To Bulb Sxn Or Not?

babyktchr, BSN, RN · Jun 11, 2006

Where does the evidence live that supports this? Do the people telling you this have evidence to back this up??? I would be interested to see it.

allnurses Guide · Jun 11, 2006

Where does the evidence live that supports this? Do the people telling you this have evidence to back this up??? I would be interested to see it.

I'm interested too . . . would you post a link to the reference?

Thanks.

steph

htrn · Jun 11, 2006

Sounds a little fishy to me. Who has told you not to bulb sxn anymore?

Finallyat40 · Jun 11, 2006

regarding suction at the perineum? There is no way that they would recommend NO suctioning at all....especially with the c-section kiddos. The new NRP guidelines no longer recommend suctioning at the perineum, especially with suspected or confirmed mec.

Jamie

burn out · Jun 11, 2006

My daughter brought a premie home 5 months ago and we still instill Baby Ayr and use a bulb sx because she still wakes up congested from dired secretions. I believe she is doing better than my kids did with ear infections etc.. so far our little one has not had one ear infection or cold and I really believe it is because we do this suctioning that she is healthier for it.

midwifemamma · Jun 11, 2006

if there is no meconium, do you still suction no matter what? i'd be interested in seeing the evidence that all babies need suctioning.

midwife2b · Jun 17, 2006

The practice of routinely suctioning the newborn infant has not been assessed in any clinical trials. Its value is questioned by the authors of "A Guide to Effective Care in Pregnancy and Childbirth" by Enkin, Marc, J.N.C. Keirse, James Neilson, Caroline Crowther, Lelia Duley, Ellen Hodnett and Justus Hofmeyr (Oxford University Press, 2000). Potential hazards include cardiac arrhythmias, laryngospasm, and pulmonary artery vasospasm. Benefits include improved air exchange, reduced risk of aspiration of secretions, and possibly a decreased chance of acquiring pathogens that may be present in amniotic fluid.

This book can be found on http://www.childbirthconnection.org. It calls into question a lot of practices that we "old timers" have just taken for granted. In the era of evidence based medicine we need support that what we do is or is not beneficial in ROUTINE use.

Of course some babies do need suctioning. But if a baby is born and is crying vigorously I wipe off the face and let him or her clear the airway. Our resident physicians are learning this method as well, and some are actually starting to delay cord clamping for a minute or so.

mitchsmom · Jun 17, 2006

I did a search on "bulb suctioning" in my university databases and came up with a few things if anyone is interested:

Oronasopharyngeal Suction versus No Suction in Normal and Term Infants Delivered by Elective Cesarean Section: A Prospective Randomized Controlled Trial

Sadettin Gungor, Ercan Kurt, Ertan Teksoz, Umit Goktolga, et al. Gynecologic and Obstetric Investigation. Basel: Jan 2006.Vol.61, Iss. 1; pg. 9--"Conclusion: Although findings remained on statistical level and did not lead to clinically adverse outcomes, there is no statistical or physiological basis for oronasopharyngeal suction as a systematic procedure in healthy, term infants delivered by cesarean section."

The Lancet, August 14, 2004 v364 i9434 p597

Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre, randomised controlled trial. (Articles) Nestor E. Vain; Edgardo G. Szyld; Luis M. Prudent; Thomas E. Wiswell; Adriana M. Aguilar; Norma I. Vivas.

--"We conclude that routine intrapartum oropharyngeal and nasopharyngeal suctioning of term-gestation, meconium-stained infants does not prevent MAS [meconium aspiration syndrome] or its complications. We believe that consideration should be given to revision of present recommendations. "

J Midwifery Womens Health. 2004 Jan-Feb;49(1):32-8.

Building evidence for practice: a pilot study of newborn bulb suctioning at birth. Waltman PA, Brewer JM, Rogers BP, May WL.

"There were no statistically significant differences in Apgar scores between groups. Apgar scores at 5 and 10 minutes were 9 or 10 for all newborns. Newborns receiving bulb suctioning showed a statistically significant, lower heart rate (P=.042) during the first 20 minutes and a significantly higher SpO2 level (P=.005) by 15 minutes of age. Although statistically significant, these findings were not considered clinically significant because values remained within normal parameters."

Fatal meconium aspiration in spite of appropriate perinatal airway management: Pulmonary and placental evidence of prenatal disease. American Journal of Obstetrics and Gynecology

Volume 176, Issue 5 , May 1997, Pages 967-975

Not about suctioning per se, but they found "Seven of the eight study infants underwent suctioning of the trachea immediately after birth. In all eight cases the neonatal lungs demonstrated histologic evidence of significant hypoxic changes of a chronic nature with onset before birth. The available placentas showed variable but significant abnormalities that support a case for subacute or chronic in utero compromise." & "As in other reports, there is evidence that meconium aspiration may be a prenatal rather than a postnatal disease"

The above Lancet study is noted in this article:

OB GYN News, April 15, 2006 v41 i8 p11(1)

Five studies that could change obstetric practices. (Obstetrics) Sherry Boschert.

