Perform endotracheal suction as per closed/open suction as per Section7 Endotracheal suction – closed system and Section 8 Endotracheal Suction – open system, of this Clinical Procedure
Disconnect sputum trap from suction tubing
Label container and send to pathology.
Explain procedure to parents
Document in progress notes
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Section 15 - Extubation
The purpose of Section 14 is to describe the process of extubation and the procedures performed prior to extubation of an infant.
The decision to extubate is made when mechanical ventilator support is considered to no longer be required. This decision is made well in advance of the procedure. Alternative modes of respiratory support i.e. CPAP, low flow oxygen, cot oxygen is determined and organised prior to the procedure.
The purpose of this Section is to provide instructions on how to deliver continuous positive airway pressure (CPAP) to a Neonate. CPAP is delivered continuously throughout the respiratory cycle ensuring a functional residual capacity and thereby reducing the work of breathing.
Alcohol Based Hand Rub (ABHR)
CPAP cap and accessories
Nasal prongs or mask appropriate for the size of the baby
Humidifier base and water
Collect all equipment
Set up circuit as per directions on CPAP trolley
Set up humidifier base. The MR850 is used for humidification and set on intubation mode
Suction the oropharynx and nares prior to application of the nasal prongs (MAX 4 cms)
Turn the oxygen flow meter to 8L/MIN and check for leaks
Set the CPAP to 5-8 cms of H2O as prescribed by Consultant/Registrar
This section lists the equipment required and the procedure on how to deliver CPAP via a Nasal Tube.
This is a system whereby mono nasal CPAP is delivered by a shortened endotracheal tube which is placed 2-3 cms into a nare. It is attached to a ventilator circuit to deliver a required level of peak end expiratory pressure (PEEP). This system is mainly used during transport following delivery/resuscitation of a baby.
ETT - refer to table below (x2 - one spare)
1cm wide leucoplast - strapping nasal tube see diagrams for option 1a or 1b
Ventilator - Stephanie or Drager with ventilator circuits/equipment
Oxygen/air source - wall outlet
Equipment for provision of oral sucrose administration (sucrose, dummy and 1ml syringe) - refer to SOP sucrose Pain relief
Parent information leaflet
Alcohol based hand rub (ABHR).
Endotracheal Tube Size
TUBE SIZE (mm)
GESTATIONAL AGE (wk)
Set up ventilator per SOP - set parameters as prescribed by the Neonatologist
Set humidifier temperature for the MR 730 at 40oC -3
Document on observation chart and progress notes
Nasal tube changes
Which nostril used
Condition of nares
Include in hourly observations documentation; parameters on the ventilator (PEEP, Fi02 and flow), humidifier temperature and rainout in circuit; position of nasal tube at nares, strapping, nares condition and need for suction
Change nasal tube 12 hourly or more frequently if required (5) especially if the assessment of infant indicates blocking of nasal tube by
Sudden increase in oxygen requirements
Reduced air entry on auscultation and increased work of breathing (7)
Suction 'free' nare and oropharynx PRN and document suctioning results
Do not irrigate nasal – tube remove the tube if blocked. Suction the nares and replace tube in other nare. If the infant is CPAP dependant a second nurse should apply PEEP via the Neopuff throughout the procedure.
CPAP equipment is secure and not traumatizing the nose or causing excessive flexion/extension or rotation of head and neck of the neonate (4)
Any change in neonate's condition has been reported to the medical officer