I have a question...I am a new NICU nurse and have been off orientation about 1 month. Tonight was my first night taking care of an intubated baby on my own and I already feel like I've done something wrong. The baby was a 26 weeker, intubated with a large air leak due to tracheal malasia. I was told he had been dingy on his monitor and was very positional and they increased his vent supprt that day and he was doing much better (was bagged 3x the previous day). Also I was told his abdominal circumference increased 1.5 cm on dayshift, no aspirates or spit ups and they have him a glycerin chipped and he pooped and circumference went back down and was stable. I had no issues from him until about 9p when he started desating at rest...I did oral suction with small amount of clear secretions and he was still desating and HR was dropping so I suctioned his ET tube and got moderate secretions. His sats and Hr increased a little but went back down. I stimulated him, increased his Fio2 and he was having color changes. I bagged him and I suctioned again and large amounts of his feeding came up. I called rapid response, they took over..extubated and reintubated but advanced ET tube .5 cm. all was good...no aspirates, no desats, continued his free dings. Then at 0030 same thing...desats, suctioned and this time I didn't even have a chance to bag him before his feeding was noted in the tube. They deep suctioned and feeding was coming out of his mouth and nose. He was extubated, reintubated and advanced the ET tube another .5 and made him NPO. We later withdrew tube .5 cm because it was in too far. Then the rest of his night was fine. I was able to wean his fio2, no aspirates, no change in abdominal circ. started fluids, etc. but my question is why?? Why was the feeding coming through his et tube?? Did I pull the tube out?? I checked placement and it appeared in place...the tube was cuffless..his air leak was audible. The MD talked to me and I explained the only recent changes were they introduced multi vits and changed his feeding to half breast milk and half formula..he thinks maybe it was an osmalarity issue and decided to hold the multi vit. But I can't help but wonder if I did something wrong?? I checked OG placement each time and checked for aspirate..I even advanced the OG 1 cm. I don't think the OG was misplaced because the MD did an X-ray and said it was fine. He also said belly looked good on the X-ray. Was it reflux? Did I extubate on accident?? I just need some peace of mind..I feel like I did all I can do but being a new nurse I wonder if I missed something. Any advice? Please be kind..I'm obviously shaken up a little.
