auscultating on HFOV

[pooperscooperrn0624]

Do you auscultate breath sounds for your infants on HFOV? If so, what method do you think is best? Our RT's say the sensormedic manual says there is no accurate way to assess lung sounds. We listen and feel for equal vibration. My nicu friend says their unit actually charts "clear and equal" on hfov. Our neos says this is impossible to tell.

[EricJRN, MSN, RN]

We use 'unable to assess due to HFOV.'

[AYEL]

It's Impossible To Auscultate The Breath Sounds Due To Vibration Given By Hfov.

[lovemyjob]

we chart that they are on the HFOV and use GCW to indicate good chest wiggle. When it comes to heart sounds, I have seen some people hit the stop button... maybe its the reset button. but they put it on hold so it they vent stops and they can listen.

[RainDreamer, BSN, RN]

You can't auscultate while they're on HJFV/HFOV .....we just put we're unable to assess due to HFJV/HFOV, and "mechanical loud" is what we use for breath sounds ...... we just make sure they're equal in all quadrants, and the baby has good chest wiggle.

Stopping a HJOV doesn't seem right, because I was told by an RT that it takes 4 (maybe 6, I can't remember exactly) HOURS for the lungs to reach maximum expansion/ventilation. And any time the oscillator is stopped, it takes that long to get it back up there. That's why we never disconnect the oscillator, even when turning the babies.

[SteveNNP, MSN, NP]

Our neos told us that you can tell the difference between wet and normal BS, because the sounds change from "helicopter" to "helicopter flying through snow"... regardless of that, we chart either "clear, vibration equal", or "coorifice, vibration equal". I will pause the HFOV for 1-2 seconds to listen for bowel sounds, murmurs, and to make sure I have an accurate HR. I believe it takes longer than 1-2 sec to derecruit the airspaces.

[NicuNightRN]

We chart that the auscultation is deferred due to HFOV. The Neo's and NNP's will pause the vent to auscultate, and I have seen RT's listen over the vent. I just look for a good chest wiggle.

[BittyBabyGrower, MSN, RN]

We rarely, if ever stop it to listen. We just put an * and unable to assess due to high frequency/oscillatory ventilation. This is includes heart sounds, bowel sounds (which you really need about 30-60 seconds to assess), and sometimes peripheral pulses on a really tiny ones as their whole body just vibrates. Under Breath sounds we put Jack Hammer and equal. We chart the chest wiggle also. We also use inline to decrease TV loss when taken off for suctioning. Only time we disconnect from the osc is if the neo wants to listen, then we bag the heck out of them....gotta love being a human osc! LOL

[wjf00]

Stopping a HJOV doesn't seem right, because I was told by an RT that it takes 4 (maybe 6, I can't remember exactly) HOURS for the lungs to reach maximum expansion/ventilation. And any time the oscillator is stopped, it takes that long to get it back up there. That's why we never disconnect the oscillator, even when turning the babies.

You are absoloutly right, stopping HFV is bad practice. Every Neo I have asked says dont do it.

[trishkellyo]

The cool thing about oscillator is that even when it is paused, the infant is still getting the MAP. You don't have to worry about derecruitment unless you disconnect the infant or suction. Pausing the oscillator briefly to listen to bowel sounds is completely ok. Check out this link so you have a visual of how the oscillator works. Play close attention to the MAP measurement in the window.

[MegNeoNurse]

The cool thing about oscillator is that even when it is paused, the infant is still getting the MAP. You don't have to worry about derecruitment unless you disconnect the infant or suction. Pausing the oscillator briefly to listen to bowel sounds is completely ok. Check out this link so you have a visual of how the oscillator works. Play close attention to the MAP measurement in the window.

This is what I was informed of as well, from RT and our NNPs. The MAP is what keeps the alveoli recruited when the HFOV is paused.

[heartwort]

I listen. Your not detecting "clear and equal" but you can hear decreased vibrations in an area that is atalectic, it can raise red flags for pneumos and if the left side is down your patient might be right main-stemmed. Sight and feel can be of limited usefulness in very small babes as it takes very little to make them vibrate from head to toe. Listening is just one more piece of the big picture.

I agree with pausing (not disconnecting). I do it at least once a shift to do a quick assessment of heart and bowel sounds.