HFOV

KRVRN, BSN, RN · Jan 21, 2016

We always use gel mattresses or pillows, i have not heard of it being contraindicated. Why would it be?

Chanceygrl · Jan 21, 2016

We use Z-flows if we aren't moving our babies a lot for X-rays. Gel pillows for the head always, they are easy to place and take away.

NICUNurseEliz · Jan 22, 2016

Just wondering...
Does anyone use gel-pillows/pads under patients on HFOV??
Has anyone heard that it is contraindicated??

We use gel pillows for their heads, but we do not use sheepskin or gel mattresses when they are on HFOV or HFJV. Our intensivists feel that those soft/gel surfaces prevent the baby from oscillating as well. I have no research that I can reference off the top of my head, but that is our practice. :)

NJNICUCCRN · Jan 22, 2016

A resp therapist told me it was contraindicated but couldnt give me any research/rationale. She said the gel pillow under head/chest will absorb the "bounce". I feed like the "bounce" is on the inside, no?

vanilla bean · Jan 22, 2016

A resp therapist told me it was contraindicated but couldnt give me any research/rationale. She said the gel pillow under head/chest will absorb the "bounce". I feed like the "bounce" is on the inside, no?

I learned this when I first began working as a NICU RT. I have never seen any research to support the practice, but the rationale provided was what your RT told you as well: placing the infant on a gel pad inhibits the oscillation of the chest wall.

As far as the "bounce" being on the inside, yes, that's true, but chest walls are highly compliant (particularly in neonates) and that is why you can assess quality of wiggle/jiggle/bounce by simply looking at the baby. Anything that impairs the compliance of the lungs or chest wall should be avoided while on HFOV.

BittyBabyGrower, MSN, RN · Jan 22, 2016

We don't use Z-flows on oscillating patients either for the reasons above. And they are a pain to move when X-rays are being done, which is sometimes frequently on a really sick kid.

NICUmiiki, DNP, NP · Jan 22, 2016

We leave them on the Z-flows when oscillating. They are usually supine. We even shoot X-rays through the z-flows. Apparently, the manufacturer only states not to because they haven't been trailed and approved. Our radiologists never complain about the z-flows so we don't move them.

NJNICUCCRN · Jan 23, 2016

Some feel that a gel will"absorb" the bounce. I feel like it is softer than tha standard mattress and better for the baby

SteveNNP, MSN, NP · Jan 24, 2016

Absorb the bounce? This is the most ridiculous thing I've ever heard

The chest wiggle that is seen with HFOV use is from the lungs expanding and contracting using tiny tidal volumes at a steady MAP. If the theory were true, neonatal chest wall compliance would allow for "extra bounce" on the anterior chest wall to make up for loss on the back. But since Z-flo mattresses are soft, you "should" have more "bounce" on the back anyway!

For us, the biggest issue with Z-flo mattresses is that they can often contain micro bubbles in the gel, which confound xrays. We actually got rid of them due to their prohibitively high cost, and lack of observed benefit vs standard nurse-made blanket mattresses. We do use head positioners however.

NJNICUCCRN · Jan 24, 2016

I too think it sounds rediculous! We don't use z-flow mattresses but use 5" radius pads under head/chest when baby is prone. They are taken out for x-rays. I KNOW it doesn't alter the delivered breaths but I need to find the answer in text to convince others that they are misinformed.

thanks for your response :)

BittyBabyGrower, MSN, RN · Jan 24, 2016

It isn't so much that it absorbs anything, we had people kind of mushing the kids in the z-flo and it did inhibit the chest wiggle somewhat, which made our one attending go nuts.

I prefer to use egg rate and make a nice nest for the kids. You can get them comfy and the rolls can support the tube if needed.