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?

[umcRN, BSN, RN]

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.

I think vapotherm is a more recent thing. We get kiddos from hospitals that don't use vapotherm and the kiddo comes on cpap and we're able to get them on vapotherm usually​ pretty easily. We use it a lot more then cpap or si-pap

[Bortaz, MSN, RN]

What is vapotherm?

[prmenrs, RN]

Vapotherm Therapy This is a parent site, but had some info. @Boratz: your hospital may be doing it but calling it something else.

[bmsrn]

We used Vapotherm in our unit until they had their recall. We switched to Fisher Pykel and we've been using that since then. I believe they are pretty much the same thing.

[Harparia]

We use the RAM canulas at our facility & I like them very much. One major difference from a standard NC is that you can do bubble CPAP or NIMV with the RAM & the switch is fairly simple. There seems to be far less nasal septum breakdown. Babies can start to dry breastfeed sooner & transferring to kangaroo care is soooo much easier. The one downside is that it doesn't work well for all babies though. Some just really need those Inca prongs which give a better bubble.

[umcRN, BSN, RN]

So I Know this is an old post but I had to share. I just saw this used on my unit for the first time. This is a pedi CICU and it was used on a 3 mo old whose been intubated his whole life. They extubated to it and so far he seems to be tolerating it pretty well (RR in the 100's though but appears comfy). He is on the vent mode with a rate. I'm still not understanding how he gets any peep and it's pretty obvious that its all going out his mouth as there's not much for tidal volume registering. I have no idea if we are using this in my NICU yet or not, honestly, the respiratory therapists think one of the attendings just ordered a trial, found it somewhere, and decided to give it a go! No one has had ANY education on it and all we have is the manufacturers "ad" type thing kept at the bedside.

I still do not see how this differs from vapotherm, nor do the RT's i've talked to. It's essentially just providing high flow with "breaths" at a slightly higher flow.

[nicurn5a]

My unit uses the RAM cannula and at first we had a lot of excessive bloody noses plus some breakdown on the septum. At first I didn't like it because of all the trauma, but we have found ways to prevent it especially the breakdown. I am used to using it now and it works well on the older babies but as for the little ones I guess the jury is still out for me.

[michael scott]

The Columbia bubble cpap method has been in use for fifteen plus years and is far superior to the

ram Cann. The Ram is a one way flow device, meaning the patient cannot exhale back into it. That is

why it cannot be allowed to fill more than 80 per cent of the nare. If used correctly, it cannot

provide a seal and therefore is inefficient and ineffective when compared to Hudson prongs which

maintain a seal, transmit known pressures, allow the patient to breath physiologically in and out.

In most cases the Ram is used incorrectly, allowed to occlude the nares, and therefore

impedes the normal process of exhalation. Co2 is purged by "blowbye" out the mouth. Babies are

perfectly capable of breathing on their own, they don't need the elevates rates that Ram Cann

users apply with no apparent criteria.

Yes, it is easy to use, and everybody likes the "easy button", but it is not the best choice

for patients with surfactant deficiency. The Hudson cpap system is far superior, but it

is labor intensive. It is sadly too much work for people who are more committed to their

own comfort than the correct treatment of the smallest and most vulnerable of patients.

[Breatheasier]

I just found this thread and wanted to mention that Elbw infants with symptoms you describe would be intubated and I'm sorry but I further doubt these patients are as you describe them as for one simple reason calories. The amount of energy it would take an ELBW to breathe at the rate and manner you describe burns massive amounts of calories far more than they have to expend. This alone would not allow these neonates to go "months" in this condition. I won't even get into how their digestive system would react in such a situation. Any who rams are great. Have a great day

[Breatheasier]

I didn't know you could breathe out through a Hudson prong setup. Now clearly there is gas escape into our fluid medium in which the exhalation limb is placed but I think it's a bit much to say they breathe out through these devices. If they did we wouldnt need to vent these tiny bellies repeatedly. o

[babyNP., APRN]

hey there welcome to allnurses! Not sure if you noticed, but this thread is over 5 years old. We definitely welcome input on this forum- but might be more relevant to make a new topic on the subject because it gets confusing being such an old thread (Does anyone else miss Bortaz desperately??)