand to create a groove for the tubing to sit in. That way the head is supported around the tubing, but the tubing isn't squished into the side of the head.

I hope that made some sense, and remember: positioning will get easier with experience and before you know it you'll be posting hints for someone else.

PS- We use the vapotherms like crazy, I haven't seen any problems with infection from them, but it seems to take a long time to wean off of them...

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Specializes in Neonatal ICU (Cardiothoracic).

Vapotherms were reapproved by the FDA in the summer/fall of '06 if I'm not mistaken. They were re-released with new cleaning guidelines and cartridge change recommendations. We mothballed all our old CPAP drivers as soon as we got them back. We had MUCH better luck with kids on Vapotherms (especially little micros) vs. CPAP. The babies were much happier too... This was in my old unit. Here we seem to shun anything we're not comfortable with, or at least refuse to hear about anything new. You can bet I'm outta here when I'm done.

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Specializes in NICU.
Vapotherms :) Are they kosher again? The babies

PS - we still have our user manuals and some vapotherm supplies tucked in the back of one of our storage rooms, wishful thinking I believe.

We use something called Comfort Flow now. It's similar to the old Vapotherm without the problem. The babies tolerate it so much better than CPAP.

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You can always ask your RT to show you how to position it. I learned more from our RT's than my fellow RN's.

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