Non-invasive ventilation support


Basic rules

• Appropriate attachment of ventilation device
• Use of humidified and warmed air (necessary to observe appropriate humidification and temperature)
• Draining water from the ventilation circuit
• Checking skin condition under nasal device every care (better to alternate masks and nostrils to prevent pressure ulcers)
• Observation of secretion and necessity to do suction
• Using hydrocolloid, NeoSeal or other consumables under medical devices to prevent pressure ulcers or other skin breakdown

  

Non-invasive ventilation support


Nursing care contains

• Monitoring of ventilation parameters
• Appropriate positioning
• Skin care
• Suction
• Device and breathing circuit control – troubleshooting, functioning
• Proper manipulation with neonate
• Care coordination, minimal handling and cluster care
• No crying strategy (risk of pneumothorax, air leak, and other complications)
• Parental engagement and education

Invasive ventilation support


Basic rules

• Appropriate position and securement of ETT
• Use of humidified and warmed air
• Monitoring level of humididy and temperature, drining water form veltilation circuit
• Checking of oral and nasal cavity every care (prevention of pressure ulcers and other skin or mucous membranes damage)
• Use of protective consumables (hydrocolloids, NeoBar, etc.)

Nursing care contains

• Monitoring of ventilation parameters (VT, PIP, MAP, amplitude, spontaneous aktivity, resistence, leaks, etc.)
• Appropriate positioning according to the patient condition
• Skin care
• Suction – preferably closed suction
• Device and breathing circuit control – troubleshooting, functioning
• Proper manipulation with neonate
• Care coordination, strictly minimal handling and cluster care,m individualized care
• Pain management, sedation, relaxation if needed
• Parental engagement and education 

Suction strategies


When do we do suction?

• When it is needed
• Obstruction by secretion (auscultation, change in ventilation parameters, visible secretion, etc.)
• For sampling

Mouth is always first

• Risk of aspiration
• For moisturizing and better suction, we can use sterile water only
• Better to use gauze instead of suction or friendly device instead of catheter

Nose

• Better to use friendly device (nasal aspirator)
• For moisturizing or better suction use normal saline only

Endotracheal suction

• Only once necessary
• Preferable closed suction
• If appropriate pressure (80-100 mmHg) and bore catheter is used (max. diameter obstruction is 50%) – less alveoli colaps
• Less reflex bradycardias
• Quicker lung recruitment after suction
• Less VAP
• Easier for nursing staff
• CAREFUL – does not have to suit all patients
• Pre-oxygenation can be done before procedure
• Sterile procedure measures
• Always necessary to measure depth of suction
• Use of normal saline for moisturizing only if it is needed (NS will never mix together with saliva or mucous)

Why do we want to avoid excessive suction

• Painful and stressful procedure
• Stimulation of vagal reflex – bradycardia, apnoea
• Oral aversion
• VAP, VAE
• Tissue damage
• Other complications

How to do it comfortably

• Swaddle the baby first
• Sucrose can be given (one drop on the tongue)
• Choose proper position (no need to turn the baby for suction, can be done in any position)
• Can be done while cuddled by the parents
• Talk to the baby
• Do it always very gently as if you are the one who's being suctioned
• Involve parents in the procedure, teach them to help you

Parental engagement in respiratory care

• Routine nursing care can be done by parents (diaper change, eye care, mouth care, skin care, etc.)
• Parents can help wiht suctioning – holding and tucking the baby (comfort, pain relief)
• Parents can change the interface of the CPAP together with nurses
• Positioning – involving parents in
• Kangaroo care can be done even on ventilatory support
• Cuddling

Complications during respiratory support
  – nursing care

• Necrosis, erosions, pressure ulcers
• Excessive secrection, damaged mucouse membranes – not optimal humidification
• Inapropriate body posture due to inadequate positioning
• Apnoea, tachypnoea, dyspnoea
• Overstimulation – inadequate or excessive manipulation
• Blockage of ETT
• Spontaneous extubation

Complications due to respiratory support

• Pulmonary Air Leaks
• Pneumothorax, Pneumomediastinum, Pneumocardium, Pneumoperitoneum
• Pulomonary Intersticial Emphysema
• Pleural Effusion
• Pulmonary Haemorrhage
• Persistent Pulmonary Hypertenson of Neonate
• Bronchopulmonary dysplasia
• Pneumonia