RAM Cannula

[juliachloe]

Curious to know if any bedside nurses like this device. We started using it in our facility this year. We did not receive any education on it. I understand that intubation can be incredibly traumatizing to a patient's trachea and lungs, especially the tiniest of babies. I understand that the longer they are on the ventilator, the more likely they are to develop BPD. I get the purpose of the device. What I don't understand is why physicians choose to torture these tiny babies by keeping them on this device when they very obviously cannot tolerate it.

I watch these babies huff and puff (RR >100), retract like mad (moderate to severe suprasternal, intercostal, subcostal and substernal), eventually exhaust themselves so much so that they become lethargic and eventually start to have apnea...and these doctors STILL do not want to intubate. When is enough enough? How is that any kind of quality of life? They spend the first 2 months in a daze because they are so exhausted from breathing. They have have had thousands of desaturations, and likely hundreds of severely hypoxic episodes in that amount of time. Forget how damaging that can be to their brains. I guarantee that if I was a parent in the NICU and FULLY informed about the care my baby was receiving and the likely outcomes, I would choose for my baby to receive a trach because they simply cannot tolerate extubation rather than them being tortured for months and then wind up being bed-ridden for the rest of their lives because of the insult their brain took while in the NICU. I have spoken at length with our docs and they firmly believe in this device, regardless of how the baby is doing and the outcome. One thought that the only time he would consider intubation is when the baby is coding. He stated that most infants with trachs wind up having CP anyway. I understand they are medicine and I am nursing but at some point the two have to come together and agree on something. I can advocate until exhaustion and it never seems to be enough.

Is this just something in my unit or are other nurses experiencing this as well regarding the RAM?

[prmenrs, RN]

The PTB need to provide nursing staff (and respiratory, too) w/a lot more education about this device and the philosophy behind it. How does the nurse manager and/or educator view this situation? Other staff? Once you are knowledgeable about the theory, you are in a better position to advocate for the patients. Can you find any conferences that have this as a topic? Can you research the literature for more info?

You're in a tough spot. But if you can get a dialogue going, you can @ least see where the docs are trying to go and why.

jmho

[prmenrs, RN]

Studies | Neotech RAM Cannula I hope this helps.

[NicuGal, MSN, RN]

I do have to say I love the Ram Cannula. Yes, they may struggle some with being on CPAP or NIMV, but the overall success is better than being intubated for long term or even having a trach. We have extubated from oscillators to this and had good success. If they are having continous B's or D's we switch over to NIMV if on CPAP. If their blood gases are good, then there really isn't a need to intubate, even if they are struggling some. Intubation leads to so many things, including laryngomalacia, stenosis.

But, if they are in distress, then they do need to be intubated. We have one doc like that too, and we document, document, document. Sometimes it is hard to be a patient advocate when they don't see what we do.

[juliachloe]

Thank you so much for the replies and links to literature. Very much appreciated.

[obprof]

My unit uses the RAM cannula a lot too and I really like it! From what I understand, the RAM decreases the risk of lung disease more than intubation does. I haven't seen babies struggle too much with it on my unit, unlike yours though. And you can easily switch from CPAP to SIMV or vice versa. The only negative thing I've noticed with RAM CPAP is how much oral care the babies need for all of the "frothing" that occurs. I need to suction their mouths out well with every set of cares.

For more information, I think the Neonatal Nurses' conference in Chicago in Sept is having a lecture on the RAM if you're going. After the conference you can purchase the lectures too.

[bmsrn]

I have never heard of this. Is this just a plain NC? And it can be used for NCPAP? So no more velcro head pieces and masks?

I went on their website and it looks like the cannulas we use, but we do not use our cannulas for CPAP.

[babyNP., APRN]

Yeah, what is the difference between this and vapotherm or other high-flow nasal cannulas? We love those on our unit and use it frequently because of skin breakdown on CPAP. Little preemies

[umcRN, BSN, RN]

I also just did some research on this since I have never seen it. How does it work? It looks like our vapotherm cannulas but says it can be attached to any ventilator/cpap/and even HFOV. I don't understand how it works, how can it provide peep & tidal volumes without a complete seal and if the baby opens their mouth?

[NicuGal, MSN, RN]

The babes are so much more comfortable on the RAM,even the full termers since it fits just like a NC. It works like the other ones, and we don't seem to need chin straps like with the traditional CPAP set up. You can go back and forth to NIMV with this too. I believe the difference is in the diameter of the tubing that allows for you to put pressure thru it. Vapotherm provides highly humidified O2 up to 10 liters, we have good success with this on our micronates who we extubate from oscillation. But the only draw back that we have found is that the smallest RAM cannula isn't as small as the smallest Vapotherm one.

They do need a lot of mouthcare, but we do mouthcare with every hands on....you have to watch the back of their throat...may the OP needs to bring that up too...we put a little sterile water on a 2x2 and wash out their mouth and suction. Sometimes they need a little NS down their noses too to help move those secretions.

[Bortaz, MSN, RN]

We just started using (well, trialing) it a month or 2 ago. It's not being used in lieu of intubation, but rather we use it with the baby on Si-pap. They are a great, wonderful improvement over the old CPAP mask/cannulas, and cause very little damage to the nose. They only recently bought updated modules for our ventilators that allow us to use the si-pap. (Sy-pap?)

[bmsrn]

Our unit does not use Vapotherm. That was before my time I guess, but now we just use Fisher Pykels. We also use Sipap- a lot.