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Nasal Prongs: Risks, Injuries Incidence and Preventive Approaches Associated with Their Use in Newborns

Authors Ribeiro DFC, Barros FS, Fernandes BL, Nakato AM, Nohama P

Received 1 March 2020

Accepted for publication 14 May 2020

Published 19 June 2020 Volume 2020:13 Pages 527—537

DOI https://doi.org/10.2147/JMDH.S252017

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser


Débora de Fátima Camillo Ribeiro,1– 3 Frieda Saicla Barros,2 Beatriz Luci Fernandes,3 Adriane Muller Nakato,3 Percy Nohama2,3

1Neonatal Services, Waldemar Monastier Hospital, Campo Largo, Paraná, Brazil; 2Graduate Program on Biomedical Engineering, Universidade Tecnológica Federal do Paraná, Curitiba, Paraná, Brazil; 3Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil

Correspondence: Percy Nohama
Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição 1155, Curitiba, Paraná CEP 80215-901, Brazil
Tel +55 41 3271-1357
Email percy.nohama@pucpr.br

Purpose: To assess the incidence of nasal injury in newborns submitted to non-invasive ventilation (NIV) via binasal prongs, to identify risks that come with using this interface, and to present actions for nasal injury prevention.
Patients and Methods: Observational and descriptive study performed in neonatal intensive care unit (NICU) of a public hospital in the south of Brazil. This research was divided into three stages. In the first one, nasal injury incidence was assessed in 148 newborns, using data collection from medical records. In the second stage, injury incidence, severity and a preliminary analysis of risks associated with the prescription of binasal prongs were analyzed in 33 newborns who required NIV. In the third stage. recommendations were presented to prevent nasal injury during NIV with short binasal prong.
Results: The incidence of nasal injury in the first stage was 37.16%, and 63.64% in the second one. As for severity, 68.42% of the injuries showed Stage I severity, and 31.58% Stage II. The main risks associated with the use of binasal prongs were inappropriate prong size, inappropriate prong model, interface reuse, prolonged NIV use exclusively with binasal prongs, incorrect prong position and NIV circuit pulled. A total of 17 preventive approaches were recommended: 13 related to newborns care and not dependent on prior investment. Among them: to choose appropriate prong size; to keep the prong and the NIV circuit well positioned and periodically massages with circular movements in the nasal septum and columella.
Conclusion: The inappropriate prong size, interface reuse, prong model, prolonged NIV use with binasal prong and incorrect prong and NIV circuit position may be associated with the high occurrence of injury in the NICU studied. Simple approaches concerning clinical staff care actions towards the newborn in NIV, which do not require a financial investment, can prevent nasal injury.

Keywords: neonatal intensive care units, non-invasive ventilation, prevention, risk factors, wound and injuries

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