What to do when my baby desats...

[shermrn]

Ok, I've been on NICU for a little less than a year, still learning a lot. One thing that drives me crazy is when I'm taking care of an infant who is desatting for no obvious reason, what i mean is, doesn't appear to need suctioning, isn't moving or bucking the vent, tube is not kinked or obstructed in anyway, vent not alarming/malfunctioning, repositioning, stimulating, increasing the O2 doesn't help, nothing changes the desat except the passage of time. Now this isn't a baby that is really low on the sats who needs to be bagged out of it either. This is a baby who is just a few points below where I have my alarms set, maybe 83% with the low limit being 85%, and just hanging out at that sat, alarming, while the parents look at me and want me to fix things. This could even be a baby who isn't on the vent, maybe rated CPAP, an extra couple of breaths doesn't help either. The baby just will not come up those few points, what to do or what to explain to the parents. Tell me what is happening with the baby in this situation and what I should be doing other than asking a more experienced RN or an RT for help, because they don't always know how to fix things other than just stand there and look at the baby. What to do, what to say? Also the baby looks ok, it's just the numbers and the monitor that indicate a problem.

[NicuGal, MSN, RN]

Just reassure them that the baby is okay, especially if they do tend to drift around. We only adjust O2 if they stay below the set low consistently.

[Bortaz, MSN, RN]

Make sure you have a shoulder roll (some call them neck rolls) to make sure the airway isn't obstructed by a chin being tilted toward the chest. Many times, I've had nurses complain about the baby desatting, and i slip that roll under the shoulders and the sats come right up.

[Justin-RN]

And preemies just tend to do that. It's what they do. Also, PDA? What are their pulse pressures like?

[verytallnurse]

Yeah. We have many of those babies. Many of them are shunting. PDA PFO ASD VSD even I can't hear an obvious loud murmur. Usually they will do those quick desats after extubation and weeks after most likely due to BPD. So I always go through my list:

obstructed airway?

Moving feet a lot?

X-ray white out?

Shunting?

RDS /BPD

What is HCT level?

Perfussion in extremities?

and last.. is there a lot of humidity in a system and baby keeps getting instilled?

THERE IS ALWAYS ONE OF THESE AND MANY TIMES THERE IS NOTHING YOU CAN FIX QUICKLY.

Hope it helped

and finally