Re: VLBW infants and positioning

Gotcha...we don't turn their heads...in my unit midline means belly up, head up. Most kids on the osc. are on their backs anyways....we don't turn them side to side, our little ones are like this until they get all their survanta doses, and aren't getting frequent chest xrays. We make a nest for them, like a huge O and lay them in the middle so they stay how we have them. I hate that big fat oscillator tubing.

Re: VLBW infants and positioning

What Steve posted makes sense, as to why it would be better positioning to keep them midline.

I think this is our policy although it's not really enforced. I'm still pretty new and my preceptor never really enforced this with me ..... I should ask her though. The other day when I was admitting a little 24 weeker (my first major admit like that, scary!), my pod partner (a traveler) was yelling at me because the baby's head was to the side. Sheeesh. "At our old hospital we kept all the babies midline". "At our old hospital we did this .... and we did that". Everything was so good there, huh? And we do everything so wrong? Well then go back there for goodness sakes! But anyway, that's a bit off topic lol.

I'd like to see more research too .......

Re: VLBW infants and positioning

Our director would have a cow if he saw oscillating babies on anything but their backs.

Re: VLBW infants and positioning

At the 30 bed Level III perinatal regional center NICU I worked in before I came to where I am now, we definately kept the baby's head midline with their body for at least the first 3 to 5 days. We would keep them positioned on their right or left side or we would have them lie supine and use the "Angel Frame" to help hold their ET tubing in such a way as to keep the babies facing midline. The same company who makes the "Angel Frames" has a new one made just for high frequency oscillators; I saw them at the Neonatal Network Nursing Conference this past September. Where I work now they don't have "Angel Frames" so the poor babies usually lie flat and face either right or left. I do my best to be assigned these tiny babies so I can position them on their sides so they can stay midline as much as possible the first few days. I don't have any research to back this up but as I understand it, having their head turned sharply away from midline increases venous pressure in the neck veins. I remember learning this from the Clinical Nurse Specialist at my previous NICU. When I think of it in a physiological perspective it really does make sense, especially when I think about how very fragile their germinal matrix is during the first few days. I hope SteveRN21 can supply us with the information he has because I'd love to take it to the small NICU where I work now!

Re: VLBW infants and positioning

Before there were "angel frames", we used to take that thick "umbi tape" and thread it under the connection from vent to ET tube and suspend it from the overhead part of the warmer. Don't know if that helps...

Re: VLBW infants and positioning

We still do the hang from the warmer or top of the isolette when we need too.

Re: VLBW infants and positioning

I had an oscillator kid for the last four days and I turned him every three hours - left side with head midline, supine midline, right side with head midline. Yes, it's a pain in the butt to do it, but they shouldn't be left in one position for days at a time. It does require extra help to turn because of the inflexibility of the HFOV tubing, but it's definitely doable.

Re: VLBW infants and positioning

Originally Posted by cathys01

I had an oscillator kid for the last four days and I turned him every three hours - left side with head midline, supine midline, right side with head midline. Yes, it's a pain in the butt to do it, but they shouldn't be left in one position for days at a time. It does require extra help to turn because of the inflexibility of the HFOV tubing, but it's definitely doable.

Now, that's something we do have a policy on, and we don't turn oscillator kids very much because they're usually unstable. They need to have their heads facing the vent because of how stiff the tubing is - it's up to us if we have them on their backs, side with head midline facing vent, or on their abdomen (rare). When they first go on HFOV, we don't turn their heads for 24 hours. Then after that, it's Q12H for turning. It just takes so much to turn the whole baby around in the bed (the vent always stays on the same side of the bed) and many of them don't tolerate the turn well at all. So instead we use gel pillows and things like that to keep pressure off the skin for those long hours spent in the same position. We rarely see skin breakdown on these babies' scalps unless they're extremely edematous.

Re: VLBW infants and positioning

I should clarify that this was a 29 weeker that was 2 days old when he went on the oscillator. He was fairly stable (no pressors, etc), but his gasses were crappy. He was on nasal canula, then CPAP, then Servo, then HFOV - then his gasses stabilized and yesterday we were weaning and getting him ready to move back to traditional vent.

We still do try to turn the patients if we can, even the micros before DOL 3, but no prone positioning because the head can't be midline if they are prone. It seems to me that the kids are always calmer if they are on their sides than supine for some reason. We are definitely taught that the turning of the head can increase the risk for IVH, so we don't do it.

Re: VLBW infants and positioning

SteveRN21, I would be very interested in your protocol. We do keep our infant's midline for about 72 hours and if they are stable we will place them on their abdomen. We provide nesting to all our infant's no matter what size or GA. We use snugglies and artificial sheepskin to protect them.