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


How to suction meconium from the trachea of a neonate.



  • neonatal compromise in the presence of meconium


There are normally no contraindications to this procedure.


  • Meconium aspiratorET tube
  • Suction
  • Meconium aspirator
  • Assistant
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.


NRP Meconium aspiration protocol

For a baby born with the presence of meconium:
Do not suction on the perineum.
Do not clamp the chest.
Do avoid stimulating the baby before you make an assessment, if there is thick meconium present.

If the baby is not vigorous (defined as depressed respiratory effort, poor muscle tone, and/or heart rate <100 beats/min)
  • suction the trachea immediately after delivery
    • avoid stimulating
    • attach a meconium aspirator to the suction tubing
    • use direct laryngoscopy
    • 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 on the way out
    • 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 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 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: Monday, 27 July 2015, 2:15 PM