DO NOT USE FOR CLINICAL PRACTICE
Please use current guidelines available on the UHNM intranet for patient treatment
Please use current guidelines available on the UHNM intranet for patient treatment
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