Nitric Oxide

[Bruno Matos]

Occasionally we use NO to ventilate our babies with PPH (in the post op of cardiac surgery).

We don't have any protocol to manage these situations (like determination of metahaemoglobin ... )

We don't have also any devices to evaluate the contamination of air.

Do you have any guidelines on this subject?

Thanks.

[gwenith, BSN, RN]

Bruno - I have used NO on adults and I will have a hunt around to see if I can find anything.

okay - here is a start from the adult ICU forum - this thread has some very good links on it

https://allnurses.com/forums/showthread.php?t=48634&highlight=nitric+oxide

[Gompers, BSN, RN]

We use NO pretty often, mostly for PPHN caused by MAS or sepsis. We don't use any devices to determine the contamination of the air. At times I've really wondered why we don't, seeing as the babies have leaks in their ETT. But otherwise, there would be no other leak as we rarely open up the system (inline suctioning, etc.). When we must bag a baby on NO, we have to manually turn on the NO tank to add it's flow to the oxygen.

As far as metahemoglobin, we do a baseline check when the baby is first put on NO, and then every 24 hours after that. In our hospital it requires less than 0.5ml in a blood gas syringe, placed in ice.

I'll have to check if we have any actual protocols written down though...

[BittyBabyGrower, MSN, RN]

I think we have a pathway...I'll have to look. We do the same...check methgb q24 hours.

I have often wondered about leaks too..I spent 3 weeks in an enclosed room with a kid on NO...and people would forget to turn the bag off and I swear you could taste it when you walked in there. I'd be interested in any studies on it. Wonder if the Nurse anethetists could answer us?

[dawngloves, BSN, RN]

I've often wondered about the contamination as well. If I had a dime for everytime the bag was left open...it's a pretty open unit, but still. :chuckle