This is a life-saving technique which is useful in many emergencies. The nurse carries out the procedure with chest compressions, artificial ventilation to maintain or restore circulatory flow until further management are employed to save the life of the infant. It supports and maintains breathing and circulation for an infant who has ceased breathing or whose heart has stopped functioning.
Aims
· Restores blood circulation in an infant
· Restores breathing
· Preserves intact brain function
Requirements
1. Self-inflating bag and mask (appropriate size)
2. Oral airways (appropriate size)
3. Laryngoscope
4. Miller blades (sizes 00,0,1)
5. Endotracheal tubes (sizes 2.5, 3.0, 3.5, 4.0mm)
6. Plastic coated stylets
7. Examination gloves
8. Stethoscope
9. Radiant warmer
10. A tray containing the following:
· Pulse oximeter
· Syringes and needles
· Cotton wool swabs
· Adhesive tape
· Methylated spirit
· Gallipot
· Receiver for used swab
· Examination gloves
· Adrenaline
· Dextrose 10%
11. Umbilical vein catheterization tray
12. Suction apparatus
13. Oxygen source
Steps
1. Check for responsiveness by gently rubbing the chest or tickling the feet
2. Establish the likely cause of the unresponsiveness and call for help
3. Establish rapport (refer steps)
4. Explain procedure to caregiver/family (refer steps)
5. Allow caregiver to take a decision of either staying or leaving the resuscitation area
6. Assign a colleague to be with the caregiver and provide needed information
7. Provide privacy
8. Perform hand hygiene and put on examination gloves
9. Provide warmth either by using the overhead radiant heater or wrapping up child in a blanket whiles exposing the chest
10. Position the infant on his/her back on a firm surface
11. Connect child’s finger to pulse oximeter and note the SPO2
12. Open the airway by tilting the head and lift the chine
13. Clear airway by suctioning out secretions gently
14. Check breathing by looking for chest movements
15. Place infant in recovery position if breathing is normal
16. Position mask over the mouth and nose and make a firm seal if breathing is not established and gently squeeze the bag to produce rise and fall of the chest
17. Start chest compression if condition persists
18. Give 30 gentle chest compression at the rate of 100-120/minute
19. Use 2 or 3 fingers in the center of the chest below the nipple, (Press down approximately 1/3 the depth of the chest (about 1 and half Inches). Allow time for chest to recoil
20. Deliver two (2) rescue breaths into the infant’s mouth and nose with the bag and mask connected to an oxygen source over one (1) second and observe for chest rise and fall/any gag or cough response, if unsuccessful, continue with chest compression
21. Appreciate caregiver’s cooperation
22. Look for rise and fall of the chest, listen to breath sounds and feel for airflow at the mouth and nose
23. Re-assess heart rate, skin colour and respiration if within normal ranges, give post resuscitation care
24. Invite caregiver to come in and see progress of baby
25. Administer IV adrenaline (1:10,000) 0.1-0.3ml/kg if the heart rate is below 60bpm
26. Continue compressions and breaths in a ratio of 2 breaths per every 30 compressions
27. Re-assess heart rate, skin colour and respiration if within normal ranges, give post resuscitation care
28. Consider endotracheal intubation with paediatrician if child is still unresponsive
29. Dispose off, decontaminate and clean used items
30. Document findings and procedure
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