NICU Nurses who use NIRS?

adventure_rn, MSN, NP · Aug 16, 2020

I've only ever seen them used in PICU. Once in a blue moon, we'll put them on a term baby awaiting a transfer to PICU.

In my opinion, the biggest barrier to use in NICU would be skin integrity. NIRS are so sticky (and so expensive) that they're designed to stay on for 24-48 hours at a time, and can't be routinely rotated. It makes sense that they have to be super-sticky since they're applied to a flat surface can't be wrapped circumferentially, like a pulse ox.

With most preemies, if you left on a NIRS for more than about six hours, they'd start to experience skin breakdown. They'd be at especially high risk for breakdown if they had pressure on the probe, like laying on top of flank NIRS or wearing a CPAP hat over cerebral NIRS.

They're so sticky that routine removal and replacement would probably cause even worse skin breakdown (much like when we remove EKG leads). You'd have to use an adhesive removal wipe, which would destroy the integrity of the probe.

In preemies, I also wonder whether or not the trends would be very helpful? Unlike peds patients, whose vitals are generally a bit more consistent, many preemies are prone to frequent brady/desat spells. It might be hard to trend NIRS on kids whose vitals are so labile.

Maybe you'd find the them in big, stand-alone children's hospitals that don't have their own OB/delivery services; they'd have kids who are sick enough to need NIRS, and tend to have very few micropreemies.

Let us know if you find some. I'm curious to hear other practices.

HyperSaurus, RN, BSN · Sep 3, 2020

My unit uses them frequently on term PPHN, MAS, ECMO, coolers, post-op, or just freaking septic. We use Mepitel (or some clear thingy) to attach to the probe itself, which minimizes the contact with the baby's skin. Unlike our facility's CICU, we do move our NIRs probe q4hr. I don't see them on preemies very often, if at all.

NICURNSF · Oct 30, 2020

We use them so feel free to reach out with any questions.