Noninvasive positive pressure ventilation (NIPPV) and tracheostomy placement have advanced medicine by providing life-saving therapies for those experiencing respiratory insufficiencies. While the benefits are many, the risk of developing medical device related pressure injuries still looms. Not only are pressure related injuries personally costly to the patient, but also to the hospital that will not get reimbursed for hospital acquired pressure injuries (HAPI).

The article by Miske, Garcia, and Stellar (2017) discusses interventions enacted throughout hospitals in hopes of diminishing the amount of HAPIs that occur. While all interventions can be made available, staff members must be consistently accountable and practice the guidelines in place in order to prevent wounds in patients. The protective equipment can be made available such as having appropriate size interface and cushions for CPAP and BiPAP machines, but the benefit is only obtained if the staff unfailingly uses them.


As a nurse I know that we have the ability to enact change during each shift, as hospital protocol requires hourly rounding that allows for repositioning and skin assessments. Creating a sense of staff accountability for their patients must be addressed. Figure 7: PREVENTT acronym (Miske et al., 2007) is an effective key that could serve as a template for an inpatient flow sheet where wound documentation can be recorded. Handoff reports should also note the presence of a wound and what interventions are in place- silicon/foam padding, barrier creams, etc- and if the intervention is showing positive benefits. High patient to nurse ratio should be controlled so additional time can be spent on thorough skin checks during each shift. Standardizing frequency and methods for performing neck and skin assessments for patients with a tracheostomy or NIPPV along with staff accountability has a great potential to diminish the high incidence of HAPIs.

Jennifer Gomez, RN
Complex Care, Children’s Hospital at Montefiore

Miske, L.J. et al. Airways and injuries: Protecting our pediatric patients from respiratory device-related pressure injuriesCritical Care Nursing Clinics of North America. 2017 Jun; 29(2).

Figure 7: PREVENTT acronym (Miske LJ et al, 2017)