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Discussion

weighing on NCPAP

Hello---

Keeping up with the non assisted ventilation trend, our unit (a 16 bed level III) is extubating our 26-30 weekers quickly to NCPAP. However, I think we are experience more reintubations than other units. I just went to the Neonatal Conference in Las Vegas and realized that the nurses may be responsible for our Cpap "failure". Many of the lecturers stressed the importance of keeping positive pressure as much as possible. Currently, our unit takes our time without the mask when weighing and in my opinion, aren't very viligent in keeping the pressure.

So here's my question. I'm preparing an educational update for the staff to explain the importance of keeping those little lungs inflated during all procedures- including suctioning and weighing. Does anyone out there have a guideline of care for suggestions to my staff? One speaker said their unit knows the weight of cpap and weighs with it intact...however I don't know if that is feasible with our system...All ideas appreciated!

Thanks

Courtney

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    I don't have a guideline but do know that our Neo's and NNPs want us to weigh the babies with their CPAP intact. They say they always assume we are weighing the babies with their caps and CPAP masks/prongs intact and they take that into account when reviewing the weight changes each day. I think they figure the CPAP things weigh about 30 grams but don't quote me on that. As you have heard at conferences about the importance of maintaining the alveoli in their open condition, I have heard this too. It makes sense that if you take off the CPAP then the alveoli will collapse and then when you put the CPAP back on the alveoli will have to be re-recruited. Certainly their ventilation will suffer for a bit when off the CPAP and then you have to wait until they open again when the CPAP is put back on. I wonder what damage occurs during this time... maybe no damage to tissues but possibly the lack of oxygenation causes some cellular damage??? I am only a staff nurse and don't have any education like a NNP would have. I wish a NNP would answer your question.

    Good luck with your presentation!

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    The trend of weight gain is most important. When you weigh the baby with their ETT, the weight is not exactly the weight of the baby no matter how hard you try! Once CPAP is placed on the baby, yes the initial weight may change... but after that when CPAP is left intact you will still see trends in the baby's weight/growth accurately. As far as a correct dosing weight for drug calculations, the doses are not changed on a daily basis but when the weight trends up... so it's maybe not perfect, but close. They want us to keep the CPAP on!

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