Endotracheal Intubation Protocols vs guidelines

[KristineRN,NICU]

Hi all! I am on our clinical practice committee and am revising an old protocol on endotracheal intubation. Our current protocol is mainly steps for intubation, which is performed by residents, NNPs, or transport RNs. So, I am looking to see what other NICUs do for this - should we scrap the protocol and just write a NICU guideline for setting up/assisting with the procedure, or keep a formal protocol and just leave out the actual intubation steps? Please let me know what you have in place in your NICU... Thanks! ps- any EBP/references you have would be helpful too!

[umcRN, BSN, RN]

hmm i haven't noticed any kind of protocol for intubation in my NICU. Basically the doc decides they're going to do it and the course is based on the reason. Is it sudden respiratory failure? Then rt is bagging, meds (fentanyl/versed) are given if there is time and the doc/nnp intubates. Is the kiddo teetering on vapotherm/cpap and has worsening ABG's and resp deterioration? If thats the case things go a little slower, meds get drawn up and given (fent/versed until kiddo seems appropriately knocked out) and then said person intubates, but really, there is no protocol that I have ever seen.

In the cardiac ICU (still many babies) they have a bit more of a written protocol and use rapid sequence intubation procedures - kiddos get fentanyl/versed then vec, and also a dose of atropine during the attempt. A time out procedure is used with nursing documentation of that.

[karnicurnc, MSN, APRN, CNS]

We use an RSI policy. It works well.

[NicuGal, MSN, RN]

We don't have a protocol for intubation, we use NRP guidelines on size of blade, depth, etc. We cover certain things in our VAP pathway, such as not laying the larygnoscope on the bed, etc.