Pulmonary Hemorrage.

Specialties NICU


Haven't seen one, but I understand the onset is pretty fierce. What would your responsibilities be if that should happen? I'm thinking have suction set up, chest tube set up, obviously assist with airway. But what else?

Jolie, BSN

6,375 Posts

Specializes in Maternal - Child Health.

Have your resuscitation cart at the ready, and be prepared to hang blood.

Specializes in NICU.

I've only seen this happen once, and it was another nurse's baby, but it happened SO quickly I just couldn't believe it. One minute she yelled, "He's hemorrhaging!" and like, 20 very short minutes later the baby was gone. Very, very messy and very, very sad.

Sorry; I have no advice for you. :D Just had throw in.

RN from OZ

75 Posts

I have had this happen to me.

You get no warning...slight drop in sats ...attributible to many things then the blood. Yep airway, suction, Intercostal cath, blood

warmer I have seen it several times...usually on CPAP Bubs and not a one survived.


22 Posts

Specializes in NICU.

I have seen this twice and as everyone has said it happens very quickly. Despite resusc efforts both babies died.:o


1,334 Posts

Specializes in NICU.

Also be prepared to draw coags and hang FFP or Cryo in case it's DIC.


71 Posts

I've worked in the NICU for 24 years and have seen a pulm. hem. a couple of times....ussually the micro-premies.

We have given recemic epi via ETT with good success. The pts I remember did survive, but some have died. They tend to have many other diffuculties going on.

We now have a very set policy for suction depth now and also use inline suction.


150 Posts

Specializes in NICU, PICU,IVT,PedM/S.

We have had a few but none died. There was one that was septic,he came down from out Intermediate Care. He was whiter than anything I have ever seen. The nurse sx while the parents were at the bedside and it was all blood. The nurse was so calm it kept everyone including me calm. That baby was sick for weeks but he pulled through! We also use inline sx and increase the I:T ratio.


89 Posts

seen this a few times on nicu usually with the smaller babies, and most commonly if they are very sick and have DIC. Thankfully not always the dramatic ones sometimes it is just a small one, and most babies seem to survive but by no means all particularly if they have clotting problems such as DIC. We commonly swap onto Oscillation as a form of ventilation as it can sort of put pressure on the bleed which helps.

NicuGal, MSN, RN

2,743 Posts

Specializes in NICU, PICU, PACU.

I have seen more than my fair share of pulmonary hemm. I had one patient die on my because of it...I will never forget that....as fast as we pushed the blood in, it came out the oet....it was awful.

We get some hemm. with the smaller kids, esp. with the 3rd or 4th dose of Survanta. We will up the PEEP or got to osc or HFV to stop it. And if we have to suction, it is with an RT and we try to do it only every 12 hours if needed. We have also put Epi down the tube.

Those are the most unpredicatable things...fine one minute, go to suction and boom, there it is~


81 Posts

just a quick message, i know this is an old thread, but my son had one 11 years ago.....hes sitting on the couch now, smart as can be!!


409 Posts

Specializes in NICU.

Most of the pulmonary hemmorages that I have seen on my unit are on the micro-premies... not fun let me tell you. Usually we will suction as much of the blood out on that "suction pass" as we can, and then no more suctioning for a while. The baby also gets put on the HFOV, to help with higher pressures in the lungs. We also send the usual blood work (CBC, blood gas...) usually as soon as the CBC comes back, we are getting orders for blood, and sometimes platelets as well.

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