delee suctioning

[jctiabecerra]

I work in a rural hospital we do about 400 deliveris a year. My question is about delee suctioning of newborns. It is common practice to delee all newborns orally and some nurses suction nasally too. What is everyone else doing. I have heard that it is unnecessary. I have quit using it all together and the babies do just as well.

[Jolie, BSN]

Absolutely unnecessary on a routine basis and not consistent with current recommendations by professional organizations.

[crissrn27, RN]

Agree with unnecessary and will add that it sometimes gives the newborn an oral aversion and makes feeding harder.

[jctiabecerra]

Which professional organizations address this?

[Jolie, BSN]

I don't have access to the current course materials, but I am certain that the NRP program, developed by the American Heart Association and the American Academy of Pediatrics addresses this.

The following site may be helpful:

http://pediatrics.aappublications.org/cgi/content/full/117/5/e1029

Those newly born infants who do not require resuscitation can generally be identified by a rapid assessment of the following 4 characteristics:

Was the infant born after a full-term gestation?

Is the amniotic fluid clear of meconium and evidence of infection?

Is the infant breathing or crying?

Does the infant have good muscle tone?

If the answer to all 4 of these questions is "yes," the infant does not need resuscitation and should not be separated from the mother. The infant can be dried, placed directly on the mother's chest, and covered with dry linen to maintain temperature. Observation of breathing, activity, and color should be ongoing.

(No mention of routine suctioning or any routine measure to clear the airway of an apparently healthy, breathing or crying newborn.)

[southernbelle08]

Nope!

We only do that when absolutely necessary. We have a few Pediatricians that get mad and want a detailed explanation as to why you used the delee if it has to be done. Of course, there are some situations where we have to and they understand that...but to make it routine? No way!

[SmilingBluEyes]

Even routine bulb suctioning is being questioned now. Really the above posts say it all. Routine suctioning esp deep suctioning, is not evidence-based nor healthy! If the baby is stable/breathing well and vigorous, just observe skin to skin, on mom is best.

[swise]

I agree with the previous posts and would suggest the reference of the American Academy of Pediatrics and their Neonatal Resuscitation Program. They removed the reference for suctioning in the last edition in 2006 for meconium unless not vigorous. As an instructor I also struggle with this practice change in the real world. Suctioning does cause irritation to the throat and can cause feeding issues. My suggestion is to keep up the discussion as the event occurs.

swise