NICU Procedures- Surfactant administration in a preterm infant

Summary

This 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

00:00

🚀 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.

05:01

🔧 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.

10:03

💊 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.

15:04

👶 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.

Keywords

💡Surfactant Therapy

Surfactant therapy refers to the medical treatment involving the use of exogenous surfactant to prevent or treat respiratory distress syndrome (RDS) in premature infants. In the video, it is highlighted as a crucial intervention for infants with surfactant deficiency, emphasizing its importance in neonatal care.

💡Exogenous Surfactant Replacement

Exogenous surfactant replacement is the process of administering artificial surfactant to the lungs of a newborn to treat or prevent respiratory issues. The script describes how this therapy is delivered via the endotracheal tube, which is a key aspect of the instructional content.

💡Surfactant Deficiency

Surfactant deficiency is a condition where the lungs lack the necessary surfactant, a substance that reduces surface tension and helps in breathing. The video script mentions this as a common issue in pre-term infants, leading to respiratory distress or failure, and the need for surfactant therapy.

💡Respiratory Distress Syndrome (RDS)

Respiratory distress syndrome, or RDS, is a condition characterized by difficulty in breathing due to underdeveloped lungs, often seen in premature infants. The script identifies RDS as an indication for surfactant therapy, showcasing its relevance in neonatal health.

💡Meconium Aspiration Syndrome

Meconium aspiration syndrome occurs when a newborn inhales meconium, the first stool, into their lungs, which can cause respiratory issues. The video script includes this as another condition where surfactant inactivation might occur, necessitating surfactant therapy.

💡Prophylactic Treatment

Prophylactic treatment is a preventive medical intervention given before symptoms appear to prevent a disease or condition. The script mentions surfactant can be given prophylactically, indicating its use not only in response to symptoms but also as a preventive measure.

💡Rescue Treatment

Rescue treatment is an intervention used when initial treatments have failed or in emergency situations to stabilize a patient's condition. The video script refers to surfactant administration as a rescue treatment, emphasizing its role in critical care for neonates.

💡Bradicardia

Bradicardia is a medical condition characterized by a slower than normal heart rate. The script warns of this as a potential adverse effect of surfactant administration, highlighting the need for trained professionals during the procedure.

💡Oxygen Desaturation

Oxygen desaturation refers to a decrease in the amount of oxygen in the blood. The video script mentions this as a possible transient adverse effect of surfactant therapy, underscoring the importance of monitoring during the procedure.

💡Hypotension

Hypotension is a condition where blood pressure is abnormally low. The script includes it as a potential adverse effect of surfactant administration, indicating the need for close monitoring of the infant's vital signs.

💡Intubation

Intubation is the process of inserting a tube into the trachea to facilitate breathing. The video script describes the steps for intubation as part of the surfactant administration process, showing its critical role in neonatal resuscitation.

💡Manual Ventilation

Manual ventilation refers to the process of providing oxygen to the lungs using a manual resuscitation bag. The script details the steps for manual ventilation during surfactant therapy, illustrating its importance in maintaining the infant's respiratory function.

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