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By using problem-solving techniques, to reduce the rate of nasal continuous positive airway pressure (NCPAP) tubing dislocation in newborn infants in neonatal intensive care unit at Kaohsiung Medical University Hospital .
Methods:
A total of 19 newborns who used NCPAP during hospitalization had been enrolled in June, 2014. The rate of NCPAP tubing dislocation, including nasal prongs are dislodged was 309 infant/time (147%). We analyzed the reasons of tubing dislocation with clinical records, as follows 1. nasal prongs fixed by magic carpet (VELCRO) on face are not fully engaged and dislodged from nostrils; 2. inappropriate size of nasal prongs for nostrils；3. disconnection of the nasal prongs and tubing, one side or both sides；4. The cap for fixing the tubing is too loose to support of NCPAP tubing；5. The infants have irritable crying resulting in tubing dislocation.
The strategy to improve NCPAP tubing dislocation as follows: 1. Design a new method to fix tubing and nasal prongs；2. Use the suitable size of nasal prongs according to the body weight of newborn；3. Use the clothes-pins to support the tubes of NCPAP to prevent dislocation；4.Choose the appropriate cap to fix the tubes of NCPAP tightly；5. With “Ning grip” care and “comfort bag” to calm crying infants；6.Advocate training program to enhance the caring of NCPAP and make standard care of NCPAP in our unit.
Results:
The tubing dislocation were 124 times during a total of 165 man-days useing in July 2014. The rate of NCPAP tubing dislocation dropped to 75.1% (much decreased compared with June 2014). 74 times tubing dislocation occurred during a total of 178 man-days in August 2014, the rate of NCPAP tubing dislocation further dropped 41.5%. There were 64 times tubing dislocation during a total of 156 man-days in September 2014, which the rate dropped more to 41 %.
The rate of NCPAP tubing dislocation decreased from 147% to 41.02% in July to September 2014 in neonatal intensive care unit at Kaohsiung Medical University Hospital.
Conclusion:
After the implementation of the project, we significantly reduced the rate of NCPAP tubing dislocation. The strategy to decrease the rate of NCPAP tubing dislocation could make the infant using NCPAP more comfortable and safe.