NICU Procedures- Surfactant administration in a preterm infant
Summary
TLDRThis educational video script outlines the learning objectives for surfactant therapy, including indications and administration techniques. It covers the importance of surfactant replacement in treating respiratory distress in pre-term infants and the process of administering exogenous surfactant via the endotracheal route. The script provides a step-by-step guide on preparing equipment, inserting a catheter, and delivering surfactant while ensuring patient stability and safety. It also emphasizes the need for trained personnel and adherence to institutional guidelines.
Takeaways
- 📚 The module aims to educate on the indications for surfactant therapy and how to administer exogenous surfactant replacement therapy.
- 👶 Surfactant deficiency can lead to respiratory distress or failure in pre-term, late pre-term, or term infants.
- 💊 Indications for surfactant replacement therapy include surfactant deficiency in pre-term infants with respiratory distress syndrome and surfactant inactivation in infants with meconium aspiration syndrome.
- 🚑 Surfactant therapy can be administered prophylactically or as a rescue treatment and is delivered via the endotracheal route.
- 🏥 Proper placement and patency of the endotracheal tube are crucial before administration of surfactant.
- ⚠️ Transient adverse effects of surfactant administration may include bradycardia, oxygen desaturation, and hypotension.
- 👩⚕️ Surfactant should only be administered by those trained and experienced in neonatal resuscitation and stabilization.
- 🔧 The script reviews equipment used for surfactant replacement therapy and demonstrates a technique to deliver surfactant to an intubated mannequin.
- 🌐 The demonstration includes using a catheter kit with a five French catheter and adapters for different ET tube sizes.
- 🔄 The process involves disconnecting the bag, replacing the adapter, inserting the catheter, administering the surfactant, and then removing the catheter while ensuring the patient's stability.
- 🔄 The surfactant is administered in two aliquots, with the baby positioned on their right and left sides, and vital signs are monitored throughout the procedure.
Q & A
What are the learning objectives of the module discussed in the transcript?
-The learning objectives of the module are to understand the indications for surfactant therapy and to learn how to provide exogenous surfactant replacement therapy.
What conditions can result from surfactant deficiency in infants?
-Surfactant deficiency may result in respiratory distress or respiratory failure in pre-term, late preterm, or term infants.
Which infants are indicated for exogenous surfactant replacement therapy?
-Indications for exogenous surfactant replacement therapy include pre-term infants with respiratory distress syndrome and infants with conditions like meconium aspiration syndrome where surfactant is inactivated.
Can surfactant be given as a preventive measure or only when needed?
-Surfactant may be given as either prophylactic (preventive) or as rescue treatment.
What are some potential adverse effects of surfactant administration?
-Transient adverse effects of surfactant administration may include bradycardia, oxygen desaturation, and hypotension.
Who should administer surfactant therapy?
-Surfactant therapy should only be administered by those who are trained and experienced in the care, resuscitation, and stabilization of neonates.
What equipment is necessary for surfactant replacement therapy as described in the transcript?
-The necessary equipment includes a catheter kit with a five French catheter and different size adapters for the appropriate size endotracheal (ET) tube.
How is the surfactant adapter connected to the ET tube?
-The stock adapter from the ET tube is removed, and the appropriate size surfactant adapter from the kit is placed where the original adapter was.
What is the procedure for administering surfactant to an intubated patient?
-The procedure involves inserting the catheter to the proper placement, administering the surfactant, and then removing the catheter while ensuring the patient's stability throughout the process.
How should the catheter be inserted into the ET tube for proper surfactant administration?
-The catheter should be inserted matching the markings on the endotracheal tube to the proper markings on the catheter, and then advanced about half a centimeter beyond that.
What is the recommended time to wait after administering surfactant before suctioning the patient?
-It is recommended to wait a minimum of 1 hour after the administration of surfactant before suctioning the patient.
Outlines
🚀 Introduction to Surfactant Therapy
This paragraph introduces the learning objectives of the module, focusing on understanding the indications for surfactant therapy and the process of administering exogenous surfactant replacement. It highlights the potential for surfactant deficiency in pre-term, late pre-term, or term infants, leading to respiratory distress or failure. The indications for therapy include respiratory distress syndrome in pre-term infants and meconium aspiration syndrome. The therapy can be prophylactic or rescue and is administered via the endotracheal route. The paragraph also mentions the importance of proper tube placement and the potential adverse effects of surfactant administration, such as bradycardia, oxygen desaturation, and hypotension, emphasizing the need for trained professionals to administer it.
🔧 Setting Up for Surfactant Administration
This section describes the setup for administering surfactant to an intubated patient, using a specific catheter kit with different size adapters for various endotracheal (ET) tubes. The process involves removing the stock adapter from the ET tube and replacing it with the appropriate size adapter from the kit. The catheter is then inserted into one port of the adapter, while the other port is connected to a manual bag or ventilator circuit. The paragraph demonstrates the preparation for surfactant administration, including the proper setup and connection to an intubated mannequin or patient.
