Policy Change Statement

The UWMC NICU has approached the problem of monitoring the level of arterial PO₂ in infants at risk for ROP to date by attempting to obtain a daily arterial sample. This results in considerable stress and discomfort to the infants, is often associated with artifactual desaturations, and requires extensive nursing time. Oftentimes attempts to obtain arterial blood are unsuccessful (+50% of attempts). Moreover, a recent QA analysis regarding the above approach was less than reassuring as to its effect on patient care. Accordingly, after considerable discussion, the approach to this issue will be modified as follows: 1) all infants who are at risk for ROP while in an FiO₂ increased from room air will be monitored with an O₂ saturation monitor; 2) the upper limits for the O₂ saturation monitor alarm will be routinely set at 95% (this is subject to change by physician order); 3) daily attempts should be made to lower the FiO₂ in stable, convalescing infants with O₂ saturations in the low- to mid-90’s; and 4) correlating arterial samples will be obtained/attempted twice weekly (this is subject to change by physician order).

ROP O2 Monitoring Policy

1. Administer oxygen via a hood as a primary mode of delivery for infants less than 1500 grams. Use nasal prongs as a secondary mode for bathing, holding, feeding, etc.
2. Use oximetry to determine the optimum flow and distance from the face when using short term blow-by O₂.
3. Administering oxygen via "troughed" prongs may be used when excessive nasal irritation occurs as a last resort. Use oximetry to confirm correct FiO₂ and flow for "troughed" system.
4. Monitor infants at risk for ROP who are receiving an FiO₂ above room air by setting a strict upper limit for the oximeter of 95%. The limit can be changed only by attending physician order; to be documented in the record.
5. If possible a calibration arterial PaO₂ should be obtained twice weekly (Monday/Thursday); simultaneous FiO₂, SaO₂ and PaO₂ will be recorded. This frequency may be changed by physician order; to be documented in the record.
6. Obtain an arterial blood gas when an "at-risk" infant who was previously in room air is retreated with oxygen. Exception requires physician order.
7. If the arterial PaO₂ is above 90 mmHg notify a physician and document the response, which should be to reduce the FiO₂ appropriately, on the flowsheet.
8. Adjust FiO₂ based on ordered parameters using oximetry and/or transcutaneous monitoring.
9. Ensure that an ROP check has been done at six weeks of age on infants with a birth weight equal to or less than 1500 grams.

AUTHORS

About NICU-WEB Authorship

EMAIL feedback regarding this document