this presentation talks about how protect babies who are intubated from self extubation , and which procedure we have to be done to prevent UE.

1. Protect our baby from
Unplanned
Extubation
Belal Almulla
Ali Aljarrash

2. Objectives
 Pt movement Vs. UE
 Ventilator Circuit Vs. UE
 Secretion Vs. UE
 Sedation Vs. UE

3. Pt movement Vs. UE

4. What are the major movements
babies have ?
 Head movement
 Baby frequent turning and positioning.
 Infant removal from isollette or warmer,
weighing , Kangaroo care.
 Hand movement

5. Head movement
 Babies have extreme short trachea compared to
peds and adults, higher risk of UE.
 How can we control the head movement in
intubated baby to prevent UE?
- Keep the head position on the same side of the
body position that usually lead to decrease the
angle of movement of the head.
- In supine position using rolled linen will support
the head and control the head movement.

6. Hand Movement
 What are the conditions in which babies
should be wrapped?
- Term baby with excessive hand movement.
- Any Baby has the tendency to hold the ETT.
- Active moving baby.

7. Ventilator Circuit VS. UE

8. Ventilator Circuit Securing
 How is the circuit should be secured to decrease the risk
of UE?
- Circuit should be on the same side of the pt position.
- Circuit position should not cause ETT tension during pt’s
head movement, that mean it should allow movement
within the expected head’s angle of movement.
- Attention must be paid for infant sliding down in the bed,
this will cause tension and ETT dislodgment.
- Avoid straight circuit position over infant head as it
increases the chance of circuit condensation going to the
pt.

9. Ventilator Circuit During handling
 How can we decrease the risk of UE during
handling & positioning?
- At least 2 HCP should be available during
Handling or positioning for any intubated
baby.
- The circuit should have enough distance and
flexibility during weighing the pt and during
positioning, then to be secured again as
explained above.

10. Secretions Vs. UE

11. What are the cases that have
excessive secretions compared
to others ?
 Pulmonary disease leading to excessive
sputum production.
 Presence of artificial airway.
 Excessive condensation from the vent circuit.
 Frequent pt turning cause secretion
mobilization.

12. How can we decrease the risk of UE for
pt with excessive amount of oral
secretion ?
- Changing the Tape or NeoBar in regular basis and PRN
if the tapes become loose.
- Suctioning the oral secretion frequently.
- Checking the tape or NeoBar frequently.
- Pulmonary toilet PRN.

13. Sedation Vs. UE

14. When the pt should be sedated or
increasing the amount of sedation to
decrease the risk of UE ?
 Uncontrolled agitation
 ± during re-taping
 ± during handling and positioning.
 Low Pain management score.
 Following unit sedation protocol.

15. Thank
you