It is very easy to use bubble cpap with nasal prongs. The only hitch is ,if we are not vigilant enough we might endanger columella and cause it's destruction by pressure necrosis. Can you please tell us what precautions you take to avoid columella injury while using nasal prongs?.

thanks

dr.r.selvan

We always make sure there is no pulling back on the tubing and to make sure of this have taped it to the top of the bed. We have a protocol to remove the prongs every 2 hrs and massage the nose.

Hi, i am very interested in your CPAP protocol, is it possible that you sent me a copy?

Hi, we are careful to make sure that the prongs are positioned correctly and are the correct size - too small and the baby won't get enough pressure, too big and the baby will have pressure damage to the nares, both inside and outside. We also use thin duoderm as a barrier to keep the prong from pushing up the nose -even with these precautions we still get some nasal trauma, especially in very active babies. We just continue to do our best to ensure that there is as little trauma as possible. It's not ideal but its better than being intubated!

There is a new product called Septal-H produced by LQproduct.com. It seems to be efficient in preventing Columellar injury. The idea behind Spetal-H came from using a Duoderm barrier as JoannieO mentioned in his comment. This product is also cost effective but has not been studied to my knowledge.