The core causes of facial pressure ulcers during long-term nasal oxygen tube use are prolonged localized pressure, friction, and a moist environment. A sound fixation method should be designed around the three core objectives of "distributing pressure, reducing friction, and maintaining dryness." This involves a comprehensive protective system, encompassing material selection, structural optimization, and dynamic adjustments, to reduce the risk of pressure ulcers. First, the properties of the fixation material directly determine its fundamental impact on the skin. Ideally, the material should be soft, breathable, and moderately elastic. Soft silicone or medical-grade polyurethane materials can conform to facial contours, avoiding the localized pressure of hard materials on prominent areas such as the nose and cheeks. A cotton or breathable non-woven fabric fixation strap can reduce the feeling of stuffiness between the skin and the material, preventing sweat accumulation that can weaken the skin barrier and reduce the risk of moisture-related pressure ulcers. Furthermore, the material must exhibit good biocompatibility to avoid allergic reactions that can cause redness, swelling, and itching, which can weaken the skin's tolerance to pressure. After all, skin inflammation caused by allergies can make localized tissue more susceptible to damage from pressure.
A rational fixing structure is key to pressure distribution. The nasal prongs and straps of nasal oxygen tubes should be designed to avoid areas of the face prone to pressure ulcers. The prongs should be curved, conforming to the physiological curve of the nose, rather than being pointed or flat. This increases the contact area between the prongs and the skin, distributing localized pressure across a wider area of skin tissue and avoiding concentration of pressure on the thin skin along the sides of the nose. The width of the strap and the distribution of pressure points are equally important. A wide strap (typically no less than 1 cm) distributes pressure more evenly than a narrow strap, reducing the amount of pressure per unit area of skin. The strap should be positioned away from bony prominences such as the auricle and nasal bridge, and should be positioned to apply pressure to areas with thicker soft tissue, such as the cheeks or mandible. The fat and muscle in these areas can better buffer pressure and reduce the risk of tissue ischemia and hypoxia. Some nasal oxygen tubes also incorporate soft pressure-relieving pads at key points where the strap meets the skin to further mitigate localized pressure, creating a multi-layered pressure protection structure: nasal congestion distribution, strap pressure distribution, and pressure-relieving pads.
Dynamic adjustment of the fixation system is crucial for avoiding prolonged pressure on the same area. Even if the fixation structure is well-designed, maintaining the same position for extended periods can still lead to local tissue fatigue. In clinical practice, it is generally recommended to gently adjust the fixation of the nasal oxygen tube every 2-3 hours. For example, by slightly moving the prongs 1-2 mm on either side of the nose or adjusting the tightness and wrapping angle of the fixation strap, the pressure on the previously compressed skin area can be temporarily relaxed and blood circulation restored. During adjustments, care should be taken to be gentle and avoid pulling the skin. This is especially true for elderly individuals with reduced skin elasticity or those who are bedridden for extended periods. Excessive pulling can cause skin breakdown and increase the risk of pressure ulcers. Furthermore, the skin at the contact area should be inspected after each adjustment. If redness, tenderness, or dryness or peeling is observed, the fixation position should be changed promptly and a medical moisturizer should be applied to protect the skin barrier and prevent further damage.
Reducing frictional irritation is also crucial in fixation design. Repeated friction between the skin and the nasal oxygen tube or fixation strap can damage the stratum corneum, making it more susceptible to pressure injuries. Therefore, the edges of the fixation strap should be rounded to prevent sharp edges from rubbing against the skin. The tube should maintain a slight gap between the tube and the facial skin, or be secured to clothing with a clip to prevent repeated rubbing of the tube against the cheek or neck during movement. Some nasal oxygen tubes also feature a smooth coating in the area where the tube contacts the skin to reduce friction between the material and the skin, thus minimizing frictional damage caused by changes in body position during daily activities. Furthermore, the tightness of the fixation strap should be controlled within a moderate range. Too loose can cause the tube to shift and increase friction, while too tight can directly increase pressure, both of which can increase the risk of pressure ulcers. A suitable setting is generally sufficient to allow one finger to be inserted after fixation, ensuring stability without excessive pressure on the skin.
Optimizing the fixation method for specific populations can further reduce the risk of pressure ulcers. For newborns and infants, whose skin is delicate and whose facial contours are small, a dedicated pediatric nasal oxygen tube should be used. The nasal prong size should be matched to the newborn's nose, and the fixation strap should be made of ultra-soft elastic material to avoid skin damage caused by improper size or too hard a material. For patients who are bedridden for a long time and have limited mobility, a dual fixation method of "mandibular fixation + head-assisted fixation" can be used to reduce the possibility of strap displacement due to turning or head movement. Soft padding should also be added to the occipital area or neck to prevent double pressure between the strap and the occipital skin. For patients with minor facial skin injuries, an ultra-thin hydrocolloid dressing can be applied to the affected area before fixation. This not only protects the wound surface but also cushions the pressure and friction of the fixation material on the damaged skin, creating conditions for skin repair.
The maintenance and cleaning of the fixation method also affect the effectiveness of pressure ulcer prevention. Long-term use of the nasal oxygen tube fixation strap is easily contaminated with sweat, sebum, and secretions. These dirt not only reduces the breathability of the material but also may irritate the skin and cause inflammation. Therefore, it's important to regularly clean the fixation strap (if reusable) or promptly replace the disposable fixation component to keep the fixation material clean and dry. Use a mild, neutral detergent when cleaning, avoiding harsh soaps or disinfectants to prevent dryness and sensitivity due to chemical irritation. Also, inspect the fixation material for signs of aging, hardening, or deformation. If the material loses elasticity or has a rough surface, replace it promptly to prevent aging material from causing additional pressure or friction damage to the skin.
When using nasal oxygen tubes for a long time, the risk of facial pressure ulcers can be reduced from multiple perspectives by choosing soft, breathable fixation materials, optimizing the fixation structure to fit the patient's physiologic curves, dynamically adjusting the fixation position to distribute pressure and reduce friction, customizing the design for specific patient groups, and maintaining proper maintenance and cleaning of the fixation system. The core logic of these measures is to reduce the adverse factors of long-term pressure, friction and moisture on local tissues through scientific fixation design, protect the skin barrier function, and maintain smooth local blood circulation, so that the nasal oxygen tube can meet the needs of oxygen therapy while minimizing the risk of skin damage. It is especially suitable for patients with chronic respiratory diseases or people recovering after surgery who need to rely on nasal oxygen tubes for a long time.
