The Effect of Development Clinical Practice Guideline on Preventing Endotracheal Tube Displacement and Skin Injury in Neonatal Intensive Care Unit, Nopparat Rajathani Hospital

Abstract

Background: A recent routine practice guideline for nursing care of an intubated neonate in NICU uses a transparent adhesive plaster to prevent skin injury. However, we have found that unplanned extubation occurred at a higher rate in 2020 (29.1%). An updated practice guideline was revised. Objective: In this study, we aimed to compare the rate of unplanned extubation and skin injury between the updated practice guideline and routine practice guideline Method: A non-randomized intervention research with historical controlled was conducted by collecting data from 32 cases with routine guideline from October 1, 2020, to September 30, 2021.The other group’s data, consisting of 73 cases with the updated guideline, were collected from October 1, 2021, to September30, 2022. The data collected from both groups were baseline characteristics, disease, rate of unplanned extubation, skin injury and followed up to 72 hours after intubation. Multivariable rate regression and multivariable proportion difference regression were compared between 2 groups. Results: 105 cases were analyzed. Baseline characteristics, birth weights, birth asphyxia rate, duration of intubation and excessive salivation were different. When adjusted with statistical methods, updated guideline had a decrease rate of unplanned extubation from 100 times to 4.18 times per 100 hour of plaster applied time. (95%CI -0.48,36.59 time per 100 hours of plaster applied time) And rate of skin injury was decreased for 2.3% (95%CI -13.18,8.57) Conclusion: Updated practice guideline tends to decrease the rate of unplanned extubation and skin injury but there is no statistical significance. More participants are needed in order to establish the precise results.