Nasal Bridge Pressure Injury: What Is the Best Preventive Dressing?

 

INTRODUCTION:  Literature review establishes that nasal bridge pressure injury is a potential problem when patients are using non-invasive ventilation (NIV).  Currently there is no best practice recommendation for a preventive measure.  In efforts to reduce nasal bridge pressure injury associated with NIV our organization piloted three preventative dressings.

OBJECTIVE:  To evaluate the efficacy of prevention dressings while patients are managed with NIV. 

METHOD: An interdisciplinary team including WOC Nurse, Nurse Manager, Nurse Educator, Respiratory Therapist, and Unit Based Council was formed.  The team discussed that the current preventive dressing was hydrocolloid.  Despite the use of the hydrocolloid preventive dressing, patients were still developing hospital acquired pressure injuries related to NIV. It was decided to trial 3 different preventive products: a silicone faced foam dressing, gel protector, and nasal pad. The Intensive Care Unit was selected as the trial unit.  Each individual product was trialed for 4 weeks.   The products were evaluated by staff for ease of use, skin protection, improvement of clinical outcomes, NIV seal, and product meeting recommended usage/wear time.   The team concluded that the nasal pad was the best choice.    

RESULT:  In 2016 there were 12 hospital acquired pressure injuries related to NIV.  In early 2017 there have been 3 pressure injuries. All were acquired while using hydrocolloid as the preventive measure.  With the transition to the nasal pad as the preventive dressing there have been 0 hospital acquired pressure injuries. The nasal pad has achieved better results than the previous preventive hydrocolloid.   

RECOMMENDATION: Our interdisciplinary team recommends implementation of the nasal pad for the preventive dressing with the use of NIV.  This facilitates and promotes best practice for prevention of nasal bridge pressure injury.