💊 Administering Surfactant: Technique and Considerations
The paragraph details the steps for inserting the catheter, administering surfactant, and removing the catheter while ensuring patient stability. It emphasizes the importance of measuring the correct depth of the catheter in the ET tube and administering the surfactant over a period of 15 to 30 seconds. The summary also mentions the potential for surfactant to come back up the tube and the need to continue bagging the patient to prevent this. After administration, the cathacter is removed, and normal bagging is resumed. The paragraph also includes a demonstration of administering surfactant with the baby positioned on their side, highlighting the importance of checking vital signs and ensuring proper tube placement before and after administration.
👶 Post-Administration Monitoring and Precautions
This paragraph discusses the monitoring and precautions to take after surfactant administration. It advises on the importance of waiting at least one hour before suctioning the patient post-surfactant treatment. The summary includes the process of administering the second aliquot of surfactant after the first has been given and the baby has been returned to a neutral position. It also mentions the need to monitor vital signs and to ensure stability before and after the procedure. The paragraph ends with a note on the importance of proper technique and patient positioning during the administration process.
Mindmap
Keywords
💡Surfactant Therapy
💡Exogenous Surfactant Replacement
💡Surfactant Deficiency
💡Respiratory Distress Syndrome (RDS)
💡Meconium Aspiration Syndrome
💡Prophylactic Treatment
💡Rescue Treatment
💡Bradicardia
💡Oxygen Desaturation
💡Hypotension
💡Intubation
💡Manual Ventilation
Highlights
Learning objectives include understanding indications for surfactant therapy and administering exogenous surfactant replacement therapy.
Surfactant deficiency can lead to respiratory distress or failure in pre-term, late pre-term, or term infants.
Indications for surfactant replacement therapy are infants with surfactant deficiency or inactivation.
Surfactant therapy can be given prophylactically or as rescue treatment.
Proper placement and patency of the endotracheal tube are crucial before administration.
Transient adverse effects may include bradycardia, oxygen desaturation, and hypotension.
Surfactant administration should only be done by those trained in neonatal care, resuscitation, and stabilization.
Different methods are used to deliver surfactant replacement therapy to neonates.
Demonstration of surfactant administration through a catheter using a catheter kit.
The catheter kit includes a five French catheter and adapters for different ET tube sizes.
Proper setup involves removing the stock adapter and attaching the appropriate size surfactant adapter.
Intubated baby with a 3.0 ET tube is manually ventilated before surfactant administration.
Catheter insertion involves matching markings on the ET tube and catheter for proper placement.
Surfactant is administered over a few seconds to ensure it does not come back up the tube.
After administering surfactant, the catheter is removed and normal bagging is resumed.
Demonstration includes administering surfactant while the baby is positioned on the right and left sides.
Vital signs and breath sounds should be monitored before and after surfactant administration.
Bilateral breath sounds confirm proper tube placement before surfactant administration.
Bagging rate should be adjusted before and after surfactant administration to ensure stability.
Surfactant administration should be followed by a wait of at least one hour before suctioning.
Transcripts
the learning objectives of this module
are to know the indications for
surfactant therapy and to learn how to
provide exogenous surfactant replacement
therapy surfactant deficiency may result
in respiratory distress or respiratory
failure in pre-term late preterm or term
infants indications for exogenous
surfactant replacement therapy includes
infants who have surfactant deficiency
such as pre-term infants with
respiratory distress syndrome
or surfactant inactivation such as
infants with meconium aspiration
syndrome surfactant may be given as
either prophylactic or as rescue
treatment and is delivered via the
intertrial
route prior to Administration it is
important to ensure proper placement and
patency of the endral
tube transient adverse effects of
surfactant Administration may include
bradicardia oxygen desaturation and
hypotension
therefore it should only be administered
by those who are trained and experienced
in the care resuscitation and
stabilization of
neonates there are several different
ways to deliver surfactant replacement
therapy to a neate in the first section
of this module we will review the
equipment currently being used in one of
our ncu for surfactant replacement
therapy and then demonstrate a technique
to deliver surfactant to an intubated
mannequin in the second section we will
demonstrate surfactant Administration to
27 we pre-term male infant with
surfactant deficiency secondary to
respiratory distress
syndrome remember to always follow your
own institution's guidelines when
providing surfactant replacement
therapy in this video we are going to
demonstrate um surfactant Administration
through a catheter here at our
institution we use a catheter kit shown
here uh the catheter kit comes with a
five
French
catheter to administer the surfactant
through it also comes with three
different size adapters for the
appropriate size ET tube that you will
be using a 2.5 a 3.0 and a 3.5 for the
proper setup we have a 3.0 o ET
tube if we were using that on the baby
that we will be giving
surfactant the what we do is we remove
the stock adapter from the ET tube like
so you then get the appropriate size
surfactant
adapter which is the
3.0 you put that where your original
adapter was
and then we have the setup here where we
