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Overview and Principles of Resuscitation

Lesson 1: Equipment CheckPerformance Checklist

N R P

Term gestation?

Breathing or crying?Good tone?

Warm, clear airway if necessary,dry, stimulate

No

Yesstaywith mother

HR below 100 bpm,gasping, or apnea?

Laboredbreathing

or persistentcyanosis?

No

No

PPV,SPO2monitoring

Yes

Clear airwaySPO2monitoringConsider CPAP

Post-resuscitationcare

Targeted Pre-ductal SPO2After Birth

1 min

2 min

3 min

4 min

5 min

10 min

60-65%

65-70%

70-75%

75-80%

80-85%

85-95%

Yes

HR below 100 bpm?

HR below 60 bpm?

IV epinephrine

No

Birth

30 sec

60 sec

No

Take ventilationcorrective steps

Yes

HR below 60 bpm?

Consider intubationChest compressionsCoordinate with PPV

Yes

Routine Care Provide warmth Clear airway if necessary

Dry Ongoing evaluation

Yes

The Performance Checklist Is a Learning Tool

The learner uses the checklist as a reference during independent

practice, or as a guide for discussion and practice with a Neonatal

Resuscitation Program (NRP) instructor. When the learner and

instructor agree that the learner can perform the skills correctly and

smoothly without coaching and within the context of a scenario, the

learner may move on to the next lessons Performance Checklist.This Equipment Check Performance Checklist includes only the most

essential supplies and equipment for neonatal resuscitation. You may

wish to add supplies or additional safety checks to meet your units

standards or protocols. When the learner knows the routine and

supplies are present and functioning, the Equipment Check should take

approximately 1 minute to complete.

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L E S S O N

Knowledge Check

Why is it important to have an organized routine for checking the

presence and function of resuscitation supplies and equipment prior

to every birth?

Besides checking presence and function of equipment, what otherresources should be assembled prior to a birth identified as high-

risk?

Learning Objectives

Demonstrate an organized routine for checking presence and function

of supplies and equipment necessary for newborn resuscitation, using

the NRP flow diagram interventions as your guide.

Identify any additional preparatory routines for high-risk birth

specific to this birth setting.

Locate the Quick Pre-resuscitation Checklist in the Appendix of

this lesson.

You are notified that a woman has been admitted to the hospital in

active labor. Check your supplies and equipment to prepare for the

birth. As you work, say your thoughts and actions aloud so I will

know what you are thinking and doing.

Instructor should check boxes as the learner responds correctly. The

learner may refer to this checklist or the Quick Pre-resuscitation

Checklist that follows it to ensure the availability and function of

essential supplies and equipment.

Performance Steps Details

Warm:

Preheat warmer

Lay out towels or blankets

Learner begins with equipment

needed for initial steps of

resuscitation and ends with

equipment needed for complex

resuscitation.

Clear the airway 3 ways:

Bulb syringe

10F or 12F suction catheter

attached to wall suction, set at

80-100 mm Hg

Meconium aspirator

Turns on wall suction to continuous

and occludes suction tubing; adjusts

suction to 80-100 mm Hg.

Auscultate

Stethoscope

Picks up stethoscope, places in ears,

and taps on diaphragm to ensure

function.

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Overview and Principles of Resuscitation


Oxygenate

Turn on oxygen flowmeter to

5-10 L/min

Adjust blender to hospitalstandard for initiation of

resuscitation

Pulse oximeter probe

Pulse oximeter

If birth is imminent, suction and air/

oxygen should be turned on and

ready for use.

Are air/O2tanks full, if used in yoursetting?

Safety Check: Even if beginning

resuscitation with 21% oxygen, the

air/oxygen flow should be turned on

in the event that supplemental

oxygen is needed. A self-inflating bag

will work even without gas flow;

therefore, turn on air/oxygen so that

gas is flowing if blender is turned up

to administer supplemental oxygen.

Ventilate

Check presence and function

of positive-pressure

ventilation (PPV) device

Check presence of term- and

preterm-size masks

8F feeding tube and 20-mL

syringe

It is most important to check that

safety features are working to prevent

over-inflation of lungs with PPV.

Manometers present and

functioning? Connected to

oxygen/air?

Self-inflating bag: Pop-off valve

working?

Flow inflating bag: Does it inflate

properly (no rips or missing

attachments)?

T-piece: Maximum circuit pressure setappropriately? Peak inspiratory

pressure and positive end-expiratory

pressure set appropriately?

Intubate

Laryngoscope

Size 0 and 1 blades with bright

light

Stylet (optional)

Endotracheal (ET) tubes (2.5,

3.0, 3.5, 4.0)

End tidal CO2detector

Laryngeal mask airway and5-mL syringe

Learner should know how to attach

and detach blade from laryngoscope;

check laryngoscope light.

If setting up for intubation, ET tube

should stay clean inside its package

even if package is open and stylet is

inserted.

Medicate

Access to

1:10,000 epinephrine

Supplies for administering

medications and placing

emergency umbilical venous

catheter

Documentation supplies

Location and protocol for checking

emergency medications and supplies

for vascular access are specific to

each birth unit.

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L E S S O N

Instructor asks the learner Reflective Questions to enable self-

assessment, such as:

Tell me how using this organized approach to checking

resuscitation equipment works for you.

If all equipment and supplies were present, how long would it take

you to confirm readiness for a birth?

Did you notice anything in this Equipment Checklist that is

missing, specific to our birth setting? What would you change

about this checklist?

Neonatal Resuscitation Program Key Behavioral SkillsKnow your environment. Allocate attention wisely.

Anticipate and plan. Use all available information.

Assume the leadership role. Use all available resources.

Communicate effectively. Call for help when needed.

Delegate workload optimally. Maintain professional behavior.


Thermoregulate

For very preterm newborns

Plastic wrap or bag

Chemically activated warming

pad Transport incubator

Other

Unit-specific items

These items may be specific to your

unit.

Tailor the Equipment Checklist to

meet facility requirements.

Documents

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