Non-invasive NAVA and PPV *New Grad*

[NicuNurseRNBSN]

Hi,

At my new job, the unit uses non-invasive NAVA (via nasal prongs). My question is if I were have to provide PPV for my baby would I remove the prongs in order to use the face mask connected to the neopuff? My worst fear (besides the baby coding) is ripping off the baby's skin from trying to remove the tape that helps keep the tubing leveled on the baby's cheeks to keep the prongs in their nose. Sorry in advance if this is a stupid question!

Thank you ?

[prmenrs, RN]

It's not a stupid question! Talk to the Resp Care and/or more experience nurses, and develop a "game plan" in your mind. Stupid questions are way better than stupid mistakes!

[meanmaryjean, DNP, RN]

No such thing as a stupid question if it keeps you from making an error! Keep asking!

[adventure_rn, MSN, NP]

Yes, if you need to give PPV, you've got to take off the prongs in order for the Neopuff to get a good seal on the baby's face (plus, if the prongs are still in, they're going to occlude the nose so you can't give PPV anyway). I remember having the same fear about fumbling to get the giant CPAP mask set up off when I was trying to give PPV as a new grad, and I needed help the first time I actually had to do it.

The thing is, if a kid needs PPV, you're getting dangerously close to an emergent intubation and/or code situation, and many kids who are on non-invasive NAVA are touchy enough that one bad event can get them reintubated in a heartbeat. It's great that you're concerned about skin, but in that situation, it is at the bottom of your list of nursing priorities. If your baby ends up with a skin tear because you needed to give PPV, you still made the right choice. We see this sometimes too with unplanned extubations; the baby may get a nasty facial skin tear while you're pulling off the old ETT tape, but if that's what you've got to do to maintain your airway, then it is what it is.

I agree with @prmenrs, it's best to talk through the exact plan and set-up with the RT or an experienced nurse. They may have some suggestions about how to remove the set-up or tape in the least traumatic way possible. Also, if you're in that situation and you need help with the set-up, do not be afraid to ask for help. The code bell/staff assist buttons exist for that precise reason.

[Kitiger, RN]

What is NAVA and PPV?

Google says, "Nava is a public benefit corporation working to radically improve how government serves people." And the only PPV I could find was Pay Per View.

It has to be some type of ventilation system, right?

[adventure_rn, MSN, NP]

1 minute ago, Kitiger said:

What is NAVA and PPV?

Google says, "Nava is a public benefit corporation working to radically improve how government serves people." And the only PPV I could find was Pay Per View.

It has to be some type of ventilation system, right?

Lol, your response made me smile. You are correct, they're modes of ventilation.

PPV is Positive Pressure Ventilation; it's when you use the device to deliver a breath (because you're ventilating by giving positive air pressure). Giving PPV is the same as 'bagging' a patient. Most peds units give PPV with a ambu bag and mask, but a lot of NICUs give PPV with an infant t-connector resuscitator (NeoPuff, which the OP referenced, is the most common brand). It's preset with the PIP and PEEP, so the user just has to tap it to give a breath.

Non-invasive NAVA is a mode of ventilation where the patient isn't intubated but is getting respiratory support from the ventilator. Basically, instead of being connected to an ETT, the vent circuit is hooked up to a CPAP mask. NAVA stands for Neurally Adjusted Ventilatory Assist; basically, the NAVA set-up has a esophageal catheter (basically a fancy OG tube with an embedded sensor) that senses the movement of the baby's diaphragm. The OG tube sends a message to the vent, and every time the vent senses the baby's diaphragm moving, it gives a breath into the CPAP circuit. You can actually use NAVA on intubated patients as well ('invasive NAVA') as a bridge to extubation and non-invasive NAVA.

So here's the root of the OP's question: The NAVA set-up is massive (it's basically the same as CPAP), and in the OP's unit, some element is taped to the baby's face. If the baby becomes apneic, you have to yank off the set-up to bag the patient (aka giving PPV), which can cause a skin tear.

[NICUmiiki, DNP, NP]

For time's sake, we will often leave the prongs and place the mask over it as long as you can get a good seal. If the prongs are interfering with the seal too much, then take them off. I wouldn't try to bag using the prongs itself.