Babies that are choking-- HELP PLEASE!!

[LINUS]

I've been working in a mother/baby unit for almost a year now. I love my job, but on occasion a baby in the nursery will start making choking sounds out of the blue (in their sleep sometimes). Usually turning them on their sides and patting their back will loosen whatever is caught and it comes up no problem. But, on rare occasions, the baby can't gt it up and they start arching their backs and turning blue in the face. Usually there is a seasoned nurse around that I can turn to for help, but it still scares the heck out of me and brings back a fear of going to work the next day. When this happens, I freeze and can't think of what I should do. Usually we can suction the baby and give it O2 and it's fine, but I'm worried about suctioning because I've never had to do it before. Any suggestions or helpful hints on clearing the baby's airway any easier??? We have bulb syringes in the cribs, but we've always been told NOT to use it down their throats, only in the mouth.

[dawngloves, BSN, RN]

My guess is that they are coughing up all the maternal junk in their lungs and belly. I suggest you get a preceptor or charge nurse ASAP to show you how to deep suction. You may find yourself alone one day.

[Jolie, BSN]

Dawngloves is absolutely right: you need someone to inservice you on this immediately, and set up a practice session on suctioning.

Are you not NRP certified? Suctioning is covered in that course.

Perhaps attending some deliveries with an experienced nurse would afford you the opportunity to observe and learn suctioning techniques.

You need to be able to teach parents how to handle choking episodes and how to use the bulb syringe. That should be part of your basic DC teaching routine.

[LINUS]

I know how to use the bulb syringe and I do teach parents how to use it as soon as they're admitted to my unit. My hesitation is when to use the wall suction to deep suction. I don't want to use it if it's not necessary because I've heard horror stories about how that can cause a baby to have a vagal response. That's what scares me. Also, I did take NRP when I first started on the floor, before I was a new grad, still in orientation, and I was so overloaded with so many things all at once. Since we never (knock on wood) have to resuscitate our babies, it's not always the first thing on my brain. I still new at this....

[Jolie, BSN]

I know how to use the bulb syringe and I do teach parents how to use it as soon as they're admitted to my unit. My hesitation is when to use the wall suction to deep suction. I don't want to use it if it's not necessary because I've heard horror stories about how that can cause a baby to have a vagal response. That's what scares me. Also, I did take NRP when I first started on the floor, before I was a new grad, still in orientation, and I was so overloaded with so many things all at once. Since we never (knock on wood) have to resuscitate our babies, it's not always the first thing on my brain. I still new at this....

Then you definitely need a review. If the bulb syringe is insufficient to clear the baby's airway, then suctioning is needed. Again, I think attending deliveries with an experienced nurse will offer you the best opportunity to observe and practice this technique in short order, as it is required in the DR far more frequently than on the floor or in the nursery. Ask your manager or nurse educator to arrange this for you. Good luck!

[BETSRN]

I know how to use the bulb syringe and I do teach parents how to use it as soon as they're admitted to my unit. My hesitation is when to use the wall suction to deep suction. I don't want to use it if it's not necessary because I've heard horror stories about how that can cause a baby to have a vagal response. That's what scares me. Also, I did take NRP when I first started on the floor, before I was a new grad, still in orientation, and I was so overloaded with so many things all at once. Since we never (knock on wood) have to resuscitate our babies, it's not always the first thing on my brain. I still new at this....

You need to keep current with your resuscitation skills. Even though you may never use them. I like the idea of you shadowing some of the L&D nurses who go in to be a second in a delivery so you can see what is usually done to a normal newborn (not usually too much) and those who need more aggressive resuscitation.

Often on the PP side of things babies can choke on mucous plugs and turn blue. Happens quite frequently, actually. You NEED those deep suctioning skills lest you have to rely on them. You may not have to do it often, but you HAVE to be able to do it and not go running looking for help BEFORE you start to intervene. Don't worry. Most babies do fine....it's just scary when it is happening.

Please do not say "we never have to resuscitate our babies." It can happen at the blink of an eye to normal, healthy newborns at any time after birth (not just right after). It is never a good idea to become too complacent.

I do not mean to scare you, but to make you aware that this is not an issue that resolves once the baby leaves the DR area (or however you are set up). This can happen two and three days later. So that is why nurses in all areas of OB need to have and maintain these skills. Where I work, we have to be recertified in NRP every two years (or we can not keep our position). I believe that is pretty much the standard. If it is not, you are in an unsafe environment.

