I was wondering if anyone else could share a similar story. I'm about to enter my second year of nursing in a smallish level 3 NICU (26 bed, no surgeries or ECMO). We haven't had a lot of vented patients since i've come off orientation in June but I had the opportunity the last 3 days to take care of a micropreemie (800 gm 25 weeker). i really enjoyed the experience and learned a lot. Two of the three nights I had him, he self-extubated. I'm still trying to understand this. He was positioned prone on a pony both times, ETT tape secure, head was sandbagged to prevent too much movement, etc...sats started dropping, not having any spontaneous breaths on the vent (low tidal volumes)...so I suctioned, called for RT, we put on CO2 detector, no change...listened for BS bilaterally...pretty much was clear he was extubated. Now when you looked at the CXR you can see the ET tube and it's position near the carina (one xray it was a little high and our reintubation was T3), and it's definitely apparent in a tiny baby like this there is not a lot of room between intubated and extubated. I somehow feel responsible for this happening...I was not at the bedside when it happened (I mean I wasn't in there doing cares or anything) but is there anything I could have done to prevent it? Someone told me we have a day charge nurse that considers it "an incident report" when this happens so now i'm questioning myself (*note this was just info told to me by someone else, no incident report was written). Anyone have any advice for me on this?
