Continuous Positive Airway Pressure
Airway Management of Babies on CPAP

 

 Reviewed by Victoria Wells -
Nurse Educator
May
2009
Clinical Guidelines Back Newborn Services Home Page
Principles of Management Process

Principles of Management

Process

Step Action Rationale
1
  • Collect all equipment necessary.
  • Attach suction catheter (have saline warmed and opened for use if required).
  • Ensure oxygen supply or anaesthetic bag is within reach if needed.
Preparation ensures the least time disconnected from CPAP for baby.
2
  • Pre-oxygenate baby if required or give blow-by oxygen during suctioning.
Used where baby desaturates rapidly without CPAP.
3
  • Suction mouth first only if required.
 Lubricate catheter with oral secretions
4
  • Measure from nose to pinna of ear.
  • Add half that distance to measurement already obtained. 
This is a rough estimate to ensure the catheter passes far enough into the airway to clear the secretions.
5 Remove prongs from nose instill 2 drops or 0.2ml normal saline into each nostril if required for thick secretions.

This is not a routine procedure.

 This helps to loosen secretion and aid suctioning.
No more than required drops are needed, as any excess will only be swallowed by baby or lie in oropharynx.
6
  • Suction down each nostril. Go down to predetermined distance.
  • Apply suction and hold there for a few seconds prior to removing, slowly twisting as you come out.
Allows time for secretions to be suctioned.
7
  • Length of time for each suctioning will depend on the infant’s condition.
  • Baby should be suctioned at least twice down each nostril. 
Excessive suctioning can cause deterioration in baby’s condition. CPAP prongs can be reinserted and suction repeated when baby stable again.
8
  • If there is difficulty passing a catheter into the nasopharynx, the finger port can be used.  This should be only placed at the entrance of the nares and the catheter kinked.
Allows for secretions to be removed from the nares clearing sufficiently to allow passage of a suction catheter
9
  • Lavage and suctioning can be performed as many times as seen necessary for thick copious secretions. 
May find easier to remove thick secretions with numerous suctions rather than prolonged suctioning episodes.
10
  • After procedures, return the infant to a comfortable position. Hold the infant until vital signs return to normal parameters.
Reduction of stress on the baby and ends procedure with a positive touch.
11
  • Consider use of 2 nurses for fragile infants such as:
  • ELBW/ VLBW infant
  • Infant relying on CPAP pressure
  • Infant with increased O2 requirements.
 This optimises the procedure ensuring the infant is supported appropriately.
12 Documentation of procedure. Note down:
  • Colour and consistency of return.
  • Quantity
    • Minimum - Just in catheter
    • Medium - Not up to finger port –
    • Copious - Up to and past finger port
  • Time of suctioning.
  • Documentation in comments column baby’s response to suctioning for future reference.
 Aids other staff to ascertain any changes in secretions and frequency required.

Enables other staff to anticipate response of baby and reduce stress.
13
  • Where there is difficulty in passing size 7 catheter, a size 6 can be used or use finger port.

Ask CPAP Team for help / support / critique

Size 6 does not adequately aspirate secretions but may be useful with babies who have inflamed nasal passages. If there is difficulty passing the size 6, use of the finger port initially may be appropriate