Canberra Hospital and Health Services Clinical

Canberra Hospital and Health Services

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Canberra Hospital and Health Services

Clinical Procedure

Ventilation – Invasive and Non-Invasive (Neonates and Infants)


Contents 1

Purpose 3

Alerts 3

Scope 3

Section 1 - Intubation 4

Section 2 - Colorimetric CO2 Detector for Intubated Infant 7

Section 3 - Endotracheal (ETT) Strapping Neobar 10

Section 4 - Nasal Endotracheal Tube Strapping/Restrapping 12

Section 5 - Care of the Ventilated Infant 14

Section 6 - Surfactant Administration 19

Section 7 - Endotracheal Suctioning Closed System 25

Section 8 - Endotracheal (ETT) Suction Open Method 27

Section 9 - High Frequency Ventilation 28

Section 10 - Neurally Adjusted Ventilatory Assist (NAVA) in Neonates 34

Section 11 - Care of Muscle Relaxed Infant 44

Section 12 - Nitric Oxide (NO) Administration 46

Section 13 - Nitric Oxide-INOvent® Operation 49

Section 14 - Endotracheal Aspirate 54

Section 15 - Extubation 55

Section 16 - Bubble CPAP for Neonates 56

Section 17 - Continuous Positive Airway Pressure (CPAP) via Nasal Tube 59

Section 18 - High Flow Therapy 63

Section 19 - Low Flow Nasal Cannula-Oxygen Therapy 67

Evaluation 68

Related Policies, Procedures, Guidelines and Legislation 69

References 69

Definition of Terms 73

Search Terms 74

Consultation 74

Attachments 75


The purpose of the Invasive & Non-invasive Ventilation Procedure is to outline the safe and effective management of Neonates/Infants requiring respiratory support while being cared for under the care of acute and sub acute clinical units in ACT Health.
This document outlines the equipment required and how to assemble it in order to deliver respiratory support for the Neonate/Infant. This document also outlines the procedures the neonate/infant requires while receiving respiratory support to ensure they receive evidence based care.



The Paediatric Patient 2 years or less requiring Intensive Care may be admitted to NICU (after consultation with the Neonatologist on service). The decision whether to transfer to a tertiary PICU is made by the Neonatologist in consultation with NETS NSW.
The Pain Tool PIPP-R is used for all babies who are intubated, on CPAP or who are suspected of being in pain. Appropriate pain management such as positioning or administration of medication should be implemented according to the infant’s PIPP-R score.


The document pertains to infants and babies nursed in the Neonatal Intensive Care and Special Care Nursery.

This document applies to:

  • Medical Officers

  • Nurses and Midwives who are working within their scope of practice (Refer to Scope of Practice for Nurses and Midwives Policy)

  • Physiotherapists

  • Physiotherapy Students under supervision

  • Student Nurses under direct supervision.

Strict hand hygiene should be adhered to at all times when performing all clinical procedures as per CHHS Healthcare Associated Infections Procedure.

Section 1 - Intubation


The purpose of Section 1 is to list the equipment required and the process for placement of an oral or nasal endotracheal tube (ETT).
Intubation of the infant is required for the treatment of:

  • Pulmonary disease e.g. surfactant deficiency

  • Airway management e.g. post surgical infant

  • Central causes e.g. apnoea

  • Miscellaneous causes of respiratory distress e.g. sepsis


  • Resuscitation trolley

  • Prepared ventilator as per SOP Ventilator Leoni

  • Suction setup with 10Fg or larger suction catheter, plus size 6Fg and 8Fg for suctioning the endotracheal tube

  • Neopuff and appropriate size mask

  • Endotracheal tube (ETT) (see table 1 below for correct size for weight)

  • Laryngoscope and light source Blade 1 (term newborn) Blade 0 (preterm)

  • Tapes for securing endotracheal tube (see Sections 3 & 4 of this Clinical Procedure: Securing oral ETT tubes and Securing nasal endotracheal tubes )

  • Scissors

  • Stethoscope

  • Introducer

  • Monitoring see the following SOP’s

  • ECG monitoring

  • Saturation monitoring

  • Transcutaneous monitoring

  • CO2 detector

  • Drugs for premedication-see medication manual

Table 1: Guide for Endotracheal tube sizes

Tube Size mm

Weight (grams)

Gestational Age (weeks


Below 1,000

Below 28

2.5 3.0

1,000 2,000


3.0 3.5

2,000 3,000


3.5 4.0

Above 3,000

Above 38


  1. Collect all equipment

  2. Ensure all settings on the Neopuff and suction device are correct

  3. Draw up premedication drugs (must be checked by 2 nurses)

  4. Position the infant supine on a flat surface with the head in a midline position

  5. Assist with suctioning of the nasopharynx and oropharynx as necessary

  6. Intubate according to ILCOR guidelines (medical officer)

  7. Monitor the heart rate, saturation and colour during the procedure

  1. See guide below for recommended tube length

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