Oxygenation guidelines

Specialties NICU

Published

Specializes in ob/maternity/nbn.

I am desperately seeking a concise oxygenation policy/protocol/guidelines for nurses to use in NICU. I am not having much help from the neonatologists with narrowing this down. The research I have gotten seems to be all over and somewhat confusing for staff to implement. I would like to keep it simple and practical if possible but am in need of help. Anything you can share or suggestions would be appreciated?

Up Vote Up Vote ×
Specializes in NICU Level III.

We keep sats for all kids 85-95% unless they are on room air or cardiac.

Up Vote Up Vote ×
Specializes in ob/maternity/nbn.

NeoNurseTX , Thanks for the response.

Does your institution have a written policy or guidelines regarding these parameters that you could share?( you could block out the name or it would be referenced appropriately). I am looking for anything related to this that I could present for policy consideration ( ie increments of O2change, nurse/md action to maintain these sats, paramaters related to gestation). Your help is appreciated:)

Up Vote Up Vote ×
Specializes in NICU Level III.

I don't see one online. The 85-95% is a check mark on the admission order sheet. If the MD wants other parameters, they write for them. Last place I worked at had a protocol for their sat limits according to gestational ages but I don't remember the numbers.

Up Vote Up Vote ×
Specializes in NICU.

We use the following at my institution:

31-37wks 87% and above

38+wks 91% and above

Cardiac kids get customized limits

Kids on Nitric usually also get a 95-100% goal.

Up Vote Up Vote ×
Specializes in NICU.

we set our babies' o2 sats limits at 80-95% if they are on o2, especially if they are less than 32 weeks gestation. the target sats of 85-93%. this is to protect their eyes from rop. this is backed by studies. i will post them at the end.

if the baby is on room air or 21% o2 on flow or ventilator, then sats should be at 85-100%.

certain cardiac babies have limits set at 75-85%

older babies may be set at 90-100%

[color=#003399]chow lc, et al. can changes in clinical practice decrease the incidence of severe retinopathy of prematurity in very low birth weight infants? pediatrics 2003;111:339-345.

[color=#003399]

[color=#003399]tin w et al. pulse oximetry, severe retinopathy, and outcome at one year in babies of less than 28 weeks gestation. arch dis child fetal neonatal ed 2001; 84: f106-10.

[color=#003399]

[color=#003399]penn js, et al. the range of pao2 variation determines the severity of oxygen-induced retinopathy in newborn rats. invest ophthalmol vis sci 1995; 36: 2063-2070.

[color=#003399]

[color=#003399]askie lm, henderson-smart dj. restricted versus liberal oxygen exposure for preventing morbidity and mortality in preterm or low birth weight infants. cochrane systematic reviews. http://www.nichd.nih.gov/cochraneneonatal/askie4/askie.htm

Up Vote Up Vote ×
Specializes in ICN.

For our babies under 32 weeks, we have the ROSE limits: 85-93%. ROSE stands for Reducing Oxygen Saves Eyes in out hospital. This has definitely helped reduce the amount of ROP we have and is backed by research, according to our docs. Not that I know where it might be!

Up Vote Up Vote ×
Specializes in NICU.

this is what our NICU uses:

>2000grams on oxygen target sats 90-94 alarms at 86-96

>2000 grams on RA target 90-100 alarms at 86-100

we have had no ROP since starting these parameters :)

Up Vote Up Vote ×
Specializes in NICU.
this is what our NICU uses:

>2000grams on oxygen target sats 90-94 alarms at 86-96

>2000 grams on RA target 90-100 alarms at 86-100

we have had no ROP since starting these parameters :)

I'm wondering what your acuity is like and what your rate of ROP was prior to these limits. I ask because our guidelines are similar and actually slightly more strict overall, but we continue to see ROP.

>28 weeks 85-93% if in oxygen

Room air kids need to be greater than 80 or 85 depending on gestational age. Cardiac kids have custom limits. Our alarms are set at these same limits. Overall, I would say that we're pretty good at not cranking the oxygen and chasing kids around. However, I wonder if our acuity is part of the reason we continue to see ROP. We have higher than expected survival for micro preemies according to our VON data, and I suppose with survival of kids who shouldn't have made it, you're going to see more ROP.

Up Vote Up Vote ×
Specializes in NICU.

We are a 42 bed level 3 NICU. We get a fair share of micro-preemies. Our alarms limits are monitored every shift. The alarms are responded to (high sats) immediately. Also, we changed our pre-oxygenation to 10 percent above what the patient was origionally on. No more cranked up o's for suction, turning etc. It took a lot of time to get everybody on board for this

Up Vote Up Vote ×
Specializes in NICU.

So, if you wean the oxygen anytime they are saturating high, do you spend a lot of time sitting there turning them down, up, down, up? We just find that it doesn't seem to do labile kids a favor responding to high OR low alarms immediately (obviously if they're really low...). Just curious how we can be better.

Up Vote Up Vote ×
Specializes in NICU.

We dont "chase" babies esp if they are labile. However, we do first silence the high sat alarm and standby...if the sat does stay high, we will tweak the baby down. I think we respond quicker to high sats rather than low ones esp in labile babies.

Up Vote Up Vote ×
+ Add a Comment