Oxygen saturation

Specialties NICU

Published

I work in the midwest in a 25-30 bed NICU. We have 6 MDs and therefore 6 ideas on just about everything - including the 'proper' SaO2 parameters. The most often seen ordered is 90-95%.

Even tho this isn't terribly narrow we still have lots of audible alarms (in an already too noisy world) Our Nelcor monitors have a preset neonatal range of 80-95%.

Your comments?

It is a real pain. I stay in their room most of the time I just silenced them. If I have to leave or take a break I just put the alarm back on.

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Wow, I can't believe the variation in O2 concentration parameters. In our NICU all premies less than 36 weeks or so have to have the alarms set at 82-92. If they are in RA most of the time we can increase the parameter. Over 36 weekers are kept above 93 or 94. Also depends on the baby and the specific order. We have a doc who insists on 82-92, don't even get caught with any other settings. Luckily, I work nocs and have never personally met her She also likes NC 2L, says it's like CPAP, anyone else seen this in practice?

On a different note, we had a baby die the other day. Don't know how many weeks but supposedly he died from cardiac tamponade from Hal/lipids around his heart. He had a uvc or uac and a chest xray confirmed proper placement. Waiting for autopsy results. Has anyone heard of this. I am new to the NICU, got off orientation in April. Also, we got a 24 weeker the other day and the neos refused to put in a line because of this, the experienced nurses are upset at this. Are there signs of cardiac tamponade in a preemie? What do you all think of this?

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We had a baby who had to be transported out to a level IV NICU for heart surgery after a percutaneous catheter leaked TPN and Lipids into the pericardial sac around the heart... cardiac tamponade. We were thankfully able to recognize it in time and the baby ended up doing just fine. It wasn't from a UVC though.

After that, for a few weeks, all the neonatologists and nurse practitioners were hesitant to insert per-q-caths for sure!!

I've also heard of using nasal cannula at 2 liters/minute as a type of CPAP technique on the larger babies. As long as their lungs can take the volume it works ok for the short term. After a while their noses and sinuses can get raw and bleed. We used it a few times, but not as a routine.

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Our O2 parameters are individually ordered for each baby, but follow general guidelines according to gestational age.

We use High-flow NC frequently, especially to get them off of CPAP sooner due to the discomfort of NCPAP prongs and the difficulty of turning or parents holding them. Usually we put it on a blender and will wean the O's before the flow. We call it "poor man's CPAP". Also we put them on it after extubation instead of NCPAP.

We recently had a baby whose chest circumference increased dramatically in a short time (our protocol calls for circumference q 8hrs for the body part potentially affected by a PICC). The PICC was pulled and nothing unusual on x-ray. No sequele, thank goodness! A reminder that we must always be vigilant.

We have had a lot of "mechanical phlebitis" with PICCs lately. We never had that problem before. Discovered it involved just one lot# and sent those back to the manufacturer - seems that the problem is solved for now.

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Thanks for your replies. We use 2l flow even in babies not full term, I think it is irritating to them and if they needed cpap why not the infant flow, even though I hate to work with it.

We had mechanical phlebitis about a few months ago and the company said they were able to repeat it on test subjects. Who would volunteer for that test? Anyway we stopped using them for awhile and are now trying them again.

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when you give that much Low flow is it humidified?

We humidify Low flow over 1letre and it is a prob as it condences in the tubing and the baby gets a nose full of water every so often if your not careful (not very pleasant)

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We humidify all of our NCs. Haven't had a problem with condensation - do you use heated humidifiers for NCs?

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we use heated humidity for NC

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karenelizabeth,

We only use heated humidifiers on vents, hoods and NCPAP.

All NCs are just on a bubble-thru humidifier; that's probably why we don't have a problem with rainout.

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