Continuous positive pressure on aircraft in neonates: care provided by the nursing team

Abstract

Objective: to describe the nursing care of the neonate in continuous positive airway pressure (CPAP) with prong analyzing them in the light of the systematization of nursing care / process. Method: Descriptive research, qualitative approach. We interviewed 30 nursing professionals from the neonatal intensive and intermediate care units of a school hospital in Maceió / Alagoas, from August / 2016 to January / 2017, through a semi-structured interview, in the light of Bardin's content analysis. Results: Although unit nurses are aware of the use of CPAP and the care associated with this therapy, mid-level professionals still find it difficult to systematize systematized knowledge about the system. The tripod's correlation between CPAP, the formation of nasal lesions and the assistance provided was highlighted. Conclusion: It is necessary to carry out training, such as raising the awareness of professionals about the importance of keeping records up to date and applying protocols.

Lesão de septo nasal em recém-nascidos hospitalizados: estudo descritivo exploratório

“…While another study that aimed to test the application of hydrocolloid in a double layer, that is, in the nostrils and in the high-flow nasal catheterprong, observed that the cases that presented favorable results may have been due to the vigilant care of the teams of neonatal unit nursing, an extremely relevant factor for the protection and care of the skin of premature newborns (18)(19) . In that investigation, the hydrocolloid patch used in only seven babies was placed when the injury was already present, differing from the studies in which its use was recommended as protection against the appearance of septal injuries (7,9,(12)(13) . There is evidence in the literature of other forms of treatment for septal injuries.…”

“…NIV has therapeutic advantages for the recovery of newborns with respiratory problems, however, the use of prongs without preventive care can result in injuries and may cause deformities, nasal asymmetry and airway obstruction (6,(8)(9) . Nasal trauma among premature babies due to the use of prongs can vary between 20 and 60% worldwide and in Brazil it can reach percentages from 70 to 100% (10,16) .…”

“…Newborns on NIV, using nasal prongs, need specialized care in view of the damage and iatrogenic effects that this device can generate due to the pressure exerted on the nasal septum. Prematurity is a determining factor of integumentary immaturity and can lead to the development of more severe injuries in the nasal mucosa (9) . The vulnerability of the skin of preterm infants is due to the absence of protection by the vernix and the stratum corneum in the epidermis.…”

“…However, its use is not exempt from adverse events, which require professional training for the proper management of the devices necessary for NIV. The use of nasal prongs, a necessary device for NIV, when in contact with the newborn's skin exerting a local pressure, predisposes the nasal septum to injuries, causing pain and discomfort (6,(8)(9) . NIV-related skin injuries are frequent in NICU, and gestational age, birth weight and prolonged use of these devices are factors that predispose the injuries (10)(11) .…”

“…The complications resulting from these injuries can lead to delays in the evolution of the clinical picture and a longer hospitalization period, causing higher costs to the health system (12) . The use of hydrocolloid dressings is usually recommended to prevent and treat the injuries in the initial stage, it is composed of a cellulose, pectin and gelatin membrane, which is adhered to the nasal septum of the newborn that is under NIV, with the objective of protecting the skin (9,12) . When an injury is already present and the newborn does not have clinical conditions or gestational age that allow the suspension of ventilatory support, it is recommended to use a hydrocolloid dressing, associated with topical products that can help in the healing process of the injury.…”