Juan J. Rivera, RRT
For the 2017 National Patient Safety Week, across our three campuses (St Joseph Regional Medical Center, St. Vincent’s, and St. Joseph’s Wayne), our quality department asked me to present a poster board on the subject of pressure ulcers due to BiPAP use. I thought this would be a great opportunity to showcase what respiratory therapists do and also to educate on the proper techniques and precautions we need to take to ensure that our patients are provided the highest level of care. I began by developing three focus points for my poster board: Problem, Literature, and Results.
A problem identified by many hospitals was that too often patients develop a pressure ulcer on the bridge of the nose. Hospitals also cited a lack of proper education of staff members in how to prevent or minimize these ulcerations. Literature states that it’s vital to have proper protection on the bridge of the nose (Black J et al), along with a properly fitted mask (Visscher et al). Most important is to limit the length of time a patient is on BiPAP to less than 26 hours, otherwise skin breakdown will be inevitable (Yamaguti et al). The result of implementing a comprehensive multidisciplinary approach starts with identifying patients who are at greater risk of developing pressure ulcers. This may be patients suffering from poor nutrition, those who have various comorbidities, limited mobility and/or old age. The use of a properly fitted mask, the use of pressure relieving dressings and the actual time spent on BiPAP are all important factors and can result in decreased ulcerations, create enhanced processes and improve patient outcomes.
Black, J., Alves, P., Brindle, C. T., Dealey, C., Santamaria, N., Call, E. and Clark, M. (2015), Use of wound dressings to enhance prevention of pressure ulcers caused by medical devices. Int Wound J, 12: 322 – 327. DOI:10.1111/iwj.12111
Marty O Visscher, Cynthia C White, Jennifer M Jones, Thomas Cahill, Donna C Jones, Brian S Pan (2015), Face Masks for Noninvasive Ventilation: Fit, Excess Skin Hydration, and Pressure Ulcers. Respiratory Care, 60 (11) 1536-1547; DOI: 10.4187/respcare.04036
Wellington P Yamaguti, Eliana V Moderno, Sandra Y Yamashita, Thelma GMC Gomes, Ana Lígia V Maida, Claudia S Kondo, Isabel CD de Salles, Christina MM de Brito (2014), Treatment-Related Risk Factors for Development of Skin Breakdown in Subjects With Acute Respiratory Failure Undergoing Noninvasive Ventilation or CPAP. Respiratory Care, 59 (10) 1530-1536; DOI: 10.4187/respcare.02942