Extubations and positioning of babies

[acapps]

We have recently had an increase in the number of unintentional extubations. We have looked into several different causes and can not pin point one particular cause. They have recently implimented a change in the way we position the babies in the bed and ventilators in the room. We use giraffe isolettes and have always placed the head towards the outside of the bed and feet towards inside where switches are, with the vents begin at the end of bed near head. Now we have turned the babies with heads at other end and vents to side of isolettes. It doesnt seem to be working well and gives less working space. What are something things that you do positioning infant/equipment that you feel help prevent/reduce extubations?

[Christina24]

Nice idea......

[gopan2596]

Hi

Accidental extubations are always very annoying . My suggestions to avoid this would be

1) Try nasal intubation if there is expertise and the staff is comfortable with that . However , if there is no experience in the same , its best avoided

2) It would be worthwhile looking into nursing allocation . I dont think this could be a problem in well established units , however its worthwhile looking into this and putting experienced staff in care of sick babies expecially very low birth weight babies . If the event has followed arrival of new nursing staffs , frequent educational sessions on ETT care would be of benefit

3) Identify preceding situations that has led to these events . Data on this could throw light on how to improve upon this situation .Then changes could be made one at a time and then see what improvement had occured after the introduction of that change .

4)there are supporting scaffolds available to hold oral tubes in position . This could be tried

I think , data collection on the preceding events that lead on to accidental extubation would be best starting point . That way , there is some direction towards the area of improvement

Hope this helps

Kind regards

Gopan

[jwiggins]

I would suggest to have the circuits entering the center of the isolette instead of the sides so if baby moves his or her head, there is less tension on the circuit and hence less on the ETT. I think there should be a constructive huddle between physicians, charge RN, RT and bedside RN to determine what are the factors contributing to self extubation. Tracking this over time might show a pattern. Sedation, quality of taping and retaping are big factors for us.