NRP outside of deliveries

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Specializes in NICU.

Hi everyone!

To all my fellow NICU nurses, I am a new grad in NICU on orientation and have been trying to figure out at what points do you consider bagging an infant or more invasive intervention during a routine shift. Im very familiar with NRP as far as deliveries go and I understand that it basically is the same anywhere but I have been having some trouble applying it. I know that you always have to check the baby first and not rely on the monitors. I obviously haven't had to intervene yet during my orientation but I wanted to get more familiar with what to do so I will feel more confident that I would be able to do the right thing if the time came. Some kind of system in my head to organize all the information.

Basically,

If the baby desats and doesn't come up, whether on 02 or not on 02, and you have turned them up. I know you can reposition and try to get sats up. If not on 02 you could stimulate if they brady too. But at what point would you bag them? Is it if the heart rate drops too? If they fall into the 60s? 40s? Obviously dont want to wait too long but dont want to bag if not necessary. I know if HR is below 60 I would start compressions after 30 sec of PPV but at what point does this all start? Is blow by another method of solving this if there is no apnea?

I hope Im making sense. I appreciate the help! Trying to organize my thoughts :dead:

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Non Intubated Patient: Check airway, increase O's, blow by if not on oxygen at baseline. If no response can you do CPAP with your bags? That would be my next option but only flow inflating bags have this option. If baby continues to desat with ANY additional drop in HR (like baseline HR 150 but now were low hundreds or even one-teens) I will start to bag & call for help. If that HR hits 59 or lower for greater than 30 seconds it's chest compressions.

Intubated Patient: Again airway, increase O's - do they need suction? Did something become disconnected? If suctioning doesn't help then bag and the steps are the same as in the above scenario.

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Every baby is different obviously but if you have sustained desats/brady (sustained is a subjective term, some kids desat/brady to code-button numbers and then return without any intervention) then you should have some sort of intervention

Some times just a touch more oxygen (increase by 20% above what they're on, as an example) for 1-2 minutes will fix it. Sometimes PPV is necessary because they're "clamped down".

Sustaining bad is important because when you're freaking out time seems to speed up, 10 seconds feels like 10 minutes and sometimes its necessary to make sure its not something that's going to resolve on its own. Sometimes its equipment. The bed often times has an 80% SpO2.

In all cases a quick assessment and notification of your colleagues is important. If you have Respiratory Therapists in your NICU they should be great resources for patient specific recommendations at the bedside.

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Hi everyone!

To all my fellow NICU nurses, I am a new grad in NICU on orientation and have been trying to figure out at what points do you consider bagging an infant or more invasive intervention during a routine shift. Im very familiar with NRP as far as deliveries go and I understand that it basically is the same anywhere but I have been having some trouble applying it. I know that you always have to check the baby first and not rely on the monitors. I obviously haven't had to intervene yet during my orientation but I wanted to get more familiar with what to do so I will feel more confident that I would be able to do the right thing if the time came. Some kind of system in my head to organize all the information.

Basically,

If the baby desats and doesn't come up, whether on 02 or not on 02, and you have turned them up. I know you can reposition and try to get sats up. If not on 02 you could stimulate if they brady too. But at what point would you bag them? Is it if the heart rate drops too? If they fall into the 60s? 40s? Obviously dont want to wait too long but dont want to bag if not necessary. I know if HR is below 60 I would start compressions after 30 sec of PPV but at what point does this all start? Is blow by another method of solving this if there is no apnea?

I hope Im making sense. I appreciate the help! Trying to organize my thoughts :dead:

Hello I am a nurse with 1 yr med surgery,I am going to be transferring to the NICU. Is there anything I should do to prepare before starting orientation? How is it goin so far? Do you love it ?

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