To artificially support the baby. To get the respiratory system normal and to prevent ventilator associate pneumonia and any infection.
Child who are on mechanical ventilator.
To take care of the child who is required Mechanical Ventilation.
Head Nurse, Staff Nurse, Auxillary Nurse Midwife, NICU Registrar Consultants.
- Follow basic principles as mentioned –
- Use strict asepsis during procedure.
- Maintain a patient airway.
- Adequate ventilation with required oxygen concentration.
- Adequate suctioning to prevent obstruction.
- Prevent hypothermia.
- Maintain comfort of the baby either by sedation or by giving muscle relaxant as ordered by the physician to make the ventilation effective.
- Observation & recording hourly and whenever necessary.
- Confirm whether the ventilator tubing is attached currently to the machine.
- Collect the following equipment on the bedside.
- Ventilator with ventilator circuit and humidifier.
- Crash Cart.
- Endotracheal tube with appropriate size.
- Laryngoscope with blade.
- Ambu Bag with face mask.
- Sterile Gloves.
- Emergency Drugs.
- Cardiac Monitor.
- Central suction with appropriate suction catheter.
- Normal saline 100 ml (2) for suctioning.
- Dynaplast and cotton swab.
- Articles for ICD in case, if necessary.
- Disinfectant for Hand Hygiene.
- Kidney Tray.
- Confirm that the endotracheal tube is in position by checking the air entry and chest expansion.
- Secure the endotracheal tube adequately and avoid traction on the tube.
- Ask for Chest X-ray.
- Confirm the ventilator setting with the doctor and observe for any small leak.
- Observe the ventilator setting and oxygen saturation on hourly basis and record in the flow chart.
- Avoid kinks in the circuit and endotracheal tube.
- Remove water collected in the circuit and water trap frequently.
- Top up the humidifier chamber with water.
- Inspired air temperature to be checked to avoid heating of inspired gas.
- Check the alarm limits frequently and see that the alarm is ‘ON’ always.
- Preform blood analysis whenever ordered by the physician.
- Change baby’s position after every 2-3 hours and whenever necessary.
- Endotracheal, Nasal and Oral suction to be done every 2-3 hours and whenever necessary.
- Post Surfactant Therapy endotracheal suction to be done after 6 hours.
- Suction catheter of appropriate size and indicated length to be used during ET suction. Indicated length should be recorded in the flow chart.
- If the baby is on ventilator, to take the weight is not possible.
- Chest X-ray should be taken whenever ordered by the physician.
- Comfort of the child to be maintained by proper positioning, if needed, sedation is given after consulting the physician.
- Chest physiotherapy with vibrator should be given if there is an evidence of consolidation on Chest X-Ray as it is exhausting for the child. The need and frequency for physiotherapy should be reviewed each day.
- Change the E.T. tube after 7 days and whenever necessary.
- Endotracheal tube aspirate for bacteriological culture and sensitivity to be sent, if necessary.
- Tip of the endotracheal tube is sent for culture and sensitivity.
- Segregate generated Bio-Medical Waste as per HIC policy.
- Observation to be documented on Nurse’s Notes.
- Vital sign – 1 hour and depends on the condition of the baby.
- Any changes in the settings on the ventilator.
- Condition of the child after ventilation.
- Oxygen saturation every 1 hour and whenever necessary.
- The amount of secretion, colour and odour during suctioning.
- Nurse’s Observation Sheet.
- NICU Flow Sheet.