What to use on the nares to prevent breakdown of skin

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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::banghead::nurse:

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::banghead::nurse:

As a veteran NICU nurse, I understand your frustration in preventing skin breakdown (septum damage) and also keeping CPAP in place. In the NICU where I work, we also experience the same problems but recently we employed this product called Septal-H, it serves as a skin barrier, preventing pressure on the septal area. In comparison to other available products in the market, such as cannulaide, Septal-H does not collect moisture, instead it protects the skin and it also allows you to suction the baby and assess the nasal area without removing the device. The beauty of this product is it works with all kinds of CPAP system, including alternating prongs and mask (Bi-Phasic). I have no problems in applying the device and it is very simple and comfortable for the babies. I am very happy to be using this product, since it significantly reduced the incidence of nasal injury and brings more benefits to our babies. It saves me headache and made all the nurses and parents happy too! :)

I believe the product's website is ( http://www.lqproduct.com ) check it out!

Best of luck.

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We actually DO use Duoderm, but we use the ExtraThin Duoderm that is "breathable". If you cut it into an inverted T shape you can put the horizontal part of the T over the philtrum and run the vertical part of the T over the septum, securing it at the middle of the nose.

We have also had good results from using a product called Cannulaide. It is a hydrocolloid like Duoderm, but it is already cut to fit noses. It comes in 4 sizes, I think. The only problem with it is if you use a "mask" or "pillow". The holes cut in the Cannulaide are for prongs, so you may get some occlusion when using the mask. Also the humidity builds up under the mask and makes the Cannulaide gummy. This could actually end up leading to maceration of the skin, so watch out for that.

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We have the same problem with RTs in my unit. I do what you do--put on Duoderm and switch from prongs to mask frequently myself. The other compliance problem we have with the RTs is their refusal to put ExtraThin Duoderm on baby's cheeks under their ET tube tape. We have had bad skin tears when the stretchy brown tape is removed from the face during retaping or extubation... What do you do to protect the face?

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Specializes in Retired NICU.

We use the cannulaide also. It goes on the nose and upper lip to protect it and there are holes at the nare openings that hold the prongs in place.

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Specializes in Retired NICU.
... put ExtraThin Duoderm on baby's cheeks under their ET tube tape. We have had bad skin tears when the stretchy brown tape is removed from the face during retaping or extubation... What do you do to protect the face?

We use NeoBars.

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Specializes in NICU.

We use the cannulaid on all CPAP babies and have had much success. Like others have said, you do have to change it frequently and it makes it difficult to assess the nares and septum. You just have to assess when you change it, when it is secure its purpose is to prevent breakdown. We use the sticky whiskers for some of our NC, but mostly use tegaderm on the cheeks. I don't see much breakdown in our unit.

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Specializes in NICU, Post-partum.
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.

Well said Steve,

I am actually surprised at this thread..as if nares breakdown is the norm.

I cannot tell you the last time I have seen an infant with skin breakdown around the nares.

Our kids that are on either a vent or CPAP are a 2/1 nurse-patient ratio and we have a dedicated RT to our unit that helps with the positioning.

We also have morphine or 2 or 3 mcg of fentynal prescribed for infants PRN that keep pulling at the mask...because it becomes a comfort issue.

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Specializes in NICU, Post-partum.
We have the same problem with RTs in my unit. I do what you do--put on Duoderm and switch from prongs to mask frequently myself. The other compliance problem we have with the RTs is their refusal to put ExtraThin Duoderm on baby's cheeks under their ET tube tape. We have had bad skin tears when the stretchy brown tape is removed from the face during retaping or extubation... What do you do to protect the face?

We also use neobars.

We also use adhesive remover on all babies having tape removed. The only time we ever have skin tears is when the nurse fails to use it.

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what kind of adhesive remover do you use? Is it FDA approved for preemies? Is there a gest. age limit or is it ok on all kerotinized skin?

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