Deep suctioning babies after delivery

SmilingBluEyes · Nov 3, 2005

Our NNP is very hands-on too. I love her; she is a genius and I am always learning something new from her......

I guess the schools of thought just vary. I can't see the harm in using blow-by either.......

JaneyW · Nov 3, 2005

I don't have any sources to cite, but I have read in recent AWHONN publications that blow by is harmful to preemies and near term. They are saying it is more harmful than not using it--something to do with the retinas. I don't know about term babies. We just use an 8fr for suctioning and don't go deep. The last place I worked used a delee. I was taught in school and in new grad training that deep suctioning is not a good idea and not to do it. That is not to say that I haven't seen people do it.

fergus51 · Nov 3, 2005

Here's one presentation I found discussing the matter just by googling. Our neos and nurses are becoming much more judicious in their use of interventions. Even if we assume O2 is beneficial for certain babies, there is no reason to give it to a baby that doesn't need it. Any treatment that is uneccesary is discouraged since it could be harmful. If I gave blow by to a baby with bluish extremities, I'm sure the neo would have a stroke. This is one reason why the new NRP guidelines will de-emphazise colour and recomend O2blenders and pulse oximetry in delivery. Really though, I don't think standard practices will change until us older folks are out of the game.

http://www.aap.org/nrp/pdf/currentcontroversies.pdf

Human studies have shown that O2 delays the onset of a regular breathing pattern in moderately asphyxiated babies. In animal studies, the use of 100% O2 was shown to depress ventilation, increase oxygen consumption and work of breathing and metabolic rate and cause a greater degree of cerebral hypoperfusion in asphyxiated piglets. The free radical stuff is to scientific for me to understand unfortunately, but I have been told that they are toxic to living tissues...

Dayray, RN · Nov 3, 2005

We dont have NNP's in attendance at all our deliveries. Most of the time we dont even have a second nurse. We call a second nurse or the NNP depending on what we are expecting. To get the Neo to come in you have to have like a 24 weeker or complications. Last time I had the neo come in was for a 26 weeker and he at first refused to come in when she was 6cm. Had to remind him that 6cm is plenty to deliver a 28 weeker and he actualy made it.

As for term and uncomplecated babies, I tend to only do what is needed. I rarely give blowby unless they dont pink up fast enough. As for suctioning I'll use the bulb if there are audable noises and the deley if the baby is breathing shallowly or looks like they are haveing troble (they look like they dont know weather to breath or swallow).

I use PPV when they are apnic (of course) and also sometimes when they are lathargic and take too long to come around wit stimulation.

90% of the time all they need is stimulation but the other 10% of the time the deley is the first thing I try unless they are really looking bad and then its PPV.

blowby is annoying to most of them and really why would a well baby need it? Also suctioning in addition to the more serious risks dry's out there nose and throat. Have you ever heard that littel sneeze they sometimes get? thats from suctioning.

To the Op - be careful not to fall into a habbit of doing things one way. Many nurses always give blowby or always deley. I even knew one that would always use PPV. Read your NRP book, pay attention to what helps and what does'nt, ask yourself why you are doing something.

As I have said many times before assessment is the key. It makes all the differnce if you assess before you do something. Of course assessment skills are something that comes with experance and research. the very fact thta you are asking this question is a good start and shows that you are assessing the situation. With time will come skill.

SmilingBluEyes · Nov 3, 2005

Here's one presentation I found discussing the matter just by googling. Our neos and nurses are becoming much more judicious in their use of interventions. Even if we assume O2 is beneficial for certain babies, there is no reason to give it to a baby that doesn't need it. Any treatment that is uneccesary is discouraged since it could be harmful. If I gave blow by to a baby with bluish extremities, I'm sure the neo would have a stroke. This is one reason why the new NRP guidelines will de-emphazise colour and recomend O2blenders and pulse oximetry in delivery. Really though, I don't think standard practices will change until us older folks are out of the game.
http://www.aap.org/nrp/pdf/currentcontroversies.pdf
Human studies have shown that O2 delays the onset of a regular breathing pattern in moderately asphyxiated babies. In animal studies, the use of 100% O2 was shown to depress ventilation, increase oxygen consumption and work of breathing and metabolic rate and cause a greater degree of cerebral hypoperfusion in asphyxiated piglets. The free radical stuff is to scientific for me to understand unfortunately, but I have been told that they are toxic to living tissues...

THANKS for this. I can't speak for all the "old ones" here, but this "old dog" is always to learn new, proven tricks.

fergus51 · Nov 3, 2005

THANKS for this. I can't speak for all the "old ones" here, but this "old dog" is always to learn new, proven tricks.

Well, you're probably better than me at it:) I try to stay current, but it is hard to stop doing things you've been doing for years, like giving blow by O2. It's just reflex, but I am getting better. I'm actually kind of excited about the new NRP guidelines since some of them are things we did anyways and I do think the use of pulse oximetry in the DR will be a great thing. Working NICU, I've gotten a different perspective on some things than I had as a L&D nurse and O2 is one of them. Our most vulnerable babies are the ones where I think it is most important to do the BEST practice and we can't take a "well, it probably won't hurt them much" attitude about it with them like I could with term kids KWIM?

Dayray, I didn't realize you were working as a L&D nurse talking about the OBs. It was similar for me when I worked L&D. Now that I do NICU if I am called to the delivery, the doc is probably also being called so they are involved and in my experience they are 100 times better than an OB for the baby anyways. I haven't known many OBs who were really great with the babies or interested in updating their practices in that regard. They seem to be overly scared in my experience. The L&D nurses at my hospital are great with the moms, but we have to come for anything under 34 weeks and it's a good thing IMO because they just don't do well with them (I can't tell you how many times we get there and the mask is full sized when they know they are expecting a 28 weeker). It wasn't too long ago that they still wanted NICU to come to every c-section. I can't imagine them doing well in recusitating a 26 weeker without us and considering the interventions a child of that gestation needs, they simply can't do it. Any neo that doesn't listen to the L&D staff when they ask him to come is not doing his job well IMO.

Edited to add: we don't use NNPs at all, but even if the NICU is not called, there is one nurse at delivery who is ONLY responsible for the baby as the NRP guidelines recommend.

SmilingBluEyes · Nov 3, 2005

Well I appreciate your input, as well as that of other nursery/NICU nurses a LOT, fergus. I really want to learn what is BEST practice, not just keep doing what "feels" best. Thanks so much for the information.