Nursing Care Guidelines for Prevention of Nasal Breakdown in Neonates Receiving Nasal CPAP

Abstract

Use of nasal continuous positive airway pressure (CPAP) is increasing as a means of respiratory support for respiratory distress syndrome in many premature neonates across the United States. Nasal CPAP is less invasive and may be as effective as mechanical ventilation in premature infants, and has been shown to cause less lung damage in premature neonates. Because of the increased use of nasal CPAP in neonates, especially younger and more fragile neonates, the presence of nare and nasal septum breakdown may be seen as a complication. Currently, all nasal CPAP systems use a hat and prong or mask type of delivery system. This appears to be effective for many neonates, but for some, it is difficult to appropriately fit the hat and prongs. The result of an inappropriately fitted device can be mild to severe nare and nasal septum damage. This article will discuss the need for nasal CPAP and the mechanics of nasal CPAP, but more importantly, serve to guide caregivers in the appropriate physical assessment and care of a neonate on nasal CPAP with the goal of preventing skin breakdown and nasal damage.

Hydrocolloid dressing in preventing nasal trauma secondary to nasal continuous positive airway pressure in preterm infants

“…[8] Thus relieving the pressure is the key factor for the prevention of nasal trauma. [11] McCoskey [15] reported the important role of positioning the neonate in preventing nasal injury with nCPAP application, and also pointed out concrete proposals by positioning the neonate in prone with the neonate's hand tucked under the chin to keep the mouth closed and less altering of the prongs or mask. Gunlemez [12] investigated the effi cacy of the silicon gel application on the nostrils in prevention of nasal injury in preterm infants ventilated with nCPAP.…”

To Compare the Efficacy and Complication of Nasal Prongs vs Nasal Mask CPAP in Neonates

“…Little data are available in the literature on this topic, with reported incidences ranging from 20% to 60% [7,8,9,10,11] Comparisons between published studies are difficult because of different definition of trauma. Nasal masks, which were used in the 1970s, were abandoned in the 1980s as there was difficulty in maintaining a good seal and they tended to obstruct the nasal airways.…”

Nursing Care of the Newborn in Continuous Positive Airway Pressure: Review

“…Bununla birlikte apnesi olan veya hava yolu açıklığını tam olarak sağlayamayan bebeklerde de yararlı olduğu gösterilmiştir. 3,4 Spontan solunumu olan yenidoğanda pozitif basınç ile alveol içinde kalan fonksiyonel rezidüel kapasiteyi (FRC) korumak ve atelektaziyi önlemek için uygulanır. 6 CPAP'ın erken kullanımı bronkopulmoner displazi (BPD) insidansı ve taburculuk sonrası evde oksijen ihtiyacını azaltır.…”

“…Bu eylemi yaparken FRC'yi koruyarak gaz değişimini dengeler, torakoabdominal hareketleri senkronize eder, kardiyak fonksiyonları geliştirir. 3,4,7,9,13,[15][16][17][18][19] Helimeyer ve ark. 893 geç preterm bebeklerden 528 (%59,1)'inde yenidoğan yoğun bakım ihtiyacı gerektiğini belirtmişler ve apne, bradikardi insidansı ile CPAP gereksiniminin doğum haftasıyla ters orantılı olduğunu vurgulamışlardır.…”