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Any tips for preventing unplanned extubations while turning babies?

NICU   (365,479 Views 10 Comments)
by JJ1994 JJ1994 (Member) Member

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I've been a nurse in the level 3 NICU since January. One of my biggest issues is turning intubated babies. I am terrified of an unplanned extubation. The more experienced nurses in my unit tell me that you just get used to doing it. I've been asking an RT for help when my babies need to be turned, but they are getting frustrated at my requests for help, which I understand. I was hoping some of you would have some tips for turning these babies?

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They’re right. You will get used to it but it’s always good to have a healthy respect for the procedure. I had a way of doing it with the itty bittys but it’s kind of hard to explain. I would gently put my hand over their face with the ETT clamped between my first and middle fingers and my thumb and third finger on either side of their faces,  not really squeezing their cheeks but securing. Writing it out it sounds terrible but it wasn’t in real life and I managed to never extubate a baby even when transferring into and out of a transport isolette. Hope this helps. 

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meanmaryjean has 40 years experience as a DNP, RN and specializes in NICU, ICU, PICU, Academia.

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1 hour ago, Wuzzie said:

They’re right. You will get used to it but it’s always good to have a healthy respect for the procedure. I had a way of doing it with the itty bittys but it’s kind of hard to explain. I would gently put my hand over their face with the ETT clamped between my first and middle fingers and my thumb and third finger on either side of their faces,  not really squeezing their cheeks but securing. Writing it out it sounds terrible but it wasn’t in real life and I managed to never extubate a baby even when transferring into and out of a transport isolette. Hope this helps. 

Came here to say exactly this ^^^^^^

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NICU Guy has 4 years experience as a BSN, RN and specializes in NICU.

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1 hour ago, Wuzzie said:

They’re right. You will get used to it but it’s always good to have a healthy respect for the procedure. I had a way of doing it with the itty bittys but it’s kind of hard to explain. I would gently put my hand over their face with the ETT clamped between my first and middle fingers and my thumb and third finger on either side of their faces,  not really squeezing their cheeks but securing. Writing it out it sounds terrible but it wasn’t in real life and I managed to never extubate a baby even when transferring into and out of a transport isolette. Hope this helps. 

That's three votes for the Wuzzie Technique. 

 

3 hours ago, JJ1994 said:

I've been asking an RT for help when my babies need to be turned, but they are getting frustrated at my requests for help

But if you are moving the intubated baby for skin to skin with mom, definitely do not do it without RT or another nurse helping you.

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Coffee Nurse has 10 years experience as a BSN, RN and specializes in NICU.

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I've definitely used the Wuzzie technique before too.  Alternatively, just make sure your tape is nice and secure, and that the vent circuit won't get caught on anything and start pulling.  If you have a feisty kid, make sure they can't get their hands up and grab the tube.  Then just take it slow and keep a close eye on your tape/tube as you move the baby.  It's one of those things you'll get used to with experience.

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NICU Guy has 4 years experience as a BSN, RN and specializes in NICU.

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2 hours ago, Coffee Nurse said:

I've definitely used the Wuzzie technique before too. 

I am going to start calling it the Wuzzie Technique when I teach my orientees. I would love to see how far the term will spread. I think that it would be hilarious if Wuzzie visited a NICU in another state and the nurse says "We use the Wuzzie technique to re position our intubated babies".

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8 hours ago, NICU Guy said:

I am going to start calling it the Wuzzie Technique when I teach my orientees. I would love to see how far the term will spread. I think that it would be hilarious if Wuzzie visited a NICU in another state and the nurse says "We use the Wuzzie technique to re position our intubated babies".

Okay this totally made my day!!!!😍

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All of our intubated babies get 2 person care, usually an RN and an RT. The RN does the turning and the RT tends to the tube, it’s helps prevent accidental extubation.

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Coffee Nurse has 10 years experience as a BSN, RN and specializes in NICU.

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On 10/30/2019 at 10:26 PM, NICU Guy said:

I am going to start calling it the Wuzzie Technique when I teach my orientees. I would love to see how far the term will spread. I think that it would be hilarious if Wuzzie visited a NICU in another state and the nurse says "We use the Wuzzie technique to re position our intubated babies".

I'm trying to think of a plausible backronym to boost credibility, but all I can come up with is W-U-Z-Zero Incidental Extubations.

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vintage_RN has 3 years experience and specializes in NICU.

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all of our Intubated babies are RT/RN handles. We’ve see our unplanned extubation rate decline dramatically since introducing this.

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