Poster - #2023UCDH-11 - Keywords: NICU CPAP

Skin Integrity Promotion for NICU CPAP

Elizabeth Stanfield, RN, BSN, RNC-NIC
UC Davis Health

ABSTRACT:
Skin Integrity Promotion for NICU CPAP Elizabeth Stanfield BSN, RN, RNC-NIC UC Davis Medical Center, Sacramento, California Background: Continuous Positive Airway Pressure (CPAP) in a noninvasive form of respiratory support used in the Neonatal Intensive Care Unit (NICU) setting to assist infants who are spontaneously breathing by preventing alveoli collapse. CPAP is delivered via the nasal airway opening with the use of nasal prongs or a nasal mask. Some issues associated with CPAP are prong and mask sizing, skin breakdown, and increased injury to the nasal area and septum. Increased pressure around the nares leads to skin breakdown and nasal injury. Prolonged CPAP use on infants increases chance of injury (i.e., premature, and chronic lung disease infants). Audits on the NICU showed nursing inconsistency with rotation of nasal mask and nasal prongs for infants on CPAP and lack of coordination with RT staff. Purpose: The purpose of this initiative was to promote skin integrity for infants in the NICU by having infants who are on continuous nasal CPAP using a skin barrier called Mepilex lite and alternating the delivery of method between nasal prongs and nasal mask. Collaboration between the Respiratory Therapist (RT) and bedside nurse was also promoted. Methods: The initiative plan included staff education on the use of Mepilex lite, highlighting importance of rotation of masks and prongs, and to improve documentation of eye care, skin integrity, and CPAP delivery methods. The plan was an interdisciplinary decision between the Nurses and RT staff. It was agreed upon that Nurses and RTs would complete one skin assessment together during the shift to assess the fit of the bonnet, appropriate mask, and prongs size, and fit of the tension straps and chin straps. The education was initiated in peer-to-peer training and real time feedback during bedside daily audits. Nurses were also tasked with storing all CPAP equipment in a dated container to identify when the items need to be changed. The sizing tool for mask and prongs now remains at bedside for the entirety of CPAP use. A CPAP skills station was initiated at NICU skills day, and a CPAP PowerPoint was uploaded on the staff NICU page for reference. Results: There were 75 pre project audits completed using Qualtrics. Data showed 72% use of Mepilex lite under nasal masks, 11% of infants has no nasal prong use, and 36% of infants were sized inappropriately for masks and prongs. After 6 sessions of NICU skills days were completed over the course of 6 months and ongoing teaching at bedside during CPAP audits, the results showed 80% Mepilex lite under nasal mask, 5% of infants not sized for prongs, and 31% had wrong sized prongs and masks. Conclusions: Clinical nurses from the NICU worked collaboratively with RTs to institute two skin promotion practices for infants on nasal CPAP including use of Mepilex lite under nasal masks combined with rotation of prongs and masks with infant cares. Multidisciplinary CPAP assessments with RTs were also instituted. Audits and real time teaching will continue with nurses to ensure ongoing skin promotion during CPAP use of infants.