Neobar use in the NICU

[lmse]

Surveying NICUs that use Neobars to secure ETTs:

1. How do you secure ETTs in the delivery room? If you use Neobars, do you have any trouble with poor adhesion due to vernix/ secretions?

2. How do you secure NG tubes or Replogles?

a. If you use the bar portion of the Neobar, do you have any issues with increased tension on the Neobar?

b. If you do not use the Bar portion of the Neobar, have you found a good way to secure these tubes?

c. Do you exclusively use OG tubes in infants who are intubated?

Thank you for any input that is provided.

[Burnvegas]

1. With difficulty. We use sterile water and cavilon wipes ready to go at deliveries to prep the skin, but even with that the neobar will be peeling within the hour.

2. NG and replogle tubes are secured with tape to the bar of the neobar. This bit actually works fine, but is a pain when extubating. I don't find it interferes with the tension at all, and actually helps a bit.

3. NG is standard for intubated infants, unless there is contraindications for NG.

My opinion of neobars (and neofit for that matter) is that it is an incredibly flimsy way to secure a tube... The way forward appears to be nasal intubation and neobars don't work for securing nasal tubes.

[megatronRN]

It's interesting that you said nasal intubation is the way forward, as on our unit it has been completely phased out due to facial/sinus trauma and septum breakdown. A few of our doctors still nasally intubate, but only if an infant has a history of self-extubation.

[megatronRN]

1. Neobars are secured by the RT at delivery. Even with drying and correct placement, adhesion can be an issue. On our tiniest babies (23-25w), we still use cloth tape to secure ETTs.

2. We use a thin piece of clear tape to secure the NG to the ETT.

a. I don't believe we have an issue with increased tension.

c. We also standardly use NGs unless there is an indication not to.

[Burnvegas]

It's interesting that you said nasal intubation is the way forward, as on our unit it has been completely phased out due to facial/sinus trauma and septum breakdown. A few of our doctors still nasally intubate, but only if an infant has a history of self-extubation.

Yeah, it was the same story in my old unit as well. It was put down to the nurses not strapping the tube correctly (surprise surprise, nurses blamed). I argued at the time (2009) that there was no evidence that preferred one over the other, and we were used to oral, so why change. The response was this brief that keeping the mouth free from tubes results in better developmental outcomes with feeding and weaning to solids... That came from our nidcap people. I've had difficulty finding what research that standpoint came from.

Maybe it's not the way forward then, i dunno.