Neonates should be kept on nasal continuous positiveairway pressure (nCPAP) or non-invasive positive pressureventilation (NIPPV) for the entireprocedure.
Prepare a syringe according to the bovine lipid extract surfactant suspension dosing procedures. When using BLEScath™ it is recommended to draw up 0.5 – 1.0 mL of air in the syringe followed by the prescribed surfactant dose to ensure the entire dose is expelled at the end of the procedure.
Open the BLEScath™ package and carefully remove the catheter.
There are three unlabelled black line markings near the distal tip (at 2.0, 2.5 and 3.5 cm from the end), which serve as a visual aid for controlling the insertion depth at the level of the vocal cords. Additionally, there are five line markings of 7 to 11 cm (labelled 7, 8, 9, 10 and 11) on the catheter to indicate the distance from the distal tip to the patient’s lip (tip to lip distance). The depth of insertion is 6 cm plus birthweight in kilograms. For example: The depth of insertion for a 1 kg baby is 6 cm + 1 = 7 cm. Insert BLEScath™ to line marker “7”.
Bend the catheter into the preferred shape. Use the laryngoscope to visualize the vocal cords and insert the catheter from the side and through the cords into the trachea. The unlabelled black line markings near the distal end of the catheter should be at or just below the vocal cords. Remove the laryngoscope. Adjust the insertion depth and tip to lip distance by checking the labelled line markings.
Hold the catheter and press the baby’s lips together.
Attach the syringe with surfactant to the catheter.
Instill surfactant in micro-boluses synchronizing with the neonate’s inspiration. Micro-bolusing every 2-3 breaths is also acceptable if the infant is tachypneic. It can take 1 to 3 minutes to administer the full dose.
When the instillation is complete, inject air through the catheter to empty the syringe and remove the catheter immediately.
If unable to deliver the dose successfully using MIST/LISA after three attempts, administer the dose via the INSURE method.
After surfactant instillation, monitor the patient’s oxygen requirements according to the bovine lipid extract surfactant suspension product insert.