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  • Quality Improvement Article
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Decreasing respiratory device-related pressure injuries in the NICU using 3D printed barrier templates

Journal of Perinatology (2024)Cite this article

Subjects

Abstract

Objective

Use of non-invasive ventilation (NIV) in very low birthweight infants to decrease the incidence of bronchopulmonary dysplasia can also lead to pressure injuries (PI) caused by the respiratory device interface. We aimed to decrease our incidence of PIs related to the mask/prongs interface used for NIV (PI-NIV).

Study design

We identified correct use of barriers and appropriate interface fit as key targets for intervention. Over several PDSA cycles, we developed custom 3D printed barrier templates to allow for barriers to be cut at the bedside and created concise educational documents to assist with interface fitting and troubleshooting.

Results

The incidence of all PI-NIV decreased from 5.64 to 2.27 per 1000 NIV patient-days and the incidence of reportable (stage 3–4 and unstageable) PI-NIV decreased from 1.13 to 0 per 1000 NIV patient-days during the study period.

Conclusions

With appropriate barrier usage and targeted education, the risk of PI-NIV can be minimized.

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Fig. 1: Key driver diagram created by multidisciplinary team at onset of pressure injury reduction project.
Fig. 2: Evolution of barrier templates over duration of project.
Fig. 3: Improvement in barriers after adoption of 3D printed templates.
Fig. 4: U charts of monthly pressure injury rates per 1000 days of non-invasive ventilation with mask/prongs interfaces.
Fig. 5: Graph of number of pressure injuries by location on the face over time from 2019 to 2022.

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Authors and Affiliations

  1. St Louis Children’s Hospital, Department of Pediatrics/Newborn Medicine, St. Louis, MO, USA

    Lydia Goodyear, Julia Huck, Marcy Buckles, Jordan Murphy, Zeyna Naufel, Abigail Winterbauer, Carly Wheeler, Colette Penaloza & Ashley Barthel

  2. Washington University School of Medicine, Department of Pediatrics, Division of Newborn Medicine, St. Louis, MO, USA

    Rakesh Rao & Gillian C. Pet

  3. St. Louis Children’s Hospital, Department of Quality, Safety, and Practice Excellence, St. Louis, MO, USA

    Angela Niesen

  4. St. Louis Children’s Hospital, Medical 3D Printing Center, St. Louis, MO, USA

    Zachary O’Connor

Authors
  1. Lydia Goodyear
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  2. Rakesh Rao
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  12. Ashley Barthel
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  13. Gillian C. Pet
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Contributions

LG designed the intervention, collected and analyzed data, and contributed to writing the manuscript. RR, JH, MB, JM, ZN, AW, and CW designed the project, analyzed data, and reviewed and critically revised the manuscript. AN analyzed data, prepared graphs, and contributed to writing the manuscript. ZO designed the intervention, led the 3D printing initiative, and contributed to writing the manuscript. GCP designed the intervention, analyzed data, and wrote the manuscript.

Corresponding author

Correspondence to Gillian C. Pet.

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The authors declare no competing interests.

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Goodyear, L., Rao, R., Huck, J. et al. Decreasing respiratory device-related pressure injuries in the NICU using 3D printed barrier templates. J Perinatol (2024). https://doi.org/10.1038/s41372-024-01878-7

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  • DOI: https://doi.org/10.1038/s41372-024-01878-7

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