Neonatal Ventilation

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Neonatal Ventilation

• A Nurse Led Weaning Protocol
• Carol Hudson

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Background

• First considered around 2 ½ years ago
• Literature review and information from local and
  regional units
• Consultant support and interest of staff
• Proposal advance practice group

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Bradford NNU

• 32 bedded unit, 5 intensive care cots
• Majority SHOs inexperienced in neonates
• Nurses perform and informally interpret blood
  gases
• No protocol on unit for weaning ventilation
• Guidelines basic, dont allow for individuality
  of infants

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Why Change Practice

• Develop protocol for the use of nursing and
  medical staff
• Standardise weaning of neonatal ventilation
• Provide guidelines to ensure best chance of
  successful weaning and extubation
• More holistic care approach for the patient

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Why Change Practice

• Nurses in a prime position to wean ventilation
• We spend a large amount of time at the bedside
• We record regular observations of vital signs
• We are able to observe the affect of alteration
  of ventilation on the babys condition
• A weaning protocol will allow changes to
  ventilation to be made when the infant is able to
  tolerate them

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Selection Criteria

• Initially only F G grade neonatal nurses only
• Must possess ENB 405 and have a minimum of 2
  years neonatal intensive care experience
• Must be working in neonatal intensive care on a
  regular basis

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Course Outline

• Mainly theoretical with supervised practice in
  the clinical area, included
• Pre course reading
• Pre post course quiz
• Study day -assessment of blood gas analysis

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The Study Day

• Accountability/ Scope of Professional Practice,
  Clinical Risk Management , Clinical Governance,
  Evidence Based Practice Research
• Basic lung physiology/ pathophysiology,
  Mechanical ventilation
• Blood Gas Analysis, Clinical Features of
  Respiratory Insufficiency

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Assessment Procedure

• By Consultant Neonatologists
• A total of 5 successful supervisions must be
  completed prior to assessment
• Assessment may be made at supervision 6-10 at
  consultants discretion
• No minimum time limit

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Weaning Protocol

• Individualised for each baby.
• The weaning rate and physiological parameters set
  by the senior physician on duty,in conjunction
  with the infants nurse.
• Pre weaning and pre extubation checklists are
  included on the protocol.
• Supported by an algorithm to minimise risk and
  ensure safety of the patient.

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Current Position

• Out of 13 members of staff completing the study
  day.
• 4 have completed the supervision and assessment.
• 3 concentrating on nurse led ward rounds in SCBU.
• 1 left the trust and 1 about to retire.
• Remaining 4 in the process of completing either
  supervision or assessment.

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What Next?

• Complete training period for the initial group of
  staff
• Compile report for the Advance Practice Group
• Audit
• Extend training to all senior Neonatal Nurses
  fitting the selection criteria

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Plans for the Future

• Increase the range of the protocol
• All medical and nursing personnel involved in the
  direct care of ventilated infants using the
  protocols, to optimise patient care