LAUSR

Introduction It is quite challenging to insert& accurately position Endotracheal tube (ETT) in preterms. Mal-positioned ETTs are associated with complications like hypoxaemia, pneumothorax and right upper lobe collapse. In addition, adjustment of incorrectly placed ETTs requires additional handling of the infant, exposure to radiation and potentially increased risk of infection. Aim To determine the chance of error of the ‘6cm+birth-weight’ guide for calculating orotracheal-ETT position and further review the compliance with new ‘tip-to-lip’ guidelines on a national scale. Method Three years retrospective data of pre-terms (<32weeks), requiring intubations, was collected from various hospitals. These hospitals used ‘weight+ 6cm’ as a guide for orotracheal intubations.Using the Radiology database, chest X-ray PA view of the first intubation, was considered as our standard to check optimal(T1-T3) and sub-optimal (above T1&below T3) ‘lip-to-tip’ ETT position. Data was then analysed based on birth-weight and categorised as follows: 500–1000 g and 1000–2000 g. The results then prompted us to conduct a telephonic survey of 18 hospitals across Ireland, providing level 1–3 neonatal services. Paediatrics/neonatal registrars were contacted by phone to answer a five question survey regarding the current practice of calculating ‘Tip-to-Lip’ insertion depth of ETT in pre-terms at their hospital. Results We found that as birth-weight decreases, the percentage of error (when using ‘birth-weight+6cm’ as a guide), increases. For birth-weight between 500–1000 g, our results showed a 58% (22/38) error in tube insertion depth, this decreased to 50% (11/22) for neonates between 1000–2000 g. The results from the telephonic survey were as follows: Method of insertion No. of hospitals Weight + 6cm (6th ed. NRP) 8 NTL + 1cm (7th ed. NRP) 2 7th ed. NRP (Consultant preference) 6 Don’t know 2 Conclusion It is concluded using ‘weight+6cm’ guide is less reliable and gives a higher chance of error in pre-terms <1000 g. Our survey showed that 55% of hospitals across Ireland still haven’t adopted the NRP 7th edition guidelines. The remaining hospitals though using NRP 7th edition, only 2/8 have specified the method implemented. Recommendation All hospitals should follow the new NRP ‘Tip-to-Lip’ insertion depth guidelines for oro-tracheal intubation to reduce the likelihood of error. There should be intra-departmental unanimity on implementation and documentation of specified methods to make it easier for future studies on accuracy of different methods. Practical simulation based sessions should be conducted in every hospital to propagate more awareness & to enhance intubation skills of health care professionals.