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Wojciech Durlak

CPAP-related trauma

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Could you please share your experience/protocols for preventing CPAP-related nasal trauma?

I mean not only possible septal injury but also trauma related to frequent nasal suctioning.

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CPAP nursing is key. We often rotate between prongs and mask if CPAP is given over longer time periods. We may also protect the skin that is pressured (like around the nostrils and nose tip) with a barrier (softish) tape to avoid direct contact with tubings.

And read this paper in PLOS One a few weeks by Srinivas Murki et al in Hyderabad/India:

 https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0211476

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Anchoring tubing can be a hazard. When the infant’s head is elevated (as in GERD care), the baby can slide down the mattress and increase pressure on the septum. Occurs most often at night. Tubing should be free to move with the infant.

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To reduce trauma related to frequent nasal suctioning, a noninvasive method of nasopha­ryngeal suctioning has been found to be very effective and without side effects. Sterile 0.9% saline solution is instilled drop wise into one nostril from a 5-mL syringe and suctioned from the other nostril using a Neotech little sucker or De Lee suction catheter, attached to a central vacuum source (suction pressure of 100 mmHg). This results in passage of fluid and sticky secretions from one nostril and nasopharynx to the other nostril which gets aspirated. We have stopped inserting catheters into nostrils for suctioning for over a decade in our unit.

 

See chapter 34 "Nursing Care and Endotracheal Suction in:

https://www.amazon.in/Essentials-Neonatal-Ventilation-1st-book-ebook/dp/B07LBTC95N/ref=tmm_kin_title_0?_encoding=UTF8&amp&qid=&amp&sr=

Prakash Manikoth, FRCPCH

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In AmsterdamUMC location VUMC, we have no nasal trauma giving nCPAP by VYGON, a silicone double tube, fixated with tape. They come in different sizes, so even for the extreme neonates we use these.

1780910829_Schermafbeelding2018-09-20om13_03_07.png.6e4931832b8b48dbdd7e89acf1fdc256.png

https://www.vygon.com/catalog/double-tube_575_00259615

For non-invasive suction we use the Tendernose.                                                                                                                                                                                                                                                      The Tendernose, is held in the nostril, coupled to a universal suction hose and the mucus is simply sucked away with the adjustable vacuum. Together with a specialist NICU nurse at the Máxima Medical Center in Veldhoven, Medica-Europe has developed the Tendernose. This unique product is new in Europe and CE certified

https://www.medica-europe.com/producten/ic-anesthesie-neonatologie/nasale-uitzuiger-neonaten

 

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I'm a RRT (Registered Respiratory Therapist), I have worked in a 38 Bed Level III NICU In the U.S.A for twenty years. Rarely, do I use the Neotech little sucker. I prefer the bulb syringe along with NS. Overuse and misuse is a main cause of nasal trauma. The bulb syringe provides an element of feedback, the rate of return to normal after use tells on the degree of or lack of occlusion. The  Neotech little sucker has its place but certainly not routinely.

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To Ingrid de Jong

Which device do you use to provide cpap (and where is the delivered pressure maesured)?

Do you use it for nasal ventilation ?

How do you manage secretions/nasal succioning with the tape?  Don't you have skin trauma with the tape.

I'll be more than happy to try this way of delivering cpap

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Hello Antoine, 

As above, in the VUMC Amsterdam we use, binasal Vygon. The pressure is measured at the end of the F@P tubing with a pressure-tube connected to the ventilator. We hardly give more than PEEP 8 (flow 8 liter) We use it for NCPAP en NIPPV. When suction is needed we remove one tube from a nostril, put a knot in it, so O2 (and some PEEEP?) is delivered; suction with catheter or with a Tendernose. With loads of secretion the tape will come lose sometimes, but overall no problems and no skin trauma. You can also insert one Vygon-tube, connected to your T-piece and let O2 and air flow, before extubating. With weeks/months of nCPAP the kids do get irritated by placing the tubes, no different than with mask/prongs. 

There is offcourse a resistance, especially with the smallest size. But in clinical practice we don't see that. We have used this with the Leoni ventilator and now with the Fabian ventilator.

If you are in Amsterdam, you're welcome to come and visit :) 

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