Ett suction preterms

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How often do u suction your micros, one of the MD'S were not satisfied with me when Itold Ididn't suction my babe for the last 8hrs. actually babe was doing well and vent parameters went down as well. Do any one of u have any literature suggesting not to suction micros aggressively.for me Idon't like to touch them unless indicated.

Specializes in NICU, PICU, PACU.

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 :)

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Specializes in NICU.

I suction my baby once with my initial assesment, to verify patency of the ETT, and to make sure that it isn't being partially blocked by secretions. After that, the baby is suctioned strictly on a PRN basis. I assess things like: Are the baby's breath sounds equal and clear? If the baby is on an oscillator or HFV, is the chest wall movement equal on both sides? Is the baby's chest wall "bouncing" slightly, or is there total non-movement of the chest wall? Does he have an increased work of breathing? Retractions? Is he having desats? Is he becoming agitated or restless? Are there secretions in the ETT?

I rely on the report of the offgoing nurse as to how often the baby needed suctioning on her shift. It helps to have that info., so you can see if there's a change in the baby's condition. (E.G. Is the amount of secretions increasing? Is there a change in color of the secretions?)

We do not routinely use saline lavages with suction. Studies have sited an increase in VAP with its use. (Ventilator Associated Pneumonia). We suction the baby's mouth prn, and use VAPGuard for our oral care every 3-4 hours.

On non-intubabted babies, we also suction on a PRN basis only. Sometimes theses babies, especially the ones on CPAP, tend to have more oral secretions, that can occlude their airway.

It's always a matter of assessment of the individual infant. Suctioning can cause desats.,instability, and an increased risk of IVH, especially with these VLBW babies.

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Specializes in NICU.

Our unit is more on a PRN basis. If you see secretions coming up, if the baby is desatting, if you hear crackles in the lungs, etc.

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Specializes in NICU III/Transport.

How are "crackles" (rales) a clinical finding that warrants suctioning?

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Specializes in NICU.

...how are they not? This is what I was taught during my internship...and the kiddos lung sounds are tons better after suctioning...I can't imagine it's easy to breathe or have the machine do it while having junk in your ETT!

Plus...wouldn't it contribute to retaining higher levels of CO2 if there was resistance to it being let out freely?

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Specializes in NICU Level III.
...how are they not? This is what I was taught during my internship...and the kiddos lung sounds are tons better after suctioning...I can't imagine it's easy to breathe or have the machine do it while having junk in your ETT!

Plus...wouldn't it contribute to retaining higher levels of CO2 if there was resistance to it being let out freely?

When you suction, you suction the junk outta the TUBE...if the baby has crackles, suctioning isn't going to help that. Lasix, maybe a little CPT or repositioning, but not suctioning.

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Specializes in NICU.

Maybe I'm hearing the crackles in the ETT then...because I listen to breath sounds before and after and most of the time they sound significantly better.

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Specializes in NICU III/Transport.

Just a personal note... I can't stand the use of the term "crackles". They're called rales -

You hear rales when alveoli have collapsed due to insufficient surface tension and they "pop" open on inspiration.

It sounds like you're referring to rhonchi - a course sound caused by an accumulation of mucus or other material in a bronchial tube.

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Specializes in NICU.

Well, I haven't known anything different...

But, I'm a new nurse still, I suppose I don't know much about proper terminology.

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Specializes in NICU Level III.
Well, I haven't known anything different...in school in Seattle, we used them...

And here in D.C., on the computer, they're documented as "coorifice crackles" or "fine crackles."

But, I'm a new nurse still, I suppose I don't know much about proper terminology.

No, you're not wrong. On our assessment, too, it's just "crackles" and where they are located. Nothing about rales...and the medical teams refers to them as crackles. If you google "crackles rales" they are the same thing.

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Specializes in NICU III/Transport.

There are course "crackles" and fine "crackles" (or rales)... they still differ from rhonchi or generalized course breath sounds. I didn't say there's anything wrong with the term "crackles", I just personally don't like it.

I've never heard the term "crackles" used when referring to rhonchi, or descriptive of auscultation in reference to the upper airway. What are the other descriptive options available for breath sounds on your assessment charting?

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Specializes in NICU.

^^ sorry, have been away (working!)

There's probably about 10-12 different things you can click on, plus the infamous, "other."

From off the top of my head...coorifice crackles, fine crackles, stridor, transmitted upper airway congestion...can't remember anymore but I'll take a look next week when I'm back.

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