have one port for our catheter this one
in front of my finger and the other Port
would be for your manual bag or your
ventilator
circuit so from here we take our five
French
catheter we remove the blue
cap and this catheter goes in the
smaller of the two ports
which goes like that and now you are
ready to administer your
surfactant okay now we have the baby
intubated with a
3.0 ET
tube being manually ventilated with the
bag so we have
the stock
or the adapter that comes with the ET
tube currently in place so what we will
do is we will
disconnect the bag we will
remove that
adapter we will take
the
3.0 adapter that comes in the kit we
will place
that in the 3.0 endotracheal tube
then we will take our catheter remove
the blue cap putting that end in the
smaller port and then reconnecting our
bag to the larger port and at this point
we can resume manual
ventilation like
so so the next step
is inserting the catheter to proper
placement administering the
surfactant and removing
the
catheter making sure our patient is
stable through the
process so here we have to properly
measure the correct depth of the
catheter in the ET tube and then
administer the surfactin so here for the
purpose of the video I will focus on
inserting the catheter we can pretend we
are still manually ventilating the baby
through the whole
procedure here we take the
catheter stabilizing the ET
tube so here we will insert the catheter
matching up the markings on the endot
tral tube to the proper markings on the
catheter I will be matching up the 14 on
the endotracheal tube I will look be
looking for the 14 on the catheter which
will be telling me that I am at the end
of the endot tral tube and that looks
like this I will be inserting this
through the endot tral tube down the
endotracheal tube until my
markings match up so I have the 14 at
the
14 and then you can advance about a half
cimeter beyond that ensuring that you
are just that distance beyond the endot
tral tube prior to administering the
surfactant from there we will
then take
our our aliquat or our dose of
surfactant we will administer
that over a period of a few seconds
ensuring that the surfactant does not
come back up the
tube and if it does we will just
continue to bag the patient through that
procedure and as you finish
administering the dose of surfactant
remove the
catheter and then then resume normal
bagging that's the demonstration of
inserting the
catheter and we can also demonstrate
giving both aliquat listing the baby to
the right and to the
left okay so here we have the baby
listed on his right side or her right
side we are are about to give the first
aliquat um prior to administration of
the first aliquat um things to consider
uh making sure the baby is stable Vital
sign saturation heart rate um also after
intubation um listen for bilateral
breath sounds making sure the tube is in
proper placement as
well so prior to Administration um
you might uh bag at around 40 to 60
breaths a minute or bag at a normal rate
prior to administration of the
surfactant and then after we might bag
at a little faster pace so prior here
we're bagging at a normal rate the baby
is stable we are listed to the right
side and we're ready to administer our
first of the two Alo quats so here
I will begin advancing my
catheter like mentioned
before this we will be matching our
numbers up on the catheter to the ET
tube so I will be matching up our 14 and
14 on the ET tube advancing at about a
half centimeter beyond that and now
administering the
surfactant I'll depress the syringe
administering the surfactant at a around
you want to take around 15 to 30 seconds
if possible to administer the full first
aliquat when you are done administering
your first Alo quat remove the catheter
like
so and then begin your bagging again at
around 40 to breath 40 to 60 breaths per
minute during the administration of the
surfactant you
might get some of the surfactant coming
back up the tube
um that's when you want to continue
bagging the patient through the
procedure in a way making sure that that
surfactant stays going down the tube not
up the
tube so after removal of the catheter
like mentioned before we want to bag it
around a rate of 40 to 60 breaths per
minute and while on the right side here
we would want to bag between 1 to 2
minutes making sure our Vital Signs are
stable and as we come to the end of our
1 to 2 minutes and we have
no uh remaining surfactant in the ET
tube and our Vital Signs are stable we
will then return the baby back to his or
her back or neutral position things to
consider um while surfactin is being
administered like I said the vital signs
and also after
Administration try to wait minimally 1
hour after the administration of the
surfactant uh 1 hour before you suction
the
patient so once we are done
administering the first Alo squat on the
right side and we have returned the baby
to the neutral position or on his or her
back repeat the same
process on the baby's left
side
right can you give me a little cray p
y how far do we want to be down put them
into seven go
ahead that
off I'm just putting the adapter
on and you can continue
bagging
we now put multi access C
on
let me uh just listen make sure do that
I mean I could probably put this up
now
[Music]
um should just take a few couple of
minutes
should your backing be 25 over five mhm
nice
job
yep
right so we're going to go down just
keep bagging through a whole time
yep when I actually do it I'll grab the
bag cuz it's e going to keep it up see
how we go
okay was a half a
dose okay thank
[Music]
you
[Music]
sometimes back up
there
old eyes just don't work like the is
though just going to take this
off yeah there we go
ready it's on the side right mhm
yeah
they really like sister
[Music]
f
going put up looks
good right back
up do this for about a
minute
[Music]
nice response yeah that's excellent
yeah
e
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