In recent years, neonatology has emerged as a new discipline, causing confusion and unfamiliarity among many nursing staff who are new to this field of care, including resuscitation and treatment of neonates.
One of the commonly used resuscitation devices in neonatology is CPAP, which every neonatal staff member must master. Based on clinical experience and literature, we would like to share our insights on caring for infants with CPAP, acquired through over three years of work experience.
CPAP, or Continuous Positive Airway Pressure, is a type of ventilation that provides positive pressure throughout the respiratory cycle to keep the airway dilated in infants with spontaneous breathing. This airway dilation is referred to as Continuous Positive Airway Pressure.
CPAP helps to maintain continuous positive airway pressure, which increases cross-pulmonary pressure, dilates alveoli, and improves oxygenation by expanding atrophied lungs and increasing functional residual air volume. It also reduces consumption of lung surface active substances, decreases airway resistance, and may prevent collapse of the upper and small airways. CPAP is indicated for neonates with early or mild to moderate respiratory distress syndrome, prematurity, neonatal wet lung, and other conditions.
As a neonatal staff member, it is essential to master the principles of CPAP for infants. However, proper care and precautions when administering CPAP are equally crucial for the well-being of neonates. Careful attention to the care of infants on CPAP can significantly impact their development and recovery.
The nurse on duty should position the child and connect the CPAP device upon receiving a medical order. The nasal plugs should not be too tight and should be relaxed once every two hours to prevent necrosis of the nasal mucosa and nasal septum tissue. CPAP pressure and oxygen concentration should be adjusted to maintain normal oxygen saturation and blood gases, and records should be kept.
Depending on the child's condition, mid-oral pharyngeal and nasal aspiration may be performed every 2-4 hours, and a gastric tube should be inserted for gastrointestinal decompression to prevent abdominal distention. Malfunctions should be detected and corrected promptly, and proper disinfection of the breathing circuit tubing and connectors should be carried out.
The baby should be kept warm on a radiation table or in a radiator, with temperature adjustments according to gestational age, weight, and daytime age to minimize oxygen consumption. Relative humidity in the environment should be maintained at 50%-60%, and therapeutic care operations should be centralized as much as possible.
Nutrition should be strengthened, with feeding in small amounts several times a day for infants who can suckle. Gastrointestinal or intravenous nutrition should be given to those who cannot suckle to enhance their resistance.
Strict adherence to the sterile isolation system and proper hand hygiene should be observed to prevent medically-derived infections.
Close monitoring of vital signs and changes in condition should be carried out, with detailed records of oxygen saturation, CPAP settings, and other relevant parameters. If abnormalities are found, the nasal plugs, airway, and oxygen supply should be checked, and the doctor should be informed immediately.
Oxygen administration should be warmed and moistened to prevent airway dryness, which can affect cilia function and cause inflammation and necrosis of airway mucosa. Dry and cold oxygen can also lead to sputum buildup and prevent its expulsion.
High CPAP pressure can result in air leakage, carbon dioxide retention, and affect blood flow, so it should be monitored and adjusted carefully.
Infants with emphysema or aspiration pneumonia and a PO2 level greater than or equal to 65mmHg should not use CPAP.
Tracheal intubation should be considered for infants with weak or absent spontaneous breathing.
In summary, adherence to the three treatment points and seven care points is crucial. It is essential for nurses to strictly follow the nursing system, perform all nursing tasks diligently, and ensure accuracy, timeliness, and error-free execution. These actions are directly linked to the quality of medical care and have a significant impact on patient outcomes.