Reports from 2017 NANN Conference
By Roxan Hammer RNC, BSN
The national conference had many interesting lectures. I want to share from the talk about using pH to confirm OG/NG placements in the NICU.
Studies show that 25% of our patients utilize OG/NG tubes in the NICU. Published studies site that 21-56% of these tubes are in the wrong place. This means there are a lot of opportunities for our infants to have issues to misplaced tubes. Aspiration and increased reflux are two issues with tubes too high. The studies confirm that the gold standard for OG/NG placement is an X-ray, but that isn’t feasible for every feeding received. Auscultation over the stomach with air has proven to be unreliable. The National patient Safety Agency (NPSA) and the Children’s Hospital Association (CHA) are calling for the discontinuation of auscultation for standard of care. They are asking for pH testing to become the standard if care in the NICU arena.
The NOVEL method to insert NG has been recommended as the most accurate measurement for correct placement. NOVEL measures from the tip of the patient’s nose to earlobe to mid-point between the xiphoid and umbilicus.
Then for each feeding given they are recommending checking the pH of the aspirate instead of using auscultation. There are two ways to check the pH. One is by using pH strips and the other is to use something like the Rightspot Infant pH detector that twists right onto the NG tube and checks the pH as you pull back aspirate. We should consider changing our standard of care to decrease feeding issues with our infants as well as prevent irritation, erosion or perforation of tissue from the NG being in the wrong place.
I would be interested in hearing how each of our units assesses OG/NG tube placements for feedings. Also sharing what has worked best or has been tried for your unit.
Report by: Rachel Evans
Transforming Care for Extreme Premature Babies
Speaker: Marcus Davey
As we all know, extreme prematurity is associated with many chronic morbidities. There are ongoing medical costs for families and society. And these infants have a high rate institutionalized care. In the U.S. in 2017, approximately $30 billion has been spent on extreme prematurity.Dr. Marcus Davey was a speaker at the 2017 NANN conference. He presented his solution to decreasing numbers and costs for those born extremely premature……..The ‘Artificial Womb’.
The first ‘artificial womb’ was introduced in 1965. However, there were many obstacles that made it unsuccessful with infection being the major one. Dr. Davey began his work on the “artificial womb” in 2013. He knew there were three key components to allow a fetus to survive: a pumpless Membrane Oxygenator, Umbilical Cannulation, and a Fluidic Environment. His first prototype was actually developed from a large fish tank. Since sheep are very similar in development to humans, they were used in developing the womb. The sheep were cannulated with standard ECMO cannulas in the carotid artery and jugular vein. There was continuous amniotic fluid in the tank and the sheep were given TPN, antibiotics, and PGE2. The sheep would stay in the ‘womb’ for a maximum of 3-4 weeks. There were 5 animals using this first prototype. However, survival was limited due to sepsis and cannula dislodgement. In 2014-2015, Davey worked on his second prototype. Using a similar design as the first prototype, he was able to study 5 animals. The major change was to using a smaller fish bowl for smaller fluid amounts. Again, this prototype was limited by sepsis but there was one survivor. The problem of sepsis forced a new design. Davey wanted a sealed environment to minimize sepsis, small amniotic fluid volume, and the ability to have rapid prototyping in a lab setting on a lab budget. This led to the introduction of the Biobag at CHOP. Numerous changes were involved in the development of the Biobag including using Umbilical Cannulation instead of Carotid. http://www.philly.com/philly/health/CHOP-artificial-womb-preemies-placenta-premature-baby.html With the new Biobag, researchers perform a controlled c-section, cannulate the vessels before cutting the umbilical cord, place the fetus in the bag, and then cut the cord. The survival rate has been much higher with the most recent prototype.Other points that Davey discussed included: The womb was designed to provide a better therapy for extreme preterm infants (23-25 weeks). It is NOT to be used for extending current limits of viability. The womb could do more harm than good when applied earlier than 23 weeks. Davey and his team continue to work on his research with the ‘Artificial Womb’. There is a lot more information that could be shared about Davey’s research. You can find more information from the link provided earlier in the article.
The first ‘artificial womb’ was introduced in 1965. However, there were many obstacles that made it unsuccessful with infection being the major one. Dr. Davey began his work on the “artificial womb” in 2013. He knew there were three key components to allow a fetus to survive: a pumpless Membrane Oxygenator, Umbilical Cannulation, and a Fluidic Environment. His first prototype was actually developed from a large fish tank. Since sheep are very similar in development to humans, they were used in developing the womb. The sheep were cannulated with standard ECMO cannulas in the carotid artery and jugular vein. There was continuous amniotic fluid in the tank and the sheep were given TPN, antibiotics, and PGE2. The sheep would stay in the ‘womb’ for a maximum of 3-4 weeks. There were 5 animals using this first prototype. However, survival was limited due to sepsis and cannula dislodgement.
In 2014-2015, Davey worked on his second prototype. Using a similar design as the first prototype, he was able to study 5 animals. The major change was to using a smaller fish bowl for smaller fluid amounts. Again, this prototype was limited by sepsis but there was one survivor.
The problem of sepsis forced a new design. Davey wanted a sealed environment to minimize sepsis, small amniotic fluid volume, and the ability to have rapid prototyping in a lab setting on a lab budget. This led to the introduction of the Biobag at CHOP. Numerous changes were involved in the development of the Biobag including using Umbilical Cannulation instead of Carotid.
http://www.philly.com/philly/health/CHOP-artificial-womb-preemies-placenta-premature-baby.html
With the new Biobag, researchers perform a controlled c-section, cannulate the vessels before cutting the umbilical cord, place the fetus in the bag, and then cut the cord. The survival rate has been much higher with the most recent prototype.
Other points that Davey discussed included: The womb was designed to provide a better therapy for extreme preterm infants (23-25 weeks). It is NOT to be used for extending current limits of viability. The womb could do more harm than good when applied earlier than 23 weeks. Davey and his team continue to work on his research with the ‘Artificial Womb’. There is a lot more information that could be shared about Davey’s research. You can find more information from the link provided earlier in the article.
