Bishopp A, Oakes A, Antoine-Pitterson P, Chakraborty B, Comer D, Mukherjee R, et al.
The Ulster medical journal. Date of publication 2019 Jan 1;volume 88(1):17-20.
1. Ulster Med J. 2019 Jan;88(1):17-20. Epub 2019 Jan 22.
The Preventative Effect of Hydrocolloid Dressings on Nasal Bridge Pressure
Ulceration in Acute Non-Invasive Ventilation.
Bishopp A(1), Oakes A(1), Antoine-Pitterson P(1), Chakraborty B(2), Comer D(1),
Mukherjee R(1).
Author information:
(1)Department of Respiratory Medicine & Physiology, Birmingham Heartlands
Hospital, Bordesley Green East, Birmingham, B9 5SS, UK.
(2)School of Mathematics, University of Birmingham, Edgbaston, Birmingham, B15
2TT, UK.
Background: Non-invasive ventilation (NIV) is a valuable treatment in the
management of acute hypercapnic respiratory failure. NIV is not without risks.
One such adverse effect is the development of pressure ulcers over the nasal
bridge which have an incidence of up to 20% of patients requiring NIV in this
setting. The role of medical devices in the development of hospital acquired
pressure ulcers has been increasingly recognised with 10-35% of all hospital
acquired ulcers attributed to medical devices. Guidelines on acute NIV use
suggest good skin care strategies. However, data on the magnitude of the problem
of nasal bridge pressure ulceration and the effect of proactive preventative
steps remains scant.
Method: A quality improvement project was designed to reduce the incidence of
nasal bridge pressure ulcers during acute NIV. Hydrocolloid dressings were placed
over the nasal bridge in all patients requiring NIV between 30th October 2015 and
the 29th October 2016. Tissue viability was assessed daily with new pressure
ulceration defined as grade 2 or above. Rates of nasal bridge pressure ulcers
were compared to all patients requiring NIV in the 12-month period prior to
intervention.
Results: In Group 1, there were 161 admissions and 9 grade 2 pressure ulcers from
666 NIV bed-days. In Group 2 there were 134 admissions and 0 pressure ulcers from
718 NIV bed-days. There was a statistically significant reduction in grade 2
pressure ulceration rates (p= 0.0013) in Group 2 compared to Group 1.
Conclusion: Application of an early prophylactic pressure-relieving hydrocolloid
nasal dressing reduces the risk of developing grade 2 pressure ulcers in patients
in patients requiring acute NIV.
PMCID: PMC6342034
PMID: 30675073
Conflict of interest statement: Provenance: externally peer-reviewed.
