When to Bag Your Baby??

Specialties NICU

Published

Hello all!

I am fresh out of nursing school and landed my dream job in the NICU this past May. So, now I have completed my orientation and I am on my own....:confused:....and I am terrified!!! On my first shift alone my baby had to be bagged, but I wasnt the one to do it. Luckily, another nurse was in the room helping me start an IV when the baby deteriorated (having A's & B's) and she recognized that he needed to be bagged and did it, but now I am terrified because I didnt think that he needed to be bagged at that time. If I was the only person in the room I would have tried to wait and see if he would have come up on his own. But that scares me because I dont want to wait too long and harm my babies...So, is there a certain number (O2 sat or heart rate) that I should be bagging my babies at? And has anyone else ever felt like this, and if so, what can I do to help myself not feel like this????

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You need to try less traumatic things first like stimulation. Also you reposition and push the chin up. If the baby is coming up (even slowly) then give a few more seconds before moving on to the bag. When I put the bag on I'll even try holding cpap for a few seconds to see if that works before actually giving breaths. Some times though a baby will just be falling like a rock and you move through these steps really quickly!! I'm pretty conservative....... perhaps too conservative...... But some people are just "bag happy" These people also like to bag vent babies without trying manual breaths first. Maybe that's what you encountered today?

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Specializes in Pediatrics, ER.

I bag for Bs...blue or bradycardia that doesn't respond to stimulation, as well as an apneic event longer than 20 seconds. I always try to go from least invasive to most. Flicking their feet, a gentle sternal rub, a pinch first, and then sometimes I'll try blow by with the BVM before I actually form a seal and deliver pressure. It depends on how the baby looks and how much time you have to safely try interventions before things take a critical turn. Over time you develop instincts and you get to know your patients and how they've responded in previous situations. Sometimes a situation is subjective and one nurse would bag a patient when another nurse would continue trying other interventions.

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Specializes in NICU.

Some tips I've heard from different nurses...

For a typical A & B, you should give them 30 seconds of stim and blowby, with your stim becoming progressively more vigorous. If there is no improvement, time for BMV. (Think similar to NRP...)

For a vented baby, 60 seconds of saturations below 60% despite increased oxygen. Probably sooner if you also have bradycardia. Consider manual breaths first.

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Thank you all so much for the helpful advice! Its scary being new and having someone's life in your hands, but I am just trying to learn as much as possible to become better. Thanks again for helping me learn and (hopefully) become a better NICU nurse! :redbeathe

Heather

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