Survanta question

Specialties NICU

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Hello! I have been a "lurker" here for quite some time and thought it was about time I should start posting and adding to the discussions! I work in a 29 bed Level 3 NICU in West Virginia.

I was wondering if any of your units have a protocol on whether an infant that needs to be on NCPAP and also needs Survanta is intubated each time the Survanta is given, or, do you intubate the infant, leave on either a HFOV or a Conventional Vent and then place on NCPAP after the last dose of Survanta? We are using NCPAP much more than vents lately (with great results!) and have questioned what should be done. Also, do any of you give Survanta to a certain gestational age infant (such as 24-25 weeks to 34-35 weeks) routinely?

Susan

We will intubate just to give Survanta and if a second dose is needed reintubate.They are left on a conventional for about 30 minutes. We give it up to about 32 weeks. It really depends on the kiddo. We've even given it to a 36 weeker and had 30 weekers that didn't need it.

prmenrs, RN

4,565 Posts

Specializes in NICU, Infection Control.

We intubate, give surfactant, and extubate right away. Then use a non-invasive form of ventilation--e.g. Nasal SIMV. We often start Indocin, and nutritional support the first day.

nurseiam

150 Posts

Specializes in NICU, PICU,IVT,PedM/S.

Anthing less than 28 wks is intubated in the del room and given survanta. Indocin is given in the first 30 minutes. 32 wks and less depends on the O2 requirement. We stared using a new NCPAP with the little mask, the babies seem to be calmer.

kitty29

404 Posts

How interesting to see how each place does things. We generally intubate if there is RDS at birth and give the survanta as needed. Generally we don't have to reintubate to give a dose after the baby has been extubated (ya know the first round).

Mimi2RN, ASN, RN

1,142 Posts

Specializes in NICU.
Originally posted by nurseiam

Anthing less than 28 wks is intubated in the del room and given survanta. Indocin is given in the first 30 minutes. 32 wks and less depends on the O2 requirement. We stared using a new NCPAP with the little mask, the babies seem to be calmer.

What is the little mask like? We are using CPAP with nasal cannula that look very big in a tiny baby's nose. I felt so sorry for the little guy I had this week. He had a bili mask, and a hat with the tubing velcro'd on. His nose was squished in the middle. It was hard to adjust everything to fit. He didn't complain, though.

He was given surfactant shortly after birth, on a vent for less than a day. It didn't need to be repeated. He's a scrawny little 29 weeker, doing better now.

NicuGal, MSN, RN

2,743 Posts

Specializes in NICU, PICU, PACU.

We intubate, give the survanta, wait to see if a second dose is needed then extubate to NIMV or NC.

When giving the indocin that soon, aren't you concerned about the kid having a duct dependent lesion? We used to give Indocin just based on symptoms until we had one die. I don't know how comfortable I would be with that.

We have been gung ho about starting them on CPAP early, hence the re intubation for Survanta. Of course we've had a couple fail. Why they want to extubate a day old 25 weeker is beyond me and I've said so!So they wait until I leave!:rolleyes:

This is the CPAP we use.

The mask makes the kiddos happier, but they still get breakdown on their bridge and...frenulum? If we see this start to happen we alternate between mask and prongs.

Sorry to high jack the thread!

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