A Follow-Up to Implementing a Sizing Chart for Nasal Cannula Placement to Decrease Associated Pressure Ulcers in Infants

Abstract

Background:

The Joint Commission definition of a pressure ulcer is a broader term that includes decubitus ulcers, but also includes any ulcerations associated with pressure. In 2015, over a 3-month period, the intensive care nursery at Thomas Jefferson University Hospital had 5 patients who developed pressure ulcers due to placement of an improper size nasal cannula being used for that patient. Infant nasal cannulas are typically classified as being for micro premature, premature, neonate, infant, and intermediate infant size patients. To this day, there is no instruction by most manufacturers for fitting a nasal cannula to the actual size of the patient in kilograms. Also, cannulas are not of a universal size from various manufacturers.

Methods:

In October of 2015, using manufacturer specifications and measurements taken by our biomedical department, a sizing chart was developed to fit the proper size cannula based on a patient’s weight in kilograms. Four products from 4 different manufacturers were used in our nursery at that time. In January of 2018 a fifth product was added to our already existing products. (see table)

Results:

Since the implementation of the nasal cannula size chart in the intensive care nursery at Thomas Jefferson University Hospital, the incidence of pressure ulcers has remained zero. Thus far, from November 2015 through January 2024, a total of 983 patients have been followed. Surveillance of these patients has shown that 8 patients developed redness with no skin breakdown and 3 developed bruising. Of the 3 patients who developed bruising, 2 developed it from face planting, and none had any skin breakdown.

Conclusions:

The implementation and use of a size chart based upon a patient’s weight has been proven to be a vital tool in our unit for reducing the incidence of pressure ulcers associated with nasal cannula use in the infant population. It may also be a vital tool that should be included in the manufacturer packaging material for use at other institutions. We will continue the use of this tool, along with continued patient surveillance to confirm that the use of a nasal cannula size chart is a vital method in reducing pressure ulcers associated with nasal cannula use in the neonatal/infant population.

Nasal Cannula Size Chart

&nbsp;	<750g	750-1000g	1000-2500g	2500-4000g	>4000g
Ram Cannula	Micro Premature	Premature	Neonate	Infant	ConsiderPediatric
Salter Cannula	**********************	Premature	Neonate	Infant	IntermediateInfant
Vapotherm Cannula	Premature	Neonate	Infant	IntermediateInfant	ConsiderPediatric
Fisher & Paykel Cannula	Premature	Neonate	Infant	IntermediateInfant	ConsiderPediatric
OptiFlow Junior	<1-3kgPremature	2-8kgNeonate	3-15kgInfant	12-22kgPediatric	**********************