Continuous Positive Airway Pressure
Maintenance of CPAP

 

 Reviewed by Victoria Wells -
Nurse Educator
May
2009
Clinical Guidelines Back Newborn Services Home Page

Step Action Rationale
1 Care of the Baby:

Observe and document a baseline assessment of the infant prior to the commencement of CPAP.  This includes:

  • Respiration: rate, effort, breath sounds, signs of distress (tachypnoea, nasal flaring, sternal indrawing, rib retractions, grunting)
  • Temperature
  • Cardiovascular: central and peripheral perfusion, blood pressure, auscultation
  • Neurological: tone, response to stimulation and activity
  • Gastro-intestinal: specific characteristics (e.g. cleft palate, omphalocoele), abdominal distension, visible loops, bowel sounds
  • Technical: pre-ductal (preferably right arm) oxygen saturation probe, cardio-respiratory monitor 
 Baseline observations are essential to the ongoing assessment and management of the baby. Underlying, contributing conditions may be discovered, e.g. hypothermia, choanal atresia, cardiac murmur, narcotic depression, etc.

NB: This assessment should be done with the minimum of delay.


The sooner CPAP respiratory support is initiated the better the baby’s outcome. If significant symptoms of respiratory distress exist, commence CPAP immediately. Assessment can continue once the acute situation is addressed.
2
  • Regular observations as outlined above need to be performed.
  • Minimal handling is essential for a sick infant therefore “hands on” intervention should be limited to 2-4 hourly if possible. Initially some fine tuning of the CPAP system may be necessary but limit handling to essentials such as suctioning and core temperature monitoring.
  • Complete blood drawing, IV insertion, x-rays, etc, with the minimum delay.
 Decisions regarding ongoing treatment are made on the basis of serial assessments.
3 Keep the baby’s parents informed of what is happening. Answer questions and offer information, as you do with regard to all other aspects of the baby’s care. Parents are members of our care team and have the right to understand the care their baby receives.
4 Once the infant is stable on CPAP and is tolerating handling without compromise or agitation the usual activities of care can be performed.  
5 Parents can be encouraged to participate by being shown the techniques of soothing and containment. They can perform oral cares, nappy changes, etc. as their confidence and the baby’s condition permits. This facilitates attachment and reinforces their role as parent and caretaker.
6 Change the baby’s position 4-6 hourly. Kangaroo care is an ideal variation in position along with it’s other tactile emotional advantages. Changing position is a gentle way to move lung secretions along the airway