c-06-07-60947 respiratory care: non-invasive ventilation...

RESPIRATORY CARE: NON-INVASIVE VENTILATION: APPLICATION OF FISHER & PAYKEL INTERFACES: NICU

DOCUMENT TYPE: GUIDELINE

Site ApplicabilityNeonatal Intensive Care Unit (NICU), Neonatal Program

Practice Level Interface fitting for application of respiratory support is a basic skill of the Registered Respiratory Therapist (RRT) as outlined by the HYPERLINK "https://www.csrt.com/wp-content/uploads/EN_Framework_2016_NARTRB_NCF_Part1.pdf"Canadian Society for Respiratory Therapists (CSRT) National Competency Framework.Nursing Care of infants requiring non-invasive respiratory support is considered a neonatal nursing competency. It is practiced only after the Registered Nurse (RN) has successfully completed the non–invasive ventilation workshop and has had their learning validated.

Guideline Statements

This document outlines the appropriate sizing and fitting of Fisher & Paykel (F&P) bonnet, nasal mask, nasal prongs, and FlexiTrunkTM. These interfaces are compatible for delivery of respiratory support with the Bubble continuous positive airway pressure (CPAP) system as well as the Draeger Babylog® VN500 ventilator, Servo-n®, and Servo-u® ventilators.

See Non-Invasive Ventilation Guidelines for an outline of RN/RRT responsibilities for all patients receiving respiratory support.

The RRT must be present to fit an appropriately sized FlexiTrunkTM interface, bonnet, nasal mask, nasal prongs and upon discontinuation of therapy. The RRT is responsible for replacing the FlexiTrunkTM interface replaced every 7 days and when visibly soiled and circuit changing every 30 days.

Fitting and removing/replacing the interface and bonnet from the infant is a 2-person procedure. One health care provider (HCP) is responsible for applying the bonnet and interface and the second person is responsible for providing developmentally supportive care throughout the procedure.

One clean nasal mask or one clean nasal prong (whichever is not currently used for therapy), and unused foam blocks from the FlexiTrunkTM interface are kept in a specimen container along with the sizing template in the top drawer of the supply cart located in the infant’s room.

Shared responsibilities between the RN and RRT: Changing interfaces (nasal mask and nasal prongs) completed at least every 4 hours or sooner

if there is evidence of trauma to the skin. As part of Small Baby Care, interfaces are changed with handling for infants ≤ 28 + 6 post-menstrual age (PMA).

Bonnet replaced daily. As part of Small Baby Care, the bonnet is not changed routinely in the first 72 hours of life for infants ≤ 28 + 6 PMA.

Nasal mask and nasal prongs replaced as needed (cleaned between uses with warm soapy water).

Guideline

FlexiTrunkTM: Sizing & Fitting Sizing templates located in the FlexiTrunk™ packaging must be kept in the top drawer of the supply cart

in the infant’s room to appropriately re-size mask or prongs. C-06-07-60947 Published Date: 16-Feb-2021 of 12 Review Date: 16-Feb-2024 This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current.

http://policyandorders.cw.bc.ca/resource-gallery/Documents/BC%20Women's%20Hospital%20-%20Neonatal%20Program/C-06-07-60943%20Respiratory%20Care%20Non-Invasive%20Ventilation%20NICU.pdf



The FlexiTrunk™ is replaced every 7 days and as needed (PRN). Sized to fit with the smallest size possible ensuring the clear tubing does not extend over the patient’s

forehead.

Available in 3 sizes: o 50 mm: < 1.5 kilograms (kg) o 70 mm: 1.5-2.5 kg o 100 mm: > 2.5 kg

Grey foam blocks (located in the FlexiTrunkTM packaging) are added or removed to achieve a horizontal line parallel to the patient in the supine position. Foam blocks may need to be removed/added when changing from prongs to masks (or vice versa) to achieve proper positioning and adequate seal. Foam blocks may also be added if reddening appears on the bridge of the infant’s nose. Foam blocks must be kept in the top drawer of the supply cart located in the infant’s room.

The two clear connectors with blue caps from the end of the FlexiTrunkTM are saved for the Infant Transport Team (ITT) and placed in the RRT Equipment Storage Room.

C-06-07-60947 Published Date: 16-Feb-2021 of 12 Review Date: 16-Feb-2024 This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current.



F&P Bonnet/Headband Sizing/Fitting Replaced daily by the RN or RRT. As part of Small Baby Care, the bonnet is not changed routinely in

the first 72 hours of life for infants ≤ 28 + 6 PMA. Sized according to the infant’s head circumference: Place the tape measurer behind the infant’s head

just above the ears around to the forehead. The bonnet should fit snugly: over the ears and on the level of the eyebrows but avoiding the eyes with

the back fitting at the base of the neck. Lateral velcro straps adhere to the blue section of the straps with gentle tension and should not be overly tightened or stretched to fit as this may result in pressure sores.

Bonnets are available in 4 sizes and headbands are available in 3 sizes (headbands are indicated for larger sized patients or for when scalp access is required (e.g. electroencephalogram (EEG), scalp peripherally inserted central catheter (PICC), or ventriculoperitoneal (VP) shunts).

