Nasal Injury with Continuous Positive Airway Pressure: Need for "Privileging" Nursing Staff

Use of continuous positive airway pressure (CPAP) in neonates is associated with nasal injury (NI) for which various risk factors related to the neonatal characteristics and properties of interfaces used have been reported. "Privileging" of nursing staff may influence safety and incidence of adverse events. In this prospective cohort study, authors studied the incidence of NI and risk factors for NI in babies requiring CPAP after privileging staff for CPAP care bundles.

All neonates on CPAP over a 6-mo period were included. Standard operating procedures were formulated and staff of NICU (nurses and doctors) were educated at the start of the study and periodically in 6 comprehensive areas of care- encompassing position of head, prongs and cap; nasal suctioning and interruptions in pressure on the nose. The staff who completed the training and evaluation were declared as "privileged". NI (measured by a standard staging) and risk factors were predefined and studied.

Of the 51 babies who required respiratory supports, 35 required CPAP care. Nine babies (25%) out of 35 who required CPAP had NI (2, 4, 3 babies had stages 1, II and III of NI respectively). Seventy seven percent of babies were cared for by privileged nurses. NI was significantly higher when cared for by non-privileged staff (66% vs. 11%, unadjusted RR = 6.75, 95%CI 2.16-21.09). All other risk factors were not significant.

NI was noted in 25% neonates on CPAP, and those cared for by non-privileged staff had higher chances of NI. Quality processes and emphasis on continued monitoring and evaluation of nursing skills may help prevent these untoward complications.