How can we prevent septal necrosis during the use of the Infant flow driver, in VLBW neonates?

Thanks, Petri Mansvelt

Dear Petri Mansfelt,

I think that most of these problems could be prevented by careful nursing - our nurses are catious about of the risk of pressure induced necrosis and keep an extra eye on position and pressure of the nasal prong.

For some sensitive infants we use a different prong. It is a not really a 'nasal prong', but rather a small triangular 'hood' which covers the nose. If this 'hood' is positioned well (with not too much leakage of air) I think it works just as good as the regular prongs.

We have found with our experience with babies who require some what lenghtly ncpap coarse, that rotating between the nprongs and the nasal masks really helps( q4-8 hrs). We often see babies go weeks with little minimal problems with this application of the therapy.

Hello all,

yes, Mr. Johansson is right with meticulous care, such damages should no longer be a problem. I experienced lot of mistakes one can make alone with the right/or wrong placement of the device that´s being used!

Wrong caps, usually the wrong sizes, wrong fastening of the pressure tubes and the exhalation pipe wrong Prong(size) etc. Then, you should change the device q6 hours at minimum if possible and the use of a colloid plate cut in a T form to prevent skin damage by pressure would also be a good choice. Most problems can be solved by paying attention to the issues listed above.

Nevertheless, some problems like extremely prematurity can lead to damages by deforming the bridge of the nose by using Masks. Then you should use the Prongs more frequently (as possible) or try to make small breaks if possible.

Our technical advisor is one of the leading professionals in this matter and teaches various clinical specialists for one of the manufacturers of the SIPAP device. She has done some Powerpoints regarding this issue with good photos to illustrate what can be done wrong and what should be done the "right" way to prevent damage to the skin. This will be downloadable, soon on my Homepage.

I will let you know when.......

Hope that helps.

Norbert

I strongly recommend an article : S-C Yong, S-J Cheng, N-Y Boo Incidence of nasal trauma associated with nasal prong versus nasal mask

during continuous positive airway pressure treatment in very low birthweight infants: a randomised control study /Arch Dis Child Fetal Neonatal Ed 2005; 90 :F480-483/

In my opinion, nursing plays the most important role in avoiding nasal trauma Good condition of the baby's nose depends on constant observation, patience and tender care. In our site we have very good experience with the use of Infant Flow Driver and we also try to avoid nasal trauma by changing nasal prongs to nasal mask ( or nasal mask to n. prongs respectively ) It seems to work very well in most cases. I hope we'll see soon the presentation you mentioned in your post Norbert. I am sure it is very interesting. Please don't let us wait too long

We also have problems with nasl damage from nasal CPAP. I agree vigilance is required to prevent pressure on the nasal septum. We also use a colloid dressing to protect the nose, and rotating between prongs and mask is excellent. I am wondering if anybody has any techniques, dressings, ideas on how to manage the septum once the necrosis starts? It is difcult to keep the colloid dressing on as the area is now moist. We have resorted to using a short nasopharyngeal prong CPAP to relieve the pressure from prongs, does anybody have any other ideas?

Would also be interested in the powerpoints if they are completed.

Dear Colleagues,

We use a peice of DuoDerm cut to cover the nostrils and nasal septum with two holes to insert the nasal pronges.

It really works.

I hope you try this technique and give me feedback

Regards

Try the Cannulaide. It is a hydrocolloid seal that can "suspend" the prongs in the nose. Makes an excellent pressure seal. Should be changed every 24 to 36 hrs. Vigilant nursing care and careful positioning still vital. Be sure the soft prongs don't kink when inserting the prongs. Practice first. In the humid environment of the VLB it doesn't stick so long. Makes a difference over time with less breakdown and a better pressure seal. Reduces the need of switching back and forth mask to prongs.

Hi all, we don't use Infant Flow but we do use the Fisher and Paykel midline CPAP with short, soft prongs. We find that the single factor that contributes to breakdown and necrosis of the nasal septum is incorrectly fitting prongs. The prongs are designed to fit snugly into the nares, with a gap of about 1/8th of an inch between the prong and the septum. At no time should the prong push up on the septum. This can be difficult to manage in active babies, but we find that whether a baby succeeds on CPAP depends on meticulous nursing care and observation of the CPAP system, to eliminate any pressure on the nose or drag on the tubing, which can cause pressure on the nose. We do have babies with septal damage from time to time, but very few.

CPAP Canberra Hats to prevent nasal trauma

Hi,

There is a wonderful hat that was designed by a nurse at Canberra Hospital ACT, Australia, that almost resolves this problem completely. She markets them to quite a number of hospitals throughout Australia. The design is perfect, they come in a range of sizes right down to microprem size. they can be used for midline and Hudson prong types. They hold the prongs away from the septum securely, and can withstand the baby moving. They are washable and reusable. I can't remember the nurse's name, but if you contacted Canberra Neonatal Intensive Care Unit you will be able to contact her. I cannot recommend them highly enough, they are perfect.