What to use on the nares to prevent breakdown of skin

[wrighty]

Hi I was just wondering what other units use to put on the infants nose region to prevent pressure areas occurring (even actual septum damage) from lon term use of prongs/ mask while on CPAP. Is there a product out there to use (eg like duoderm to cover the area)???

Thanks:banghead:

[lvnurs9]

yes. I have no idea what the brand is but they were called cannulades at my last job. It actually said that on the package, so maybe that was the brand. They use something where I am working now, but they are not labeled. They look like duoderm T's. I am sure your respiratory peeps can help you find something.

[NICURN29]

We also use the Cannulaide. It's manufactured by Beevers Manufacturing. They have a website that has information about it here. I really like it, although it has to be changed often in some chronic babies because a lot of moisture can get under it.

[texas2007, BSN, RN]

We just started putting a special kind of jelly in the nares...before this we didn't use anything.

[Sweeper933]

We also use the cannulaide, although we haven't had the need for it in quite some time. I have also seen just a strip of duoderm cut to size put on the nose as well when there was just one tiny area that needed some help.

[SteveNNP, MSN, NP]

IMHO, if staff is using NCPAP prongs properly, (size, securement, placement) septal/nasal damage shouldn't be happening.

Sometimes dilated nares are inevitable, but usually happen when someone gets tired of working to make a tight seal.

[Preemienurse23]

We use the cannulaid and its great. Previously we had not been using anything on there nose. If they were beginning to get breakdown, or redness we might put a little aquaphor on the red/brokendown areas. I havent seen any redness/breakdown with the canulaids. We are also using sticky whiskers for our nasal cannulas. I have seen less breakdown on the cheeks, and horrible tape jobs with these. Though they dont hold the NC in place as well tegaderm.

[BoonersmomRN]

We only use duoderm. If they start to get breakdown they switch them to alladin mask for a break or they will go to 3L heated wire NC.

I hate CPAP. I know it's a great tool but I hate it because the babies hate it. It breaks my heart to see my lil ones grabbing and pulling with all their might to take it off. A lot of time the breakdown is a result of the baby moving/grabbing/twisting it.

[TiffyRN, BSN, PhD]

The cannualade (however it's spelled) can help with a seal, but so can duoderm wrapped around the prongs. The only thing that will actually prevent pressure related breakdown (in my opinion) is lack of pressure. Making the prongs bigger (with cannualade or duoderm) can keep them from shoving as far up the nares keeping the prongs from pressing on the septum, but that's about all you can do.

When our unit started using hudson prongs for bubble Cpap, there was a period of time to get over the learning curve where quite a few infants developed septal breakdown. Once folks figured out that there just must be a "cushion of air" between the septum and the prong apparatus, the number of septal breakdowns decreased dramatically. Nowadays the only kids getting septal breakdowns are the under 27 week crowd.

[UTVOL3]

We always just use duoderm cut to fit. It seems to help. You are all right though, the best way to prevent it is correct use of the thing in the first place.

[elizabells, BSN, RN]

I confess - I hate the Cannulaide, or the homemade version we use sometimes that we refer to as the "Hannibal Mask". The worst septal breakdowns I've seen have come about when those things are left on too long, it's wet and gooey under there, nobody checks the septum for days and notices the beginnings of redness/maceration, and you come in and take it off and BOOM. No septum.

We've started modifying the design without the bit that goes over the septum - just the moustache bit and two thin pieces that go up and over the nose. It brings the outer edges of the nares in a little so you can use smaller prongs without the danger of unnoticed early breakdown.

[psychonaut]

Our RRTs insist that the masks/prongs we use now won't cause breakdown, and I even had one smirk when she saw me cutting duoderm prior to switching from prongs to mask. I also annoy them because I insist on frequent prong/mask switches (I'll do it myself, as long as I have the extra prongs/masks at bedside).

I hate cpap like I hate bili lights; I appreciate their value, but the little ones seem so miserable with either (or both, eek).