1.8.1. Indications for intubationIf the infant’s heart rate does not rise above 60 beats per minute with chest compressions and effective positive pressure ventilation in 100% oxygen, then advanced resuscitation interventions (including drug administration) are now indicated. Show
The administration of drugs requires that the infant has intravenous access or an endotracheal tube in-situ. The indications for endotracheal intubation and umbilical vessel catheterisation are discussed below. The skills of intubation and umbilical vessel catheterisation are considered to be advanced resuscitation interventions. The opportunity to practice and apply these skills is offered to participants undertaking the Advanced Resuscitation Program. Endotracheal IntubationThere is no “set” or correct time to decide to intubate a newborn infant during a resuscitation, although there are several circumstances in which intubation is indicated if a person with the professional expertise to perform this procedure is available. These are:
Equipment for endotracheal intubation
Endotracheal size and length
The endotracheal tube diameter can also be calculated using the infant’s gestational age in weeks divided by 10. Click here to access the Neonatal Worksheet, which will calculate the correct size endotracheal tube and depth of insertion for a given gestational age and birth weight. Estimating the depth of insertion of the endotracheal tubeThe “rule of 6” can be used as an estimate as to where the endotracheal tube should be tied.
Oral versus nasal intubation
Verification of endotracheal tube position
Nellcor/Tyco Healthcare Pedi-Cap™ CO2 detector (1kg – 15kg Pediatric) You may wish to view the Pedi-Cap CO2 detector presentation on the NeoResus web site. Other clinical signs that indicate successful tracheal intubation
The “gold standard” of verifying correct endotracheal tube placement
Clinical Practice Guidelines for IntubationVictoria: Better Safe Care: Neonatal eHandbook. Intubation (Updated July 2019) How quickly should intubation procedure be completed NRP?Since the American Academy of Pediatrics Neonatal Resuscitation Program recommends that intubation should be completed in approximately 20 seconds, we measured the duration of neonatal intubation attempts by different operators, using video recordings of neonatal resuscitations.
When would you immediately initiate ventilatory assistance in a newborn?If the infant is apneic, is gasping, or has a heart rate of less than 100 beats/min, positive-pressure ventilation should be given immediately after establishing airway patency.
What are the primary methods of confirming endotracheal tube placement NRP?A chest X-ray is the gold standard of confirming that the endotracheal tube is in the trachea and inserted to the correct depth.
Which of the following is an indication for endotracheal intubation NRP?Endotracheal Tube Placement
During neonatal resuscitation, endotracheal intubation may be indicated when bag-mask ventilation is ineffective or prolonged, when chest compressions are performed, or for special circumstances such as congenital diaphragmatic hernia.
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