[LINUS]

Thanks for the help. We have to do NRP every two years too, but I think we have to take a refresher course every year. I've already signed up for one, but it still scares me when the babies choke. I've deep suctioned twice (with a more seasoned nurse standing by my side. I'm just afraid of the vagal thing that I hear so much about. Does that really happen?

You need to keep current with your resuscitation skills. Even though you may never use them. I like the idea of you shadowing some of the L&D nurses who go in to be a second in a delivery so you can see what is usually done to a normal newborn (not usually too much) and those who need more aggressive resuscitation.

Often on the PP side of things babies can choke on mucous plugs and turn blue. Happens quite frequently, actually. You NEED those deep suctioning skills lest you have to rely on them. You may not have to do it often, but you HAVE to be able to do it and not go running looking for help BEFORE you start to intervene. Don't worry. Most babies do fine....it's just scary when it is happening.

Please do not say "we never have to resuscitate our babies." It can happen at the blink of an eye to normal, healthy newborns at any time after birth (not just right after). It is never a good idea to become too complacent.

I do not mean to scare you, but to make you aware that this is not an issue that resolves once the baby leaves the DR area (or however you are set up). This can happen two and three days later. So that is why nurses in all areas of OB need to have and maintain these skills. Where I work, we have to be recertified in NRP every two years (or we can not keep our position). I believe that is pretty much the standard. If it is not, you are in an unsafe environment.

[Jolie, BSN]

Thanks for the help. We have to do NRP every two years too, but I think we have to take a refresher course every year. I've already signed up for one, but it still scares me when the babies choke. I've deep suctioned twice (with a more seasoned nurse standing by my side. I'm just afraid of the vagal thing that I hear so much about. Does that really happen?

I think you are getting way too hung up on the POSSIBILITY of a vagal response in a baby who is KNOWN to be choking. If that kid's airway doesn't get cleared pronto, his heart rate will be guaranteed to drop, resulting in bradycardia secondary to respiratory insufficiency caused by the obstruction. Failure to correct this situation will eventually result in secondary apnea, a situation far more worrisome than a vagal response.

Yes, vagal responses do occur, although, in my experience not too often. As you are suctioning, you can hold your breath and only suction as long as you can comfortably do so. That helps to prevent overly-long suctioning passes. If you see evidence of a vagal response such as gagging, or color change, simply stop suctioning, and take the measures outlined in NRP or your hospital's policy to assist the baby in recovering, such as tactile stim, and blow-by O2.

And once the baby begins to cry, rest assured that you have cleared the obstruction from the airway. Assess the need for bulb syring clearing of the mouth and nose, and continue to monitor the baby's respiratory status.

You can do this!

[dawngloves, BSN, RN]

Jolie is right. You always gotta think ABC. Airway Breathing Circulation.

I've only seen a vagal response a couple of times with deep suction and it's been when the baby was a couple of minutes old. Just a dip in the heart rate that immediatly came back up after the suctioning. Not really a big deal. I've never heard of a baby dying from deep suctioning. I think when you are more confident you won't worry so much.

[SmilingBluEyes]

I like the idea of your catching LOTS of babies. the more you are there to recover after birth the more confident you will become. Like they said, keep it basic, ABC's always. Never be afraid to deep suction if you can't relieve the choking with a bulb and stimulation of the baby. If you are unsure, you need to get into a lot more deliveries with experienced people....the more you do, the more, ABC you practice time and time again, the more confident you become.

[javanurse2000, BSN, RN]

Although I am a nurse, this response is more from a mother. During the first month of my third childs life the very thing you are describing would happen at home. I called my pediatrician really freaked out...she's choking...turning blue, arching back the whole thing...it seemed like she was holding her breath or unable to take a breath somehow...frightening to watch (years before I went to nursing school). I can remember doing all kinds of things to try to get her to take a breath. Like I said, I did contact the pediatrician...his response was if she's not limp then she's breathing. She grew out of it and we ended up with a family doc we've had for almost 10 years now. Bulb suctioning was never suggested nor did he want to examine her d/t her symptoms. I also want to comment that my baby never "brought anything up" either gastric or pulmonary.

[Mommy2Katiebaby]

I'm comfortable doing oropharyngeal suctioning, and do have an NRP, but where I work they reserve the term "deep suctioning" for a post-intubation suctioning, like with thick mec. As far as I know, that's the only way to really clear the trachea if there's something plugging it - with an ET tube. That said, the RN's on my postpartum unit do NOT do ET intubation, so we really do need help if a baby turns blue on us. What's everyone's opinion of this?