32: CLINICAL GUIDELINE OF NURSING CARE FOR NEONATAL AIRWAYS

BACKGROUND AND AIMS: Respiratory diseases are the most common cause of hospitalization and mortality of neonates in NICUs. Necessity of advanced and standard care of airways, especially when patient is under mechanical ventilation or respiratory support is obvious of every one. The usual intervention in NICUs is tracheal intubation, which lack of perfect care, can cause many side effects. Although putting Nasal-CPAP and the following nursing care requires full skill, in order to prevent occurrence of any side effects. One of the basic ways in reducing mortality rate in NICU is improvement of nursing care based on studies of Evidence Based Practice. METHODS: This study has been extracted from scientific database such as Pub med, Science Direct, Trip Database and Cochrane Database which was confirmed with cooperation by physicians and experienced nurses of NICUs. Clinical guideline of neonatal airways as a practical guideline of care giving for specific respiratory care as below:1. Nursing care of Intubated neonates during Intubation and fixation of tracheal tube.2. Protocol of neonatal Indotracheal suctioning.3. Protocol of contrivance of Nasal-CPAP in neonates and required nursing care. CONCLUSION: By considering the spread and different level of health centers in the country and lack of standard clinical guide line, in many circumstances, respiratory care is with some deficiencies and sometimes with complications for neonates. Promoting of such clinical guide lines in NICUs will benefit a scientific pattern in order to a standard and safe nursing care. This guide line includes 3 sections: 1. Protocol of tracheal tube fixation: tracheal tube must be fixed by leucoplast strip and tracheal tube should be indirect position for perfect ventilation. 2. Protocol of Indotracheal suctioning: Indotracheal suctioning, if necessary must be done by assessment of neonates requirement. Suctioning indications: decrease of oxygen saturation, bradycardia, takycardia, decrease of chest movements, visible secretions in tracheal tube, agitation, decrease of respiratory sounds, increase of airway pressure and…. In order to prevent any possible damages, the length of suction catheter shouldn't exceed 1CM of tracheal tube. There are two methods of suctioning.1) Open method 2) Closed method. 3. Protocol of NCPAP care: Mask and nasal prong must be controlled regularly to prevent damage and necrosis. Nasal prong should be fixed 1-2MM from nasal septum and suitable size of hat and nasal mask and prong is required. Use of deoderm adhesive for protection of skin and nasal septum is recommended. Calming of neonate is necessary in prevention of CPAP pressure variation.