Alarm limits and ROP

Usually 85-95 unless they're a cardiac kid. Term kids are usually 94-98. If they're on .21%, the upper limit can be 100.

For 34 wks the limits are 88-95.

We are very big on not "chasing" our kids, we are big advocates of giving them a chance to recover on their own - within reason.

We have amazing RT's on our unit and I know I am lucky to work in a unit that has a lot of consistency. We do not see alot of ROP on our unit.

When I float to other NICU's I've noticed that everyone is not as comfortable with watching a kid low sat (I'm talking 77-82 or so), and they feel compelled to up the "O's". I guess it is a "unit philosophy" sort of thing.

Hope this helps!:redbeathe

I know .. I'm one of those who will give the baby a minute to see what they do and people have been like...how long are you going to stare at that kid before you intervene? Crap, she's been dipping for a whole 10 seconds...she's fine!

This whole topic goes back to liability, and who is going to blame who for whatever kind of off the wall disorder a former micropreemie may develop. It really burns me up for several reasons. In the olden days, when our upper alarm limits were set at 95 (horrors!) I knew what my patient had averaged for sats throughout the shift, 89 vs 92 vs 95. I did not need a dinging alarm to tell me so, much less a very irritating dinging alarm with a flashing yellow light that did not cease until I had physically turned it off. I don't need an alarm to tell me to wean either. I kinda spent awhile in college so I could figure out how to "think critically!":angryfire

Anyoldhoo. To answer your question, there are kids that are yo-yo's, then there are nurses who turn their kids into yo-yo's, KWIM? I believe our current policy is to increase O's at 3-5% increments, unless in an emergency.

We've done a lot of studies on alarm limits and ROP where I work and the neos have been really happy with the policy of lower alarm limits and decreased eye disease. And decreased laser surgeries! Most preemies are kept between 88-95 until 36 weeks. after than, they can sat higher. This has been a policy for about five years now, although that first year was rough because every other person (rt, nurse, doc) walking by would turn up the Os on a low satting baby.

Yes, we have tons of 'up and down' babies, many who seem to love to sat 78-83--and for the most part, we are not supposed to chase with the oxygen unless the sats stay below 83 for a long period (say five minutes).

We have little laminated signs that say ROSE (reduced oxygen saves eyes) on the monitors of the babies under 36 weeks.

Dawn

Our limits are 80-95 for all babies with oxygen. We are very cautious to increase (or decrease) oxygen. We have a low incidence of ROP.

I can have a baby with sats of 20 and still not increase oxygen. If he/she is on CPAP and not breathing what´s the point....Lots of babies on ventilator are up and down all the time and oxygen levels usually doesn´t change that much...

Anna

We would very definitely increase if the baby's sats were 20, but yes, so many of the babies are so labile that chasing them makes more work and doesn't improve the baby's overall outcome anyway.

I think our policy is to increase by about ten if the baby's sats are in the fifties, but it depends. My little primary can go 59 to 96 in a matter of seconds, so I don't hardly chase him at all.

Dawn

For babies

For babies >32 weeks old on oxygen, limits are set 85-99.

Room air babies are 85-100.

Of course a lot of the cardiac babies and other special circumstances will have the docs writing for more specific guidelines...

Our policies don't state how much to increase by, only where to set the alarms. We are big believers in not chasing the "chronic desaters".

We have protocol that says, give them 30 sec to recover without intervention, then increase O2 by 5% increments every 30 sec until sats are within protocol. 34wks 88-92%. If they are on 21% then limit can be 100%.

Our incidence of ROP have gone WAY down since we started this

My unit uses 3 different sat ranges:

29-34 weeks -- 85%-95%

>34 weeks -- 90%-98%

Of course the high limits are 100% in in room air.

We have seen quite a decrease in the number of ROP cases and/or laser surgery over the past couple of years since implementing these ranges.