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Continuous
Positive Airway Pressure
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Reviewed by Victoria
Wells - Nurse Educator |
| May 2009 |
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| It's not bubbling! | The prongs won't stay in place | The baby won't settle | "How can we avoid septal damage?" |
This indicates loss of air flow or a pressure leak somewhere in the system. A simple way to check if it is a ‘circuit’ problem or a ‘baby’ problem is to remove the prongs from the nose and occlude them with your fingers.
If the system doesn’t bubble it means the problem is with the circuit. Systematically check the circuit, tightening all connections as you go. Begin at the wall and end at the water-bubble generator.
If the system does bubble, when you occlude the prongs with your fingers then the pressure leak is at the nose or mouth. Air will escape if the prongs are too small or if they are not curved down into the nose and fitting snugly. The suggested sizes (based on weight) are a guide only as babies nose sizes do vary. A chin strap will reduce leak via the mouth. A dummy may help an unsettled baby.
Check white tubing for accumulation of “rainout”, as this will swing backwards and forwards in the tubing without an audible bubble.
A Duoderm Patch may be applied to nares for problems with a seal / no bubbling, following assessment by a member of the CPAP Resource Team. (Information sheet will be given out at the appropriate time)
| Are they the right size? | |
| Does the hat fit snugly? | The hat is the anchor for the prongs so a loose hat will allow any movement of the head to dislodge the prongs. |
| Are the corrugated tubes fixed firmly in place on the side of the hat and are they at the correct angle to keep the prongs in place? | If there is rotating pressure on the prongs they may twist out of the nose. If in doubt, try undoing the rubber bands and with the prongs correctly positioned in the nose, allow the tubing to sit naturally in place. Reposition the pins and the rubber bands as necessary. Ensure that the base tapes are secure on the face. Do the existing ones need replacing? See application instructions. |
| Are the prongs positioned in the nares appropriately and comfortably? | |
| Does s/he need suctioning? | This may seem a contradiction when suggesting ways to settle a baby down, but a build up of secretion can cause considerable distress to a baby whose breathing is already compromised. |
| Once you are sure the airway is clear try the usual calming techniques of containment, nesting, swaddling, pacifier, etc. | |
| Aspirate any excess gastric air and vent tube to room air if necessary. | |
| Try positioning the baby prone as this can help relieve abdominal distension and diaphragmatic pressure. | |
| Often just “hands off” will allow the baby to slowly settle, especially in the early hours as they adjust to the CPAP. | |
Prevention is the key. Tissue will break down if it is subjected to continuous pressure, friction and/or moisture. Avoiding these contributing factors will maintain an intact septum:
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