Babies that are choking-- HELP PLEASE!!

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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.

One of the first things that happened to me upon my transfer from cardiac care to delivery/pp/nursery, was exactly what you describe. One infant had a laryngospasm, probably from trying to raise a plug...Anyway, my instinct was to get in there and "do something." But, after doing all the things you described, one old and seasoned nursery nurse told me something that made good sense. It is a spasm so try to calm the baby and it will pass. I thought she was bonkers, but she was right. She held him, talked gently to him and rubbed his head and all was well. Sometimes you have to calm them and I have found this to be true often..

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Specializes in NICU.
One of the first things that happened to me upon my transfer from cardiac care to delivery/pp/nursery, was exactly what you describe. One infant had a laryngospasm, probably from trying to raise a plug...Anyway, my instinct was to get in there and "do something." But, after doing all the things you described, one old and seasoned nursery nurse told me something that made good sense. It is a spasm so try to calm the baby and it will pass. I thought she was bonkers, but she was right. She held him, talked gently to him and rubbed his head and all was well. Sometimes you have to calm them and I have found this to be true often..

I agree, I sit a baby up, or turn it to it's side, and give it chance to clear it's own airway. Frequently, they'll choke during or shortly after a feeding. We tell the parents that that the baby probably found a chicken bone. ;)

I don't think it helps using a bulb syringe immediately, if a babe is flailing, gagging and choking, it needs to be centred and calmed first. So do the parents and the nurse.

If it doesn't clear in 30-60 secs, then it's time to do something else. It's rare that a baby would need to be deep suctioned. If he/she was going to aspirate, then it's already happened. The doc should be notified, and in our hospital, we might observe the baby in the nursery for a few hours.

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Specializes in Maternal - Child Health.
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?

I think we're talking about apples and oranges here. The technique you describe is appropriate for delivery room management of meconium only.

You are correct that many of us use the term "deep suctioning" inappropriately. If a bulb syringe is insufficient to clear the airway of a choking infant, then a suction catheter which can be threaded deeper into the UPPER airway may be needed. That is what we are discussing here. Suctioning below the vocal cords (with or without an ETT) is never appropriate outside the delivery room.

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I think we're talking about apples and oranges here. The technique you describe is appropriate for delivery room management of meconium only.

You are correct that many of us use the term "deep suctioning" inappropriately. If a bulb syringe is insufficient to clear the airway of a choking infant, then a suction catheter which can be threaded deeper into the UPPER airway may be needed. That is what we are discussing here. Suctioning below the vocal cords (with or without an ETT) is never appropriate outside the delivery room.

That was the way I understood it, too. I got a little worried - wondering if people were routinely intubating babies to clear them out and thinking that no, that wasn't how I learned it...

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Nope, no one routinely intubates babies, naturally. But if a kid is choking on tons of mucus plugs, hours after delivery, it is hoped that a PP or mother/baby nurse would, after not being able to relieve them by the usual ways, be comfortable in deep suctioning. That is, at least, what I thought people were saying? And if one is not comfortable with relieving choking or caring for a baby who is "blue" (and knowing it may be simple or something more) needs a refresher in training perhaps. I am also reminded cardiac lesions--- (of which we may be unaware at birth)----can sometimes not show ill effects for 12-24 hours. (babies going blue). We ALL need to know this and know how to act accordingly, as well. JMO.

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Nope, no one routinely intubates babies, naturally. But if a kid is choking on tons of mucus plugs, hours after delivery, it is hoped that a PP or mother/baby nurse would, after not being able to relieve them by the usual ways, be comfortable in deep suctioning.

Agreed, absolutely. It's not that hard to drop a small suction catheter down into the upper airway / oropharynx and clean out a bunch of goo for a new baby. Usually we do this inside the nursery, just in case of a problem (like a vagal response) because that's where our neonatal resuscitation equipment is.

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You're right. I'm talking about the suction catheter, not probably the type of deep suctioning they use in L&D. Sorry!

I think we're talking about apples and oranges here. The technique you describe is appropriate for delivery room management of meconium only.

You are correct that many of us use the term "deep suctioning" inappropriately. If a bulb syringe is insufficient to clear the airway of a choking infant, then a suction catheter which can be threaded deeper into the UPPER airway may be needed. That is what we are discussing here. Suctioning below the vocal cords (with or without an ETT) is never appropriate outside the delivery room.

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