Suctioning after birth

[NiesyLuv0o]

Question...I am studying for my OB exam and I am confused now. I know as soon as the baby emerges, you suction the mouth first and then the nose. This prevents the baby from gasping the fluid when suctioning the nose. Now, if the baby had meconium stain, based on the color of the amniotic fluid, is the suctioning the opposite? Do you suction the nose then the mouth? If this is mec stained, do you use a bulb syringe or an actual suctioning cath for deep suctioning?

Thanks in advance for any assistance

-Niesy

[tothepointeLVN, LVN]

Well at least as an RN student you get 6 weeks as an LVN student we get 3 days in L&D spread over NICU, L&D and Maternity and we are expecting to know at least 90% of the knowledge you have to know. Our school trains us as if we will all become RN's (theory wise)

[Coffee Nurse, BSN, RN]

Not really. Current NRP guidelines do not recommend suction on the perineum. Suction should be performed only if the infant is not vigorous, and not on the perineum because you cannot tell if it is vigorous before it is born. You should review NRP guidelines to get a clearer picture of what to do- there are very easy to read and clear algorithms.

Many providers are slow to change their practice but that doesn't make what they do correct. If you are in nursing school then you should be getting the most current information (but in any case the "new" guidelines are now several years old).

Thank you, I just took NRP through my employer using the fifth edition text, and do know that suctioning is not performed on the perineum -- hence "basically" everything that was said, as everything else was correct. Next time I will clarify.

[Coffee Nurse, BSN, RN]

Thanks CEG. I definitely want the correct information, so when I go to clinicals, I do not make a mistake. Also, my textbook must be old, because it said to suction the newborn as soon as the head comes out with the shoulders still in.

But does this apply only to the mec stained newborns or just about any newborn?

I know the right info now, but for my exam purposes, it will be the info in my book.

Current guidelines: endotracheal suctioning is only indicated for non-vigorous infants with mec staining. Otherwise, if the newborn demonstrates any potential for complications -- preterm, poor tone, or apnea/poor respiratory effort -- he is first moved to a radiant warmer in the delivery room, and then suctioned with a suction catheter or bulb syringe, dried, and stimulated to breathe. In either case, the baby is moved to the warmer before any other intervention is begun.

For your exam: whatever your book says.

[Halinja, BSN, RN]

Our guidelines were only suctioning if there was mec.

[epiphany]

For your exam: whatever your book says.

I agree. That was one of the frustration of taking exams in nursing school - as one of my faculty said, it takes 2 years or more for the textbook to catch up with the real worlk. I would ask the faculty what the expected answer would be, and know for yourself what latest guidelines are.

[NiesyLuv0o]

Yea, it can be very confusing. Because my clinical professor is a 20+yrs NICU nurse veteran. And she tries to teach us based on the NRP guidelines. We definitely understand that there are protocols in place, but the book makes it so much more difficult plus the lecturing professor has been out of the clinical setting for so long...

Thanks for all your help, because I know I can always ask the professionals questions.:nuke:

[CEG]

I wanted to add that re: bulb syringe it is very much an individual provider thing. I simply wipe the baby's face off with a towel and do not use the bulb unless I feel I need to (and I never do). I just feel being born and immediately have something shoved in your mouth and up your nose is not great- we didn't have bulb syringes for the majority of the evolution of mankind and here we are.

[epiphany]

I wanted to add that re: bulb syringe it is very much an individual provider thing. I simply wipe the baby's face off with a towel and do not use the bulb unless I feel I need to (and I never do). I just feel being born and immediately have something shoved in your mouth and up your nose is not great- we didn't have bulb syringes for the majority of the evolution of mankind and here we are.

Well said. Plus, research also says that use of bulb syringes do not change outcome.