HAND HYGIENE
- Meticulous hand hygiene before and after patient contact and handling respiratory equipment or condensate
- wear gloves and apron when handling ventilator condensate and other respiratory/oral secretions
INTUBATION
- Use a new, sterile ETT for each intubation attempt
- use sedation +/- video laryngoscopy for planned procedure to reduce need for multiple attempts
- Ensure ETT does not contact environmental surfaces before insertion
- Use a sterilised laryngoscope
- Have ≥2 NICU staff members present for ETT retaping/repositioning
SUCTIONING PRACTICES
- Clear secretions from the oropharynx before:
- ETT manipulation
- patient repositioning
- extubation
- re-intubation
ETT SUCTION
- Only when indicated
- Do not use sodium chloride instillation routinely
- For open suction, use ‘suction function’ on ventilator (if available) to prevent spray of condensate
FEEDING
- Adjust enteral feeding (see Nutrition and enteral feeding guideline). Abdominal distension and vomiting increase risk of reflux and aspiration
POSITIONING
- Keep head of bed elevated 15–30°
- Ensure no condensate in ventilator tubing before turning
ORAL CARE
- Use colostrum/breast milk, or sterile water if no breast milk available (see Nutrition and enteral feeding guideline)
- Carry out oral care:
- ≤24 hr after intubation
- every 3–4 hr
- before re-intubation as time allows
- before orogastric tube insertion
RESPIRATORY EQUIPMENT
- Use a separate suction catheter for oral and tracheal suction
- Drain ventilator condensate away from baby every 2–4 hr and before repositioning
- Avoid disconnection of ventilator circuit – only disconnect if:
- emergency use of Neopuff™ or ETT re-intubation
- change of circuit
- unable to remove condensate by manipulation of tubing
- Do not routinely disconnect ventilator circuit when turning baby
- Change ventilator circuit when visibly soiled or mechanically malfunctioning in addition to manufacturer’s instructions
- Clean Neopuff™ connector with alcohol wipe after each manual contact with the ETT adapter
- Use heated ventilator circuits
Date updated: