Ett suction preterms

I usually suction with hands on care 4-6 hours as needed. If their sats are fine I also leave them, I will suction before I do a gas about 30 min. I also only try to do one assessment and minimal stim thru my shift as tolerated.

Depends on the kid. If they've been having a lot of secretions, I'll do it more often. Otherwise maybe once a shift. There's research out there that suctioning can contribute to lung disease so I try to do it only as needed if I hear something or feel a rattle in their chest.

I abhor routine suctioning on micros (or any pts for that matter). If PIPs are rising (ie: AC/VG mode) I may suction. If baby is squirming, uncomfortable, etc. they may need suctioning... and of course, if their sats drop or there's visible secretions in the tube, I'll suction. I agree with 30 minutes prior to a gas as well.

You're not only bothering them and stressing them out with routine suctioning, you're suctioning their volume. I absolutely will NOT suction a pt on HFOV unless there's clinical indication.

There are studies/articles out there... if I run across one, I'll post it.

We suction our kids on a PRN basis...all you do is bug the kid, increase the risk for IVH and other undesirable things. We also use inline, which helps, but we still only do it on a PRN basis. We also do not use saline unless indicated. We don't suction prior to a gas either...why if they really don't need it, that is a non-required intervention.

I only suction if they're junky feeling and desatting. If they don't need it before a gas, I don't do it..some kids have q1h gasses and that is a LOT of suctioning. Not a fan of saline either unless dry gets nothing and they're still junky/desatting. I've read too much about it not being indicated..and had too many RTs do it w/ saline and say...we're really not supposed to do this anymore..but .. and use it.

I've only just recently come off orientation, and like most things at my unit, whether or not to suction seems to be based more off of nurse's discretion than any set protocol. Some have told me to do it with every hands-on, others say do it PRN and that's more what I agree with. Especially on a micro preemie, I don't see why we should agitate them if they're not desatting, they sound ok, no visible secretions.

Forgive me if I'm missing something obvious, but what's the rationale for routinely suctioning 30 minutes prior to a blood gas?

I've only just recently come off orientation, and like most things at my unit, whether or not to suction seems to be based more off of nurse's discretion than any set protocol. Some have told me to do it with every hands-on, others say do it PRN and that's more what I agree with. Especially on a micro preemie, I don't see why we should agitate them if they're not desatting, they sound ok, no visible secretions.

Forgive me if I'm missing something obvious, but what's the rationale for routinely suctioning 30 minutes prior to a blood gas?

So the gas looks better. I won't do a gas if I've messed with a baby or just suctioned them, but I'm not going to say, oh, my gas is due at 1600 so I'm going to suction her at 1530 whether she needs it or not. If they need it at 1530, then I will. Also, if they don't need it at 1530 but they do at 1550, I'll suction at 1550, but then wait for them to settle down to do my gas until about 1610 or so.

So the gas looks better. I won't do a gas if I've messed with a baby or just suctioned them, but I'm not going to say, oh, my gas is due at 1600 so I'm going to suction her at 1530 whether she needs it or not. If they need it at 1530, then I will. Also, if they don't need it at 1530 but they do at 1550, I'll suction at 1550, but then wait for them to settle down to do my gas until about 1610 or so.

I agree. If you have an Attending riding you about not suctioning enough... and despite undue clinical indication you haven't suction before your q8 or q12 gas... your PCO2 is going to be above 80 and you're going to be questioned as to why you haven't suctioned...

30 minutes gives them enough time to recover from the actual process of suctioning to aquire an accurate gas.

When I take report, I try to get an idea from the previous nurse how often the baby has needed suctioning. If they claim it was every hour or every care, I observe the baby to see if that is actually true. If I can see secretions in the tube, the baby is squirming, the FiO2 is up, or the baby is desatting, I will always try suctioning first to see if that helps. I also always do at least one pass with the suction catheter 30 minutes before getting a gas (unless they are q1h gasses, in which case I take a more PRN approach).

On the Jet, I obviously suction much more often...our last kid on the Jet needed to be suctioned every 45 min. to 1 hr.

We do not use routine suctioning, but only as needed on a case by case situation. We also suction 30-60 min prior to blood gas.

I'm new to nursing and NICU, so I guess I didn't really know otherwise, but we do routine suctioning with every assessment (q4hours) usually, and PRN. Usually the kids have enough secretions to warrant the q4 suctioning with assessments. We also use saline almost every time...Maybe I'll suggest a little research to the educators on our unit!

Your unit needs to get up on the lasted EBP articles!! You can go to medscape or IHI.org and look them up, but for several years now has been said to not use saline..it actually increases your VAP's and damages the fragile cilia these kids have. Also, using saline will increase your secretions on some kids. RDS is rarely a secretion producing problem.

There is also NO EBP indications on suctioning on a regular basis or before a blood gas. We do not do this at all and our kids are fine. We rely a lot more on the pulseox and do rapid weans to room air within the first 24 hours if able.

We are also almost a year without a VAP :)