Positioning of infants with RDS.

Published

Hello,

I have been a NICU Nurse for over 10 years and every place I have been we have positioned infants with any kind of respiratory distress on the giraffe with the baby facing the head of the bed so the infant is ready for intubation in the event of an emergency. I started a new job at a NICU and one doctor wants all the baby's positioned at the head of the bed regardless of the patient's respiratory status. Only when the patient is intubated is his head positioned according to NRP guide lines for intubation. We have had several sick kids with chest tubes lately and all of these kids were positioned with the infant at the head of the bed. None of these kids were intubated because the doctor tries everything possible to avoid intubation. I am wondering if anyone has seen any literature to support the traditional way of positioning the infant for an emergency. The doctor's rationale is that it makes the mother's happy. I have no problem with positioning the kids this way if they are stable. But it is scary to think of having to turn a sick baby with a chest tube all the way around to just to intubate the baby in an emergency situation.

I know some units do this but I'm old school. Your thoughts are welcome.

Up Vote Up Vote ×
Specializes in Nephrology, Cardiology, ER, ICU.

Moved to NICU forum

Up Vote Up Vote ×
Specializes in NICU.

I guess I don't understand what position you're trying to portray. Is their head towards the wall?

Up Vote Up Vote ×
Specializes in NICU, PICU, educator.

Our babies are with the head on our left, feet to the right. We don't have Giraffes so we have to pull them out and reposition them. It's been this way for 30 years, never lost a chest tube lol.

we just turn them a quarter turn so their head is on the edge of the bed closest to us, tube them and turn them back

Up Vote Up Vote ×
Specializes in NICU.

All of our babies in isolettes and warmers are placed feet towards the wall (that way the babies can read their body and isolette's temperature on the control panel) . In case of an emergency, they are in the proper position for intubation.

Up Vote Up Vote ×
Specializes in NICU.

All of our infants are placed head towards wall, feet towards unit. For intubation, the baby is briefly turned with feet towards wall, intubated, and then turned back. We really haven't had any issues. The only exception is when a baby is on HFOV.

Up Vote Up Vote ×
Specializes in NICU, Cardiac.

Our babies are position head at the wall, feet in the unit, except on HFOV when it's opposite.

Up Vote Up Vote ×

Ours are also head towards the wall, feet towards the unit. But our sister faculty in the same city positions then the opposite. Ours are faced the way they are per our managers preference unless it is over rode by the doctor. I prefer head to the unit and feet to the wall.

Up Vote Up Vote ×

Ours are feet to the wall. All respiratory equipment (bubble CPAP, vents, etc) are then positioned toward the unit. It works for us. The only downside i suppose is that hoses/plugs from wall gas source to vent are then strewn across the floor, so if you are not careful, you may trip or unplug something.

Up Vote Up Vote ×
Specializes in NICU.

If a baby is intubated then our babies are at the open end of the giraffe. Otherwise we actually switch the direction our babies face every day. We do this to prevent torticollis because preemies tend to face one direction more than the other and if there is a window in the room (we have separate patient rooms for each baby) they will look that way more. So we say "Right day (even day numbers) right way" and "Odd day (odd numbered days) odd way" meaning on even days the baby's head is at the controls and on odd days their feet are at the controls. This is part of our developemental care and we have seen a DRAMATIC drop in congenital torticollis and plagiocephally in our NICU follow up clinic. Our hospital has studied this and followed it pretty closely and it makes a difference. Hearing this I am not surprised more NICU's haven't adopted this?? Any other NICU's do this?

Up Vote Up Vote ×
Specializes in NICU, PICU, educator.

We don't do that but we sure as

heck make sure they are turned to face the other way every other hands on care. We also have OT/PT that come work with them at least 3 times per week, so we have seen less.

Our big chronic kids in open cribs get turned "backwards" so they are forced to look the other way.

Up Vote Up Vote ×
+ Join the Discussion