The majority of deliveries needing advanced resuscitation techniques are not anticipated. For this reason, it’s important to have the delivery room properly prepared.
As you set up your delivery room, be sure to follow these steps carefully:
- Cut or tear pieces of 2.5 cm wide silk tape, to secure the endotracheal tube, if necessary, using the “Three Y” method.
Unlike the popular “Two Y” method, the “Three Y” method provides an extra “Y” for use as a spare. Each piece of tape should be about 15–20 cm in length, which is approximately the distance from the tip of your middle finger to your wrist. For term infants, trim off 6 mm from the width of the tape. For a preterm infant, trim off 9 mm. Build a Y with 7 cm legs. Be sure to fold over the ends of the Y to form buddy tabs, in case the endotracheal tube needs to be repositioned after obtaining a chest x-ray.
- Turn the warmer on and set the temperature to 100% radiant heat. Delivery room temperature should be at least 25 degrees Celsius or 77 degrees Fahrenheit.
- Make a shoulder roll out of a towel and place it where you expect the shoulders of the baby to be located.
- Cross cover 4–6 warm towels.
Alternate the towels horizontally and vertically in order to remove them more easily. Be sure to fold over the edges of the blankets under the radiant warmer in order to keep them warm.
- Tightly connect the hoses of the flow-inflating bag to the combined oxygen-air mixing port and pressure transducer.
- Turn the flow to 10 liters per minute and adjust the valve so that the positive end-expiratory pressure, or PEEP, reads 5 cm of pressure with a fully inflated bag.
- Check for leaks in the flow-inflating bag and in the tubing.
- Turn the mask 90 degrees so that the nose of the mask is facing the person who will be using it. The mask is then ready for immediate use.
- Place the flow-inflating bag on the right side of the warmer behind the towels. Make sure it’ll reach the newborn’s face, if needed.
- Attach the suction canister to wall suction.
- Attach the suction hose and catheter to the suction trap and ensure the connections are tight.
- Turn on the suction and adjust it by pinching the catheter and covering the suction port, confirming that it reads between 80–100 mmHg.
- Place the suction catheter on the right side of the warmer. Make sure it will reach the baby’s face, if needed.
- Check the laryngoscope and the Miller size 0 and size 1 blades, making sure the light bulbs on both blades are functioning properly. Ensure that the bulbs are white, bright, and tight.
Place the laryngoscope with attached size 0 blade for a preterm baby and size 1 blade for a term baby on the left side, underneath the radiant warmer mattress.
- Based on gestational age or estimated fetal weight of the newborn, procure five endotracheal tubes: three that are the target size, one that is a size larger than the target size, and one that is a size smaller than the target size.
- Feel through the sterile packaging, to make sure the endotracheal cap is tightly fitted to the tube portion.
- Place the meconium aspirator nearby, along with six alcohol pads, three 2 x 2 sterile gauze pads, an end-tidal carbon dioxide detector, and an umbilical cord clamp.
- Place a pulse oximetry probe and pulse oximeter nearby.
- Confirm that your medication box is properly stocked. It should contain 1:10,000 epinephrine, naloxone, normal saline, a 21- or 23-gauge butterfly needle, an 18- or 20-gauge angiocatheter, a 3-way stopcock, extension tubing, tape, 4 x 4 gauze pads, saline flushes, and 1-, 3-, 20-, and 30-ml syringes.
- Verify that an umbilical catheter insertion tray is readily available in the delivery room.
- Double-check that all equipment and supplies are available and properly placed.
At this point, the delivery room is ready for any potential complications during or immediately after the baby’s birth.