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What do you do about leaks?

NICU   (2,767 Views | 10 Replies)

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I've found that most of the incubated babies I take care of have substantial air leaks...does anyone have any good tips on how to minimize them? It seems like I'll get the baby positioned and get the leak down below 20%, but then the baby moves half a millimeter and it's up above 60% again. Anything you've found to be helpful?

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Bortaz has 11 years experience as a BSN, RN and specializes in CDI Supervisor; Formerly NICU.

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I just curse under my breath and reposition the tube slightly.

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48 Posts; 1,937 Profile Views

I just curse under my breath and reposition the tube slightly.

Pretty much this. If it's an assessment time I'll reposition the peanut on their other side to see if it helps.

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NicuGal has 30 years experience as a MSN, RN and specializes in NICU, PICU, PACU.

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Yup, swear and then move them a millimeter lol

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hikernurse has 8 years experience and specializes in NICU.

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Agree with the others. But, technically, many are incubated as well as intubated :cool:

And swearing somehow really does help, lol.

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NicuGal has 30 years experience as a MSN, RN and specializes in NICU, PICU, PACU.

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I had two leakers last night! My roommate and I were ready to scream after 12 hours....please let them be extubated tomorrow! Lol and a few bad words were uttered hourly lol

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meanmaryjean has 40 years experience as a DNP, RN and specializes in NICU, ICU, PICU, Academia.

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Well, in my world if a kiddo has a leak BUT is getting their volumes and keeping their sats up - a leak is a GOOD thing. A tiny leak can mean the difference between barotrauma and chronic lung damage and not.

In other words, not all leaks are bad.

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TiffyRN has 27 years experience as a ADN, BSN, PhD and specializes in NICU.

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I have no novel advice other than what's been posted. One thing I've noticed is that since we went to volume guarantee ventilation, the vents go absolutely crazy when there is a leak (low VE, low VE, low VE!!). Obviously the vent can't meet it's volume when there is a huge leak so the vent screams constantly. Oh, and the baby screams off and on too, you know, audibly?

We've had a number of kids on VG that we have to change to old style pressure control due to leaks. Not because we get tired of the alarming, but they either get tachypneic or the vent overcyles them and their gasses deteriorate. They improve on pressure control. I'm not saying one's better than the other, just that it's good to have options.

I completely understand why we don't have cuffs but I sure miss those cuffs on adult ETTs & trachs.

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NicuGal has 30 years experience as a MSN, RN and specializes in NICU, PICU, PACU.

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Right there with you Tiff! They don't make small enough cuff tubes, I think the smallest is either a 3.5 or 4, at least that is what I have seen in our hospital. And a cuffed tube can cause damage if not properly inflated and deflated. We have used cuffed trachs though on the big kids. Thankfully the kids in my room were on NIMV lol.

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243 Posts; 6,234 Profile Views

Sometimes swap for a larger tube, sometimes put them on the Jet because some Neo's believe this helps, sometimes just except it and work hard on positioning. Depends on how big a leak, how well we're able to ventilate the kid despite the leak, and how stable they are.

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