"A randomized, controlled study of 2,514 infants with meconium called into question the routine intrapartum practice of oropharyngeal suctioning. "We're all trained to do that," Dr. Belfort noted.

Routine intrapartum suctioning did not prevent meconium aspiration syndrome, and in rare cases it traumatized the nasopharynx or caused a cardiac arrythmia (Lancet 2004;364:597-602).

Recommendations for routine intrapartum suctioning should be revised, he said. "

There may be more out there, I just did a quick search.

LD123 · Jun 17, 2006

I will be attending a class on this issue monday, i will let you all know the final word and any resources (if they are given) on not using the bulb sxn. typically in our hospital the doctors routinely sxn ALL baby's on the perinuem. They usually use a Delee if it's meconium. nurses only sxn again if we think the baby needs it.

babyktchr, BSN, RN · Jun 18, 2006

I did a search on "bulb suctioning" in my university databases and came up with a few things if anyone is interested:
Oronasopharyngeal Suction versus No Suction in Normal and Term Infants Delivered by Elective Cesarean Section: A Prospective Randomized Controlled Trial
Sadettin Gungor, Ercan Kurt, Ertan Teksoz, Umit Goktolga, et al. Gynecologic and Obstetric Investigation. Basel: Jan 2006.Vol.61, Iss. 1; pg. 9--"Conclusion: Although findings remained on statistical level and did not lead to clinically adverse outcomes, there is no statistical or physiological basis for oronasopharyngeal suction as a systematic procedure in healthy, term infants delivered by cesarean section."
The Lancet, August 14, 2004 v364 i9434 p597
Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre, randomised controlled trial. (Articles) Nestor E. Vain; Edgardo G. Szyld; Luis M. Prudent; Thomas E. Wiswell; Adriana M. Aguilar; Norma I. Vivas.
--"We conclude that routine intrapartum oropharyngeal and nasopharyngeal suctioning of term-gestation, meconium-stained infants does not prevent MAS [meconium aspiration syndrome] or its complications. We believe that consideration should be given to revision of present recommendations. "
J Midwifery Womens Health. 2004 Jan-Feb;49(1):32-8.
Building evidence for practice: a pilot study of newborn bulb suctioning at birth. Waltman PA, Brewer JM, Rogers BP, May WL.
"There were no statistically significant differences in Apgar scores between groups. Apgar scores at 5 and 10 minutes were 9 or 10 for all newborns. Newborns receiving bulb suctioning showed a statistically significant, lower heart rate (P=.042) during the first 20 minutes and a significantly higher SpO2 level (P=.005) by 15 minutes of age. Although statistically significant, these findings were not considered clinically significant because values remained within normal parameters."
Fatal meconium aspiration in spite of appropriate perinatal airway management: Pulmonary and placental evidence of prenatal disease. American Journal of Obstetrics and Gynecology
Volume 176, Issue 5 , May 1997, Pages 967-975
Not about suctioning per se, but they found "Seven of the eight study infants underwent suctioning of the trachea immediately after birth. In all eight cases the neonatal lungs demonstrated histologic evidence of significant hypoxic changes of a chronic nature with onset before birth. The available placentas showed variable but significant abnormalities that support a case for subacute or chronic in utero compromise." & "As in other reports, there is evidence that meconium aspiration may be a prenatal rather than a postnatal disease"
The above Lancet study is noted in this article:
OB GYN News, April 15, 2006 v41 i8 p11(1)
Five studies that could change obstetric practices. (Obstetrics) Sherry Boschert.
"A randomized, controlled study of 2,514 infants with meconium called into question the routine intrapartum practice of oropharyngeal suctioning. "We're all trained to do that," Dr. Belfort noted.
Routine intrapartum suctioning did not prevent meconium aspiration syndrome, and in rare cases it traumatized the nasopharynx or caused a cardiac arrythmia (Lancet 2004;364:597-602).
Recommendations for routine intrapartum suctioning should be revised, he said. "
There may be more out there, I just did a quick search.

How fabulous is this reply??? Just the little blurbs are a great read. THANKS!!! :yelclap:

LD123 · Jun 29, 2006

Thanks for all the great replies. Basically we are being told that the baby's can handle their own secretions and they should never be suctioned. I'm going to continue to suction if I think the baby needs it. The new NNP had already heard so much objection f/m the other nurses on the unit that she didn't discuss the issue much in my meeting. She said she has been known to hide the bulb's f/m the doc's. I can't wait to see this!