Inpatient Apnea Monitoring

Specialties Pediatric

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Specializes in CPN.

There's (supposedly) a policy at my hospital that infants under the age of 12mo are to have continuous apnea monitors on as well as continuous pulseox monitoring.

I can't find any evidence to back up this practice. What do you do at your hospital? Why/why not?

**Interestingly enough, with the 'Back to Sleep' campaign, we educate families that apnea monitors are NOT effective in preventing SIDS events....

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Specializes in NICU, PICU, PCVICU and peds oncology.

At our hospital monitoring is a physician order. All of our peds beds have the capacity to provide full cardio-respiratory and pulse-ox monitoring; about 1/3 of our patients are there for cardiac care and a significant number of other patients are trach patients with or without mechanical ventilation. We provide high-flow nasal oxygen and non-invasive ventilation on our inpatient units as well. Therefore, most of the kids we admit, no matter where they are in the hospital, are monitored.

The biggest reason that home apnea monitoring isn't a good idea is that there are so many nuisance alarms that alarm fatigue sets in quickly and the one time the alarm is for real will be the time the parents decide to ignore it.

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Specializes in CPN.
Therefore, most of the kids we admit, no matter where they are in the hospital, are monitored.

Totally makes sense. Is there a situation that you would specifically ask for an order to monitor if it wasn't previously ordered (other than the situations you already mentioned---cardiac/trach/supplemental O2, etc)? Say the patient is a 'regular' baby admitted for FTT? Or 1-2 days postop pyloric, not getting any IV pain meds? We consistently have (now superfluous) orders that aren't updated :(

The biggest reason that home apnea monitoring isn't a good idea is that there are so many nuisance alarms that alarm fatigue sets in quickly and the one time the alarm is for real will be the time the parents decide to ignore it.

THIS!!! This is a big reason that I'm asking this question in the first place... SO many 'false' alarms when it comes to babies kicking off their leads/probes, etc!! Makes me wonder about the use in the first place... Typically though, the kiddos I'm more worried about monitoring (ie-they're getting O2) are sick enough that they're not pulling off the leads anyway...

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Specializes in NICU, PICU, PCVICU and peds oncology.

I'd be wanting an order for monitoring if the kiddo has had a change in LOC, for example when they've been suffering increased work of breathing for some time and may be hypercarbic or hypoxic, or following a seizure. Sometimes those little FTT kids have reflux and micro-aspiration causing apnea and mild bradycardia that you're not going to catch with intermittent routine VS checks.

This would be a really good topic for discussion at a staff meeting. You could take a survey of your coworkers to get their take on how many kids are monitored unnecessarily and to learn what they feel would be criteria for continuous monitoring, then bring your data to the meeting. You'd need support to get buy-in from your pediatricians, but it would be worth it to decrease your workload.

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Specializes in Acute Care Pediatrics.

I can not STAND the order for monitors on a child who has no reason to be monitored. If a kid comes in with an ALTE, then sure - I get it. But if you are admitting a baby with FTT, or hyperbili, etc - essentially a healthy baby with some issues that are currently NOT life threatening - then the monitors are nothing more than a nuisance. They hinder parent/baby/child interaction since they are always tied to the monitor, and keeping a pulse ox on a healthy 9-12 month old is a joke.

The first thing I do when I get my patient assignment is look for monitor orders.... and then look at my patients and if they aren't monitor appropriate the first thing I will do is call the physicians and say... Really? This R/O sepsis baby that has been here for five days, is no longer febrile, and we are just waiting on a final culture to grow before we send this baby packing... we need this kid on full monitors? Give me a break.

And monitor fatigue is a real thing. I can not tell you how often we are just silencing the monitors at the nurses station because they aren't picking up, have fallen off, the baby is being burped (RUN OF VTACH! HOLY CRAP! ALARM ALARM ALARM).... I swear, I really do worry that one of these days a kid is truly going to go into asystole and we will just keep silencing the monitors.

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Specializes in CPN.

The only time I like a pulseox on a baby who otherwise doesn't "really" need it is (1) when the parents aren't there and occasionally (2) overnight. I liken it to the role of a babysitter or baby monitor--the alarm means the baby is awake or crying, not that there's actually a true change in sPO2 or HR. I tend to see nurses using pulseox monitors when not ordered (and occasionally vice versa...)

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There is no reason to have every pt on continuous monitors. On my regular peds floor they only get it if on oxygen. Not for asthma. Not for seizures. It isn't needed and adds to alarm fatigue.

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