Suctioning of ETT on < 27 weekers?Register Today!
- by Bortaz, RN Mar 17, '12I was recently having a discussion with one of our Neos following the death of a 23/24 weeker on our unit. The doc told me he wanted us to stop suctioning the ETT on the babies if they were under 27 weeks adjusted.
After further discussion, he clarified that we should only be suctioning if we see goop in the tube.
Several other things re: sx that have come up lately...
We were told to stop using NS bullets when we sx. I've since read that it's the consensus opinion that the NS causes inflammation.
We've begun placing the HFJV in standby while we sx. Reading the Bunnell website, I find that this is indeed the recommendation from the company.
What is the practice on your units? Do you suction the ETT on your micropremies? Use NS bullet? How about the HFJV?
Our unit is sometimes very far behind the curve and not up to date on best practices, but I'm doing my best to try to get us caught up. Resistance to change is strong, however.
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- Mar 17, '12 by babyRN.It is our policy *not* to use saline for any reason now, but some folks use it occasionally when there are plugs. Certainly it should not be used in routine suctioning and people are very good about that. It used to be that people woudl put ice-saline down the ETT for pulmonary hemorrhage, but we also do not do this anymore as well (go up on the PEEP).
We don't use jets, but use HFOV and keep the machine on while we suction. Seems like a lot of work to put it on stand-by, suction, and then hit the start button again, especially if the kid is super sensitive. We use only in-line suctioning for HFOV too (we don't routinely use in-line for kids on conventional vents).
As far as suctoning on micropreemies, that kind of policy is a little scary to me because what if you get a plug but don't see anything in the tube outside the mouth? How often would you suction? Unless I hear coarse crackles, see decompensation, other clinical signs, etc, I only suction about an hour prior to getting a blood gas or at least once a shift. I do try to leave it alone as I can so to help decrease infection rate, potential accidental trauma, stress, and that saying that the more you suction, the more you get out with a never-ending cycle. Some kids, this is not practical at all, of course, but there are fair many that do well with minimal suctioning.
- Mar 17, '12 by NicuGalWe will go 6-8 hours without suctioning many times. RDS is not a mucus producing problem. Sometimes after they are initially placed on the high freq they will rattle up some old secretions.
EBP shows that you should not routinely use saline down tubes...this can actually wash down anything colonized in your tube. We will use it if the baby does have some obnoxious secretions or we lose chest wiggle and it isn't related to positioning or tube placement.
We use inline suction on all our babies. We have to have a written order to take them off the vent. You shouldn't be doing this routinely or even at all if you can avoid it as you will get atelectasis rather quickly, esp with small babies.
Why would they want to stop suctioning? I can see routine suctioning, which should be a no no due to increasing stress and increasing BP that can lead to IVH.
- Mar 17, '12 by NICU_babyRNThere is a difference in suctioning HFOV and HFJV!!! You must put the Jet on standby but not the Oscillator.
We never instill saline in the lung. We use it only to clear the ballard catheter, being careful to not to let it pass to the ET tube.
We suction as little as possible when babies are micros. But we have no specific rules on <27 weeks.
- Mar 17, '12 by karnicurncLike the others, we do not routinley instill NS into the ETT, but rather use it to clear the suction tubing. We use inline suction on all vented babies to decrease VAP. We do not stop HFOV to suction for the reasons listed above. We have gradually moved to a practice of suctioning as needed as opposed to routine suctioning on all vented babies. I listen first to see if suctioning is warranted. It is very traumatic for the babies, as you know. Good luck with changing practice in your NICU!
- Mar 21, '12 by EricJRNWe've moved away from scheduled or routine ETT suctioning. Most of our kids <1 kg on conventional vents don't have Ballards. (Policy says that a Ballard on a kid <1 kg is at the RT's discretion, but the RT will make the doc write an order if they want one. The concern is that shifting of the weight of the Ballard may increase the risk of unplanned extubation.)
Our policy is to avoid NS except in very thick secretions, but I don't think our compliance is 100% on that one. We've also recently stopped administering cold saline for pulmonary hemorrhage. We don't currently use the jet.
- Apr 2, '12 by bmsrnI've never used NS bullets when suctioning, I only use it to clear the ballard. A lot of the older nurses and RT's do though- and by older I just mean those that have been doing this for a long time.
Our unit doesn't have any kind of policy on routine suctioning, and nothing for gestational age either. Everything is done as needed. I will suction at least once a shift though, just too see what kind of secretions there are, if any.
I didn't know that the jet had to be put on standby to suction? We don't have kids on jets that often, if I recall though, I think the way ours are set up- it takes 2 people to suction because there is no in-line for it. Who knows though, there are always new adapters they seem to have?
- Apr 14, '12 by NICURN29We only use NSS to clear the inline suction catheter. We do not instill NSS into the airway.
If you hold suction on the way in and on the way out while suctioning on the jet, you do not need to put it on standby to suction. The educator from Bunnell who oriented us to the jet recommended this method over placing the jet on standby.
- Aug 13, '12 by luvsnicuWe absolutely do not do routine suctioning on any baby of any gestation. With a little micro, I only suction as a last resort (baby desatting and doesn't come up, bad gases, etc.). Too risky due to IVH, pulmonary hemmorhage, etc.
Our facility uses both HFJV and HFOV. And yes, with Jet vents, you absolutely should put the vent in standby mode (the baby still gets conventional support, just not high-freq), suction quick, and then turn back on. If you don't put it in standby mode when suctioning, the vent can sense that its not able to give the ordered amt of pressure and will try to compensate, thereby increasing your risk of pneumo. At least, that's my understanding of the Jet. They are pretty complex machines, but work great!