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Arterial/venous puncture (collection for exams, peripherally inserted
central catheter, neonatal screening, peripheral puncture) |
Provide 25% glucose (slow oral) or mother's milk drops, from two to three
minutes before, during and after the procedure. |
The 14th Cochrane Group review shows significant reduction
of pain indicators when glucose was used as an analgesic in premature
and full-term newborns subjected to blood collection.4 Oral
glucose is broadly used because it is believed to activate the taste buds
on the back portion of the tongue, leading to the release of endogenous
opioids.2Investigation of the efficacy of breast milk and its
components for pain relief during and after the heel lancing procedure
found that sucrose and Similac (special milk formula) reduced the signs
of pain during and after the procedure.17-18
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Perform containment of the NB during the procedure. |
The "facilitator containment" (placement of idle hands, in
an elastic manner and without excessive pressure, to contain the head,
buttocks and limbs) proved to be an effective means to comfort preterm
infants during the heel lancing procedure.3Containment is a
measure that favors self-organization and suggests an extension of the
intrauterine environment, from the organization and postural sense of
safety it provides. It is the promotion of an effective comfort which
attenuates psychological and behavioral responses from neonates.3,18
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Promote skin-to-skin contact. |
Skin-to-skin contact before, during and three minutes after the procedure
calms babies, causing them to cry less during the procedure, and giving
them a calmer facial expression during and after the procedure. This finding
seems to be explained by the release of endogenous opioids, leading to
an analgesic effect.2
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Stimulate nutritive sucking (when the mother is in the unit, the newborn
can be placed on her breast) and/or stimulate non-nutritive sucking in
infants who cannot suckle. |
Non-nutritive sucking seems to be very useful in the neurological and
emotional organization of the NB after the procedure.2 One
integrative review19 identified the effectiveness of non-nutritive
sucking in the reduction of pain experienced by newborns undergoing painful
procedures.Administration of milk or breastfeeding should be used for
the relief of pain in neonates undergoing painful procedures.20For
acute pain caused by minor procedures (venipuncture, heel puncture, blood
collection, aspiration, etc.), non-pharmacological strategies should be
considered. These include: sucking at the breast, use of sweet oral solution
(glucose or sucrose), non-nutritive sucking, skin-to-skin contact and
multisensory stimulation,21 the short-term efficacy and good
tolerance of which are recognized.19
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Continuous positive airway pressure (CPAP)
|
Instill 1 drop of 0.9% saline into the nostrils before placing the prongs,
or lubricate prongs with petroleum jelly. |
Inappropriate use of prongs can cause nasal injuries in newborns, ranging
from simple hyperemia of the nasal mucosa, bleeding, crusting and necrosis,
to total destruction of the anterior septum (columella) and nasal septum.
It is important that health care professionals take into account the proper
size of the prongs, according to weight and positioning. Well-positioned
prongs do not deform the face of the neonate, and its bridge does not
touch the nasal septum, nor allow the movement of this device inside the
nostrils. Therefore, the size and inadequate fixation of the prongs are
essential factors for non-beneficial effect and injuries, particularly
smaller prongs, because when they do not fit perfectly into the nostrils
of the NBs, they cause friction of the device inside the nostrils, in
addition to encouraging escape of air. In order to provide relief and
prevent injuries, adhesive nostril protectors are used, such as common
surgical tape, hypoallergenic tapes and hydrocolloid plates, used above
the nostrils, to avoid direct friction of the prongs with the columella
and septum.22
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Use dual protection with thick hydrocolloid in a "T," or a
"pig snout" shield. |
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Properly fix the trachea, preventing the prongs from "dancing." |
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Massage the nasal septum every eight hours. |
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Fixing orogastric and nasogastric tubes.
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Perform "kitten type" fixing by two people. |
The "kitten type" attachment releases the orbicularis muscle
of the lips, leaving it free and facilitating breast sucking. In a review
of the gums of babies, the absence of dental alveolar cleft was observed. |
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Always protect the skin with thin hydrocolloid. |
One of the fundamental aspects of neonatal nursing care is preservation
of the integrity of the newborns' skin.23
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Aspiration of endotracheal tube and upper airways
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Always perform the procedure with two people, even in a closed system. |
Professionals should work together during procedures, taking care to
leave one person providing ongoing support to the NB (either father or
mother), being cautious during the care and keeping all interactions within
the tolerance of the NB.3
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Check the measurement of the tube before aspiration. |
The marking of the catheter should correspond to the length of the tracheal
cannula, preventing the catheter tip from overcoming the limits of the
cannula and traumatizing the mucous membrane.Perform bilateral lung auscultation
to avoid selective aspiration.Check the position of the endotracheal tube.Check
the setting, avoiding displacement of the tube and injury of the skin.24
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Maintain eye protection of the NB during aspiration. |
To avoid falling of discharge into the newborns' eyes, and minimize the
risk of bacterial conjunctivitis. |
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Lumbar puncture
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1. Perform containment of NB during the procedure. |
Containment is a measure that favors self-organization and suggests an
extension of the intrauterine environment from its postural organization
and the sense of safety. It is the promotion of an effective comfort which
attenuates psychological and behavioral responses to pain in neonates.3,18
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