Critical Procedure - Meconium aspiration

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For all procedures, ask yourself, 'does this need to be done 'now vs later'? And should this be done by 'me vs someone else?' Very often the answers will be 'now' and 'me' - so read on!

Meconium aspiration


Description

How to suction meconium from the trachea of a neonate.

**Do not delay resuscitation to do this - start resuscitating and do this if the airway is obstructed or there is failure of oxygenation**

Indications

Neonatal compromise in the presence of meconium and ongoing resuscitation.

Contraindications

There are no absolute contraindications to this procedure.

Equipment

  • Meconium aspiratorET tube
  • Suction
  • Meconium aspirator
Attach wall suction tubing to the narrow end. The wide end connects to the ET tube connector. Apply suction for ≤ 5 seconds by occluding the side hole.

Procedure

For a baby born with meconium present:
Do not suction the baby on the perineum - this was removed in the 2010 guidelines.

If the baby is non-vigorous
Commence resuscitation as per usual approach - suction meconium if there are signs that it is causing airway obstruction or failure of ventilation.

To suction meconium:
  • attach a meconium aspirator to the suction tubing
  • use direct laryngoscopy<html>
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    <h5>For all procedures, ask yourself, 'does this need to be done
    'now vs later'? And should this be done by 'me vs someone else?'
    Very often the answers will be 'now' and 'me' - so read on!</h5>
    <h1 class="green">Meconium aspiration</h1>
    <br>
    <h2 class="green">Description</h2>
    How to suction meconium from the trachea of a neonate.<br>
    <br>
    **Do not delay resuscitation to do this - start resuscitating and do
    this if the airway is obstructed or there is failure of
    oxygenation**<br>
    <h2 class="green">Indications</h2>
    <ul>
    </ul>
    Neonatal compromise in the presence of meconium and ongoing
    resuscitation.<br>
    <ul>
    </ul>
    <h2 class="green">Contraindications</h2>
    There are no absolute contraindications to this procedure.
    <h2 class="green">Equipment</h2>
    <ul>
    <li><img style="width: 300px; height: 131px; float: right; margin:
    0px;" title="Meconium aspirator" alt="Meconium aspirator"
    src="https://www.thecarecourse.ca/moodle/pluginfile.php/280/mod_page/content/6/meconium_aspirator.png"
    height="264" width="600">ET tube</li>
    <li>Suction</li>
    <li>Meconium aspirator</li>
    </ul>
    Attach wall suction tubing to the narrow end. The wide end connects
    to the ET tube connector. Apply suction for ≤ 5 seconds by occluding
    the side hole.<br>
    <h2 class="green">Procedure</h2>
    For a baby born with meconium present:
    <div>Do not suction the baby on the perineum - this was removed in
    the 2010 guidelines.<br>
    <br>
    If the baby is <i><b>non-vigorous</b></i><br>
    </div>
    Commence resuscitation as per usual approach - suction meconium if
    there are signs that it is causing airway obstruction or failure of
    ventilation.<br>
    <div><br>
    To suction meconium:<br>
    <ul>
    <li> attach a meconium aspirator to the suction tubing</li>
    <li> use direct laryngoscopy</li>
    <li> intubate the trachea</li>
    <li> apply suction by attaching the meconium aspirator to the ET
    tube and occluding the side hole of the meconium aspirator</li>
    <li> withdraw the ET tube, continuing suction as you do this<br>
    </li>
    <li> suction for ≤ than 5 seconds</li>
    <li> (you may the integrated ET tube/suction devices instead of
    the separate meconium aspirator piece)</li>
    <li> if no meconium is retrieved, do not repeat intubation and
    suction</li>
    <li> if meconium is retrieved and no bradycardia is present,
    re-intubate and suction if you think there is a significant
    amount of meconium still present in the trachea<br>
    </li>
    <li> if bradycardia is present, administer positive pressure
    ventilation and follow the NRP resuscitation algorithm, and
    consider suctioning again later</li>
    </ul>
    <br>
    If the baby is <span style="font-style: italic; font-weight:
    bold;">vigorous</span> (defined as normal respiratory effort,
    normal muscle tone, and heart rate &gt;100 beats/min)<br>
    <ul>
    <li>do not electively intubate</li>
    <li>clear secretions and meconium from the mouth and nose with a
    bulb syringe or a large-bore suction catheter</li>
    <li>observe but manage as a normal birth</li>
    </ul>
    <br>
    <h2 class="green">Potential pitfalls</h2>
    Delay in commencing 'normal' resuscitation in a non-vigorous baby
    because of the presence of meconium - remember - commence
    resuscitation as per normal and deal with meconium if is a source
    of airway obstruction or failure to oxygenate.Delay in intubation
    and suctioning.<br>
    Avoid 'old' potentially harmful procedures such as 'clamping the
    chest'.<br>
    <br>
    <h2 class="green">"Plan B"</h2>
    If bradycardia is present after the first suctioning administer
    positive pressure ventilation and consider re-suctioning later.
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    </div>
    </body>
    </html>

  • intubate the trachea
  • apply suction by attaching the meconium aspirator to the ET tube and occluding the side hole of the meconium aspirator
  • withdraw the ET tube, continuing suction as you do this
  • suction for ≤ than 5 seconds
  • (you may the integrated ET tube/suction devices instead of the separate meconium aspirator piece)
  • if no meconium is retrieved, do not repeat intubation and suction
  • if meconium is retrieved and no bradycardia is present, re-intubate and suction if you think there is a significant amount of meconium still present in the trachea
  • if bradycardia is present, administer positive pressure ventilation and follow the NRP resuscitation algorithm, and consider suctioning again later

If the baby is vigorous (defined as normal respiratory effort, normal muscle tone, and heart rate >100 beats/min)
  • do not electively intubate
  • clear secretions and meconium from the mouth and nose with a bulb syringe or a large-bore suction catheter
  • observe but manage as a normal birth

Potential pitfalls

Delay in commencing 'normal' resuscitation in a non-vigorous baby because of the presence of meconium - remember - commence resuscitation as per normal and deal with meconium if is a source of airway obstruction or failure to oxygenate.Delay in intubation and suctioning.
Avoid 'old' potentially harmful procedures such as 'clamping the chest'.

"Plan B"

If bradycardia is present after the first suctioning administer positive pressure ventilation and consider re-suctioning later.
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Last modified: Thursday, 13 August 2020, 10:43 AM