Surfactant Administration in the PICU

Surfactant in PICU

General

• Purpose of Surfactant
  • To decrease surface tensions within the alveoli
• Type of patients that would benefit
  • Drowning
  • RDS
  • Acute Lung Injury

Administration

• Equipment used to administer
  • Multi access catheter if ETT 4.0 or smaller
  • An in-line suction tube with a syringe connected to the end for larger ETT
  • Surfactant- # of vials dependent on the weight of the patient – (kept refrigerated)
  • Resuscitation bag and mask
  • Call charge RT
• You must first thaw out surfactant and administer at room temperature
• Process of administration, Rolling patient and splitting dose
  • Position patient in the supine position. Instill initial aliquot slowly
  • After aliquot instilled position patient with left side down. Continue PPV or ventilator-driven breaths for another 20-30 breaths
  • Reposition patient to supine position. Evaluate respiratory status of the patient
  • Instill second aliquot slowly
  • After 2nd aliquot instilled position patient onto right side, continuing PPV or ventilator-driven breaths for another 20-30 breaths
  • Return patient to supine position and re-evaluate respiratory status

Post Administration

• Parameters to Monitor
  • Heart rate
  • Respiratory Rate
  • SpO2
  • Breath Sound
  • Chest expansion
• Parameters to monitor on the Ventilator
  • PIP
  • Tidal Volume
  • FiO2
• Check vent settings Q15 min
• Suction
  • Endotracheal tube should not be suctioned for at least one hour
  • Attempt to extend this time to 6-8 hours unless suctioning is indicated
  • Do not use any saline, unless indicated, for at least two hours