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Infant airways and decels

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Two questions here..I just started a new job in labor and delivery and they were showing me how to check the infant warmers. We were going through all the equipment and came across these little plastic pieces that were infant airways. I was wondering how they are used, noone really explained them to me and during nnrp they never were even brought out.

My next question is about decels. Our pt was having decels, I thought they looked like lates, they were occuring after the peak of the ctx, with every contraction. They werent "subtle" like the lates I have seen. My preceptor said they were variables, but to me they didnt really look like the variables I have seen either, so I was wondering if variables can appear as lates or vice versa. They didnt look v-shaped, they kind of looked like a mix between a variable and late, so wasnt sure what it exactly was. Thanks!

klone, MSN, RN

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership. Has 15 years experience.

A late decel will start after the apex of the UC, and will return to baseline after the end of the UC. They can be subtle or deep. They are usually spoon-shaped, but not always. Yes, variables can have a "late component" to them.

As far as what the "little plastic pieces" are - you got me.

Jolie, BSN

Specializes in Maternal - Child Health. Has 35 years experience.

There is such a thing as an infant airway. It is a piece of plastic approximately 1-1/2 to 2 inches long with a slight curve and a hollow center. It is inserted over the tongue with the end extending out of the mouth and (in theory) keeps the tongue from falling back and blocking the airway. I don't know if it's still included in the NRP curriculum, but it used to be taught to insert an oral airway if you were unable to get good chest expansion with bag and mask ventilation. They are difficult to secure in place. Taping them is not very effective, because they move easily in the baby's mouth and come out of alignment.

In reality, they are rarely used.

picture: http://www.dentalcompare.com/details/4664/Soft-Clear-Guedel-Oropharyngeal-Airways-with-Color-Code.html

They are not a technical "airway" but rather an airway adjunct designed to pull the tongue out of the airway and allow for a better conduit for air movement. Aside from an ET tube and LMA's in the bigger infants, the number of devices you can utilise for airway management are rather limited in the little guys.

NICU_babyRN, BSN, RN

Specializes in NICU.

The oral airways are used when you have an airway tongue obstruction. It's nice to have in hand in case a baby comes out who has a "jaw malformation" which can be the case in Pierre Robin Sequence/Syndrome. They are really rarely used.

babyktchr, BSN, RN

Specializes in Nurse Manager, Labor and Delivery.

According to NICHD terminology, a variable is an ABRUPT decrease in FHR that is less than 30 secons from the beginning of the decel to the nadir. A late or early decel is a GRADUAL decrease in FHR, taking over 30 seconds from beginning to nadir. Variables can certainly be late in timing, but will be classified as variable. According to definition, there is no longer "variable with late component". It's all about the timing in your case. Although it may not have been the classic V or U, measuring how long it took to get to the nadir will be you key to what your decel actually was. If you were having either, I am hoping that you performed some intervention, since you say that they were occuring with every contraction. Just remember, a variable is a variable is a varible, no matter what the timing in relation to a contraction.

Thanks everyone! And yeah, we were doing interventions for that lady. It all started after she got her epidural, and we tried different positions, oxygen was on, pit d/c, fluids wide open. Our last position tried was her right side and the decels disappeared but baby lost variability and was tachy, so we ended up doing an emergency c-section on her.

And you can attach an ambu bag to that kind of infant airway? I never took notice.

klone, MSN, RN

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership. Has 15 years experience.

Thanks everyone! And yeah, we were doing interventions for that lady. It all started after she got her epidural, and we tried different positions, oxygen was on, pit d/c, fluids wide open. Our last position tried was her right side and the decels disappeared but baby lost variability and was tachy, so we ended up doing an emergency c-section on her.

Did you try giving her ephedrine? If it happened as a result of the epidural, ephedrine will often help, even if the mother's BP isn't noticeably lower.

klone, MSN, RN

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership. Has 15 years experience.

And you can attach an ambu bag to that kind of infant airway? I never took notice.

No, it's not like an NG tube with a port for the bag.

Oh. I'll have to look at them more closer next time we check infant warmers. And no, we didnt try ephedrine, never would have thought to try that.

klone, MSN, RN

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership. Has 15 years experience.

No, it's not like an NG tube with a port for the bag.

Oops, didn't mean NG tube! Trach tube!

Jolie, BSN

Specializes in Maternal - Child Health. Has 35 years experience.

And you can attach an ambu bag to that kind of infant airway? I never took notice.

No you use the mask over the baby's mouth and nose with the airway in place.

A late decel will start after the apex of the UC, and will return to baseline after the end of the UC. They can be subtle or deep. They are usually spoon-shaped, but not always. Yes, variables can have a "late component" to them.

As far as what the "little plastic pieces" are - you got me.

New NICHD terminology has clarified the definitions and changed some of this. There are no longer variables with a late component. Here is a brief snippet from: http://www.nccnet.org/public/files/NICHDMonograph.pdf

LATE DECELERATIONS

Based on visual assessment, a late deceleration is

defined as an apparent gradual decrease in fetal heart

rate and return to baseline associated with uterine

contractions. Onset to nadir is equal to or greater

than 30 seconds. The nadir of the deceleration occurs

after the peak of the contraction.

EARLY DECELERATIONS

Based on visual assessment, an early deceleration is

defined as an apparent gradual decrease in fetal heart

rate and return to baseline associated with uterine

contractions. Onset to nadir is equal to or greater

than 30 seconds. The nadir of the deceleration occurs

at the same time of the peak of the contraction.

VARIABLE DECELERATIONS

Based on visual assessment, a variable deceleration is

defined as an apparent abrupt decrease in fetal heart

rate below the baseline which may or may not be

associated with uterine contractions. Onset to nadir

is less than 30 seconds. The decrease in fetal heart

rate below the baseline is equal to or more than 15

beats per minute, lasting 15 seconds or more but less

than 2 minutes in duration from onset to return to

baseline. When variable decelerations occur in

conjunction with uterine contractions, the onset,

depth and duration vary with each succeeding uterine contraction.