A pilot trial to reduce pressure injuries related to BiPAP masks in the ICU.

Purpose:

Device-related pressure injuries are a preventable problem in intensive care units (ICU) (Black & Kalowes, 2017). From January 2017 to May 2018, there were 8 documented patients in our hospital suffered nasal pressure injuries from bilevel positive airway pressure (BiPAP). Currently, there is no agreed upon evidence based intervention to prevent nasal pressure injuries from BiPAP masks. The purpose of this study is to determine the feasibility and efficacy of an intervention to help prevent the incidence of BiPAP masks related pressure injuries in the ICU.

Design:

This quality improvement project prospectively enrolled 26 patients within 2 medical and surgical ICUs at an 850 bed tertiary care hospital. Prior to initial BiPAP initiation, a mineral based elastomer gel dressing was placed on the bridge of each patient’s nose. Patients using home BiPAP and patients who had BiPAP initiated in locations outside of the two study units were excluded. After in-service education by the WOC nurse, respiratory therapy and bedside nursing were integral parts of intervention implementation. 

Results:

The average age of the patients is 63 years, 14 men and 12 women. There have been 0 pressure injuries documented while the intervention has been in place. No adverse events have occurred related to the dressing itself. Nursing staff and respiratory therapy colleagues have reported that with proper maintenance, the dressing is easy to apply, can be easily customized for facial fit and stays in place.

Conclusion:

Applying a mineral based elastomer gel dressing underneath BiPAP masks may be effective in the prevention of nasal bridge hospital acquired pressure injuries. This study will potentially create a change in practice among all ICUs within this institution to prevent pressure injuries related to BiPAP.