Bonnet sizing: 17-22 centimeters (cm), 22-25 cm, 25-29 cm, 29-36 cm.

Headband sizing: 29-36 cm, 35-40 cm, 40-45 cm.




Nasal Mask: Sizing & Fitting Sizing of the nasal mask is determined with the sizing template which is included in the FlexiTrunkTM

packaging.

Nasal masks are available in 4 sizes: small (S), medium (M), large (L), and extra-large (XL). The size is embossed on the edge of the mask.

The nasal mask is sized to completely cover the nose while avoiding placement on the top of the lips, eyes, edge of the nose, or septum.

Only 1 appropriately sized nasal mask should be kept in the top drawer of the supply cart located in the infant’s room.

Cleaned PRN with soapy water.C-06-07-60947 Published Date: 16-Feb-2021 of 12 Review Date: 16-Feb-2024 This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current.



Nasal Prongs: Sizing & Fitting Sizing of prongs is determined with the sizing template which is included in the FlexiTrunkTM packaging.

11 sizes of prongs are available based on naris diameter and septal width. For example, size 5050 corresponds to 5.0 mm naris diameter and 5.0 mm septal width. The size is embossed on the edge of the prongs.




Prongs must completely occlude the nares without blanching and should sit 2 mm out of the nares. Foam blocks may be added to maintain the distance of 2 mm out of the nares before using the

Neoseal®. Prongs cannot be altered in any way. If nasal trauma is a concern, then 1 Neoseal® may be adhered to the base of the prongs.

Only 1 appropriately sized set of prongs should be kept in the specimen container in the top drawer of the supply cart located in the infant’s room.



DOCUMENT TYPE: GUIDELINE Prongs are cleaned PRN with soapy water.

Chin Straps: Use Applied with gentle tension. May be used as a last resort to achieve adequate seal and appropriate pressure delivery as it is

common that the infant opens their mouth during therapy. Chin straps are available in 4 sizes: 20-26 cm, 26-32 cm, 32-38 cm, and 38-44 cm.

DocumentationSee Non-Invasive Ventilation Guidelines for documentation.

ReferencesFisher & Paykel Healthcare Limited. (2010). Bubble CPAP system. Auckland, New Zealand: Fisher & Paykel

Healthcare Limited. Fisher & Paykel Healthcare Limited. (2011a). Bubble CPAP system set up guide. Auckland, New Zealand:

Fisher & Paykel Healthcare Limited. Fisher & Paykel Healthcare Limited. (2011b). FlexiTrunkTM: Infant interface set-up guide. Auckland, New

Zealand: Fisher & Paykel Healthcare Limited.


http://policyandorders.cw.bc.ca/resource-gallery/Documents/BC%20Women's%20Hospital%20-%20Neonatal%20Program/C-06-07-60943%20Respiratory%20Care%20Non-Invasive%20Ventilation%20NICU.pdf


DOCUMENT TYPE: GUIDELINEFisher & Paykel Healthcare Limited. (2011c). FlexiTrunkTM: Infant interface user instructions. Auckland, New

Zealand: Fisher & Paykel Healthcare Limited. Fisher & Paykel Healthcare Limited. (2013). BC115 Pressure relief manifold: User instructions. Auckland, New

Zealand: Fisher & Paykel Healthcare Limited. The National Alliance of Respiratory Therapy Regulatory Bodies. (2016). National competency framework for

the profession of respiratory therapy (2016-2021) part 1 national standards for entry to practice (including evaluation standards). Retrieved from http://www.csrt.com/download/ncf-part-entry-practice-2016/?wpdmdl=15595

Appendices

Appendix A: Appropriate Fit with Bonnet Appendix B: Appropriate Fit with Headband

Developed ByBCW Neonatal Program – Respiratory Therapy Educator; Senior Practice Leader

Version HistoryDATE DOCUMENT NUMBER and TITLE ACTION TAKEN25-Jan-2021 C-06-07-60947 Respiratory Care: Non-Invasive

Ventilation: Application Of Fisher & Paykel Interfaces: NICU

Approved at: Neonatal Leadership Committee

17-Mar-2021 Updates from Critical Care re: small baby care

DisclaimerThis document is intended for use within BC Children’s and BC Women’s Hospitals only. Any other use or reliance is at your sole risk. The content does not constitute and is not in substitution of professional medical advice. Provincial Health Services Authority (PHSA) assumes no liability arising from use or reliance on this document. This document is protected by copyright and may only be reprinted in whole or in part with the prior written approval of PHSA.


http://www.csrt.com/download/ncf-part-entry-practice-2016/?wpdmdl=15595

http://www.csrt.com/download/ncf-part-entry-practice-2016/?wpdmdl=15595


DOCUMENT TYPE: GUIDELINEAppendix A: Appropriate Fit with Bonnet

With Nasal Mask



DOCUMENT TYPE: GUIDELINEWith Nasal Prongs

C-06-07-60947 Published Date: 16-Feb-2021 of 12 Review Date: 16-Feb-2024

This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current.


DOCUMENT TYPE: GUIDELINEAppendix B: Appropriate Fit with Headband

