Published Apr 15, 2004
I always had a fear of taking care of intubated babies because everytime I would change their positions or change the radiant warmer linens my baby would end up extubated is there some kind of way to change the linens without asking someone to hold the baby, some kind of technique, as not all the time is someone available to hold the baby for me........I would appreciate some of you seasoned nurses techniques.....thank you in advance.
If my baby is unstable and has lots of lines, etc, I always get help to move the baby. Maybe not just w/re-positioning, but if I have to pick him up, say for weighing, etc. It's much better to get help than to end up w/an extubated babe. What a pain!
Gompers, BSN, RN
First of all, make sure that the tape on the baby's cheeks and ETT is very secure with little "tromboning" so that it can withstand tension during position changes. Also, make sure the baby is stable enough to tolerate moving. Side to side head changes are necessary to prevent breakdown of course, but if you're still uncomfortable just wait until someone is available to help. As for linen changes, if the baby is extremely sick and the linen is basically clean, there really is no reason for daily changes. I know that some people get very upset at this suggestion, but sometimes it's just not worth stressing the baby out, especially if it's a kid with pulmonary hypertension.
For position changes, what I usually do is unhook the babies from the vent for a few seconds and change their position, then hook them back up. 95% of kids tolerate this and because there is no vent tubing pulling at the ETT, you have very little chance of extubation. You get quicker over time, so this will eventually take only 1-2 seconds. If the baby is so unstable that he doesn't tolerate this technique, or is on HFOV or nitric, I'll always wait for another nurse or RT to help - they'll move the vent tubing while holding onto the baby's ETT while I move the baby.
As for linen changes, I do one of two things:
For tiny stable babies, I get an extra sheepskin (and put clean linens on it if using blankets) and have it right there on the bed within reach. Then I pick up the baby in one hand (the hand closest to the head of the bed) and pull the old sheepskin and/or linens out with the other hand, pulling towards the foot of the bed. Then I slide the new sheepskin into position and place the baby down again. If you have the older bedscales, you can even zero them while you have the baby in your hand to kill two birds with one stone. The way I keep from extubating them during this time is that I have them laying across my fingers with their heads stabilized by my thumb and the vent tubing running along my arm to decrese tension on the ETT. Does that explaination make sense?
For larger or very sick babies of any size, I do the old fashioned adult "complete" bedding change. I roll the old linens up on one side, gently lift the baby and roll them underneath, then remove them on the other side. I roll up the clean linen and use the same technique to place that under the baby. This way, I only have to lift the baby a tiny bit to get the linen under him. I always have to straigthen it after this, of course, but it's easy to do that once the clean linen is under the baby already, it's just minor adjustments. If I really need to fix it at the head of the bed, I'll unhook the ETT from the vent for a second as I decribed up above.
Again, if the baby is unstable, on HFOV, or on Nitric, I always get someone else to help me change linens so that I don't have to unhook the vent or risk extubation. Remember, though, babies sometimes extubate laying there sleeping if they move the wrong way or the tape was loose - so try not to beat yourself up about it, okay? Just practice and ask questions. Try to watch the more experienced nurses do it to get ideas. Good luck!
BittyBabyGrower, MSN, RN
If you are weighing the baby make your bed on the scale, zero it after the linens are on it (with a diaper on it too!) and put baby on it, get weight and put all of it on your bed :)
Thank you all very much, it just made me nervous as at our facility if a baby becomes extubated accidentally we have to write up incident reports about it and that made me even more nervous about it......I am taking assignments with intubated babies and I also watch the other nurses do just as you guys have described but it is hard for me to do it but I am willing to hang in there and give it a good try.....
Find someone to help you--don't try to do it by yourself. Even after many years, I asked for help--an RT can help you as well as an RN--they will guard their ET tube!! If you need the tube retaped, have the RT do that before you change the bedding.
Prmenrs you are fortunte to have RT to retape ET tubes as our RT do not do that they are so basic. They do not do anything except mind the vents and neb txments and run blood gases. The first NICU I worked at RT drew the CBG's and also helped with taping of ET tubes and set up your hoods and tents.
dawngloves, BSN, RN
What are you using to tape your ETTs?
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