Neonatal 3: Meconium Suctioning Portal
When a newborn infant has particulate or meconium on its body, tracheal aspiration of meconium may have occurred. A distinction is no longer made for purposes of evaluation between thick and thin meconium. A determination for suctioning is now made based on whether the infant is vigorous or non-vigorous. If the newborn is in distress (non-vigorous), perform direct tracheal aspiration using an ET tube and a meconium suctioning adapter. This is a team effort. Evaluate the heart rate after the suctioning. Do not repeat suctioning if the heart rate is decreasing. Initiate PPV instead.
Meconium suctioning is a team effort that must be accomplished quickly. Rehearse this team effort at every opportunity to maintain the team’s skill.
Administer free-flow oxygen during the procedure. Prepare 3 ET tubes (size 3) with obturators and 3 ET tubes (size 2.5) in case the size 3 tubes are too large.
The intubator visualizes the vocal cords using a laryngoscope with an infant Macintosh or Miller blade and inserts the first ET tube about 3 cm into the trachea.
An assistant removes the obturator from the ET tube and attaches the meconium suctioning adapter. Cover its aperture with a finger while slowly rotating and removing the ET tube. Set the suction at 80 to 100 torr negative pressure.
A meconium aspirator (Neotech) attached to an ET tube
The intubator does not remove the laryngoscope or lose sight of the cords while an assistant assesses the heart rate.
If the heart rate decreases, the intubator ventilates the infant with a BVM with 1 or 2 breaths at 30 to 40 cm H2O, then at 20 cm H2O.
If the heart rate remains stable, the process may be repeated until meconium is removed or infant becomes bradycardic (heart rate decreases from 100 down to 80). It may take 2 or 3 aspirations to remove the meconium. Place suction on the ET tube; withdraw as before. Evaluate the heart rate with each repetition.
Following this, insert an 8 French gastric tube through the mouth to prevent aspiration of gastric meconium.