Chapter 35 ■ Bubble Nasal Continuous Positive Airway Pressure 233

c. Fixing corrugated tubes in place

(1) Use appropriate-sized hat and fold rim back 2 to

3 cm.

(2) Place the hat on the infant’s head so that the rim

is just over the top of the ears.

(3) Hold the corrugated tubing to one side of the head.

(4) Tape the tube to the hat at the side of the head.

(5) Repeat the same procedure for the tubing on

the other side of the head.

d. Draining excess air from the stomach

(1) Pass an orogastric tube and aspirate the stomach

contents.

(2) Fix tube at appropriate position.

(3) Leave tube open to air to ventilate excess air

from stomach.

e. Maintaining a good seal for CPAP pressure

(1) Gently apply a chin strip to minimize air leak

from the mouth.

1 2

3

5b

6

4

5a

Fig. 35.2. Components of the CPAP attachment device.(1)Infant’s nose before applying b-CPAP; (2)

protective DuoDERM applied to upper lip and nose; (3) thin Velcro moustache piece: applied to upper

lip on top of DuoDERM with sharp edges not touching nose; (4) nasal prongs (prongs are slightly curved

to better fit within anatomy of nasal passages); (5a,b) thick Velcro ring pieces: wrapped around both sides

of the transverse arm; (6) nasal prongs applied to baby—prongs inserted into nares with thick Velcro rings

attached to thin Velcro moustache (allow a space between the transverse arm of the nasal prongs and nose

to avoid damage to nasal columella).

234 Section VI ■ Respiratory Care

2. Maintenance of b-CPAP

a. Check the integrity of the entire CPAP system every

3 to 4 hours (Appendix F) (12)

b. Suction nasal cavities, mouth, pharynx, and stomach every 3 to 4 hours, and as needed.

c. Keep CPAP prongs off nasal septum at all times.

d. Change the infant’s position every 4 to 6 hours, to

allow postural drainage of lung secretions.

3. Weaning off b-CPAP

a. A trial off CPAP should be given when the infant’s

weight is more than 1,200 g and he or she is breathing

comfortably on b-CPAP without supplemental oxygen.

The nasal prongs should be separated from the

corrugated tubing, keeping the tubing in place.

5

1

2

3 6

7 4