Focus on preplanning role definition improving communication and increasing efficiency of surfactant administration Revised 8513 Preplanning for Deliveries lt 27 weeks Transport RN Tell team members of impending delivery NNP RT bedside ID: 206278
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Slide1
The Golden Hour
Focus on pre-planning, role definition, improving communication and increasing efficiency of surfactant
administration
Revised 8.5.13Slide2
Pre-planning for Deliveries <
27
weeks
Transport RN
Tell team members of impending delivery: NNP, RT, bedside RN, charge RNBring surfactant and have it warmed and drawn up for babies <27 weeksHave suction readyHave PIV out & readyHave IV fluids readyHave DR and transporter readyReview preplanning checklist in DR with team (verbal)
NNP
Notify fellow/MD of impending delivery and discuss specifics of care planDetermine estimated weight and tell transport RN and RT in order to have appropriate ETT size cut, surfactant drawn up & IV fluid ready based on estimated weightHave UAC/UVC out, flushed & ready
RT
Bring vent to DR
Bring Neopuff to DR. Starting settings
PIP=25, PEEP = 6
Have appropriate size face
mask out and ready, have ETCO2 detector & pulse oximetry ready
Have sterile blade, appropriate size ETT based on estimated weight cut & ready in sterile fashion on Mayo stand in DR
Have one ETT size bigger and one smaller than the ETT that is cut available in DR for use if needed (not cut prior to delivery)
Have neobars
availableSlide3
Pre-planning for Deliveries ≥
27
weeks
Transport RN
Tell team members of impending delivery: NNP, RT, bedside RN, charge RNBring surfactant for infants 27-34 weeks but do not warm or draw up. Do not routinely bring surfactant for infants >34 weeks unless stated by MD/NNPHave suction readyHave PIV out & readyHave DR and transporter readyReview preplanning checklist in DR with team (verbal)
NNP
Notify fellow/MD of impending delivery and discuss specifics of care planDetermine estimated weight and tell transport RN and RT in order to know appropriate meds, ETT size, and IV fluid rate based on estimated weight
RT
Bring Neopuff to DR. Starting settings
PIP=25, PEEP = 6
Have appropriate size face
mask out & pulse oximeter readySlide4
Surfactant administration in DR
Goal: Safely improve efficiency in surfactant administration to neonates warranting intubation in the delivery room
New Process:
(
if warrants intubation in DR)Suction mouth then nose per NRPIntubateNNP/MD to hold ETT at appropriate insertion length to roof of mouthConfirm ETT placement by auscultation, condensation in tube, and + yellow pediacap color changeReconfirm appropriate length at lipsAdminister surfactant WITHOUT TURNING the infant’s position in 2 equally divided aliquots with PPV bagging for 1-2 minutes at approximate rate of 60bpm in between aliquots
RT to temporarily stabilize ETT using silk tape and 1 wrap around ETT RT to stabilize ETT and vent tubing position so no torque on the baby/ETT/tubing
NNP to work on accessRT to measure for Neobar and warm itOnce access complete and baby ready for transfer back to NICU, Neobar to be applied by RT and RN under controlled environment to minimize extubationFinal preparation and return to NICUGuideline for ETT
Weight
ETT size (mm)
Cut length (cm)
Insertion
l
ength at the lip (cm)
500gm
2.5
13
5.5
-
6
750gm
2.5
13
6
1000gm
2.5
13
6
1500gm
3.0
14
7
2000gm
3.0
14
7
2500gm
3.5
14
8
3000gm
3.5
15
8
3500gm
3.5
15
9
4000gm
4.0
16
10Slide5
Quick Reference Guides
Weight
ETT size (mm)
Cut length (cm)
Insertion
l
ength at the lip (cm)500gm
2.5135.5 -
6
750gm
2.5
13
6
1000gm
2.5
13
6
1500gm
3.0
14
7
2000gm3.01472500gm3.51483000gm3.5158 3500gm3.51594000gm4.01610
Approx.
Gest. Age
~50% for weight estimate
24 weeks
500gm
26 weeks
750gm
28 weeks
1000gm
30 weeks
1500gm
33 weeks
2000gm
35
weeks
2500gm
40 weeks
3500gmSlide6
QUICK REFERENCE GUIDESlide7
Delivery Room Quick-Check List