Managing O2 changes in preemie

[twizzlers67]

I'm a new RN just off orientation and I've been taking care of a 24week preemie on SIMV. I've been struggling with a few things mainly his oxygen support. It can be such a struggle to balance his O2 sats with his FIO2. He will desat and I give him time to come up but how much time is too much time? At what point do I decide it's time to turn up the oxygen. I know I don't want to give him too much 02 too quickly for fear of IVH and ROP but when he continues to drop his sats I'll look at him to make sure the tube is in the right placement, make sure it's nothing mechanical, then give him a bump in his oxygen. But when do I decide okay he may need another bump of oxygen? How long do I give him to respond to the 02 change? I know he may just take a while to come up but it seems like an eternity watching him sat low and waiting for him to come up on his own. It seems like anything I do to him agitates him and will cause him to desat but I know I need to get in there to assess him. I try to get it done quickly but calmly but even doing something as simple as changing out a diaper can be difficult because it bothers him and causes him to drop his sats. I give him time to recover but at what point do you determine he's not going to bring up his sats on his own and may need some 02? Sorry if this is a confusing post, I have so many questions with I'm sure many different answers that come with experience but having little experience makes it difficult to make the best decisions for my patient! I have a lot of support from other RNs on my unit but I just wanted to see if I could get a little more from the forum. Any suggestions for caring for a 24 week preemie in general would be helpful as well! Thanks!

[prmenrs, RN]

Some kids can't make up their minds whether to be blind or stupid.

Aggravating as all get out.

[gudiarani, BSN, MSN, DNP, RN, NP]

Someone mentioned a really good point. If the baby has a PDA, then they're probably shunting and their sats will be on the low side. So I wouldn't be so quick to turn up the O2.

The other thing is watch your H&H, esp if the baby is having a lot of desats! They may just need some blood, and a lot of the time, this is the case. Look for other signs of anemia: they may get tachycardic, start to retract and get rather tachypneic.

One other point is to minimize suctioning for these tiny ones, esp if they don't need it. It can be more damaging then helpful, especially if they don't have a lot of secretions. A lot of nurses will turn the O2 up a significant amount before/while suctioning (that dreaded "suction support" button someone mentioned earlier) and then dump a whole lot of saline drops into the ETT. It's also insanely stressful to the baby, so just do it PRN. I've read that the saline can be more harmful than good, so if you need to use it, use very little just to moisten up any plugs, etc!

And one more point, if the baby has an OGT (for decompression), make sure it's the smallest size possible. I've seen some teeny ones with the 8Fr, and obviously, that's just HUGE for the micros. It may just be the simple cause for his/her desats!

I'm a new grad, too, and have been working for 5 months now, so these are just things I've learned so far. The feedback in this thread has been very helpful :)