Preparing for Transfer

Most of the principles of preparing a baby for transfer are identical to stabilising a baby for admission to a unit.  There are, however, a few areas in which transport teams have special requirements.  We understand that you are very busy, but the more that can be done before our arrival, the quicker we can leave with the baby.

The most important thing  is a prompt and comprehensive handover of the patient on our arrival at your unit so that we can have a complete clinical picture and work with you to stabilise the patient as quickly and safely as possible.

Airway

  • the ET tip should be T1-T2 on the chest x-ray, we will not transfer a baby with a higher or lower tube even if they are ventilating well
  • the ET tube should be well secured, if there is any movement within the tube holder a suture should be put through then a suction catheter passed to ensure the tube can still be suctioned
  • the ties to the hat should be tight and not easily undone

Breathing

  • we now have access to advanced ventilation modes on transfer including synchronised/triggered modes such as SIMV and high frequency oscillation (HFOV)
  • however babies are more likely to be ‘fighting’ and asynchronous with the ventilator during transport so should receive adequate analgesia (morphine bolus then infusion), sedation (diazepam or midazolam bolus then infusion), and if necessary paralysis (pancuronium bolus then vecuronium infusion ideally) and the ventilation re-optimised following the likely drop in CO2 clearance
  • Nitric Oxide therapy can be given on transport: if your patient has PPHN (pulmonary hypertension) please keep in 100% FiO2 and start nitric oxide (if available) which will then be continued during the transfer
  • our teams can now usually provide all common non-invasive ventilation modes such as  high flow nasal cannula oxygen (Optiflow / Vapotherm), CPAP and bi-level CPAP (BiPAP / DuoPAP / PA-CPAP) but please discuss with the transport nurse or doctor to establish your baby’s specific requirements

Circulation and fluids

  • all fluids should be drawn up into 50mL syringes; we cannot give fluids from a bag
  • please ensure that there are at least 2 good peripheral venous cannulae which are well secured or one peripheral line alongside central venous access
  • patients with unstable blood pressure or ventilation should ideally have an arterial line sited
  • central lines can be useful but are also time consuming, particularly waiting for x-rays: please consider whether a line is necessary before starting
  • we do not give parenteral nutrition on transport, please change the baby to a suitable infusion e.g. 10% dextrose +/- sodium and potassium
  • we prefer not to feed a baby on transport, if your baby is having enteral feeds please discuss with us the timing of transport and consider giving an IV infusion to support the blood sugar

Documentation

  • please complete a full Badgernet SEND summary and print two copies
  • please photocopy your drug charts and intensive care charts for the last 48 hours
  • please photocopy your blood results and investigation results including echos, cranial ultrasounds etc.
  • have important microbiology results to hand and alert the team and receiving unit to any infection or colonisation that may require isolation
  • have your radiology department electronically link any images to the receiving unit

Parents

  • please update the parents fully and explain the reason for transfer
  • we can usually take one parent with us on the journey as long as they are fit and well
  • we are not able to transfer a mother for admission to a ward, this needs to be done by your normal inpatient transfer service
  • NTS will usually bring information about the receiving unit, but if you are able to give the parents the units telephone number, parking details etc. this will help them to feel supported – an easy option is to print out an NTS hospital information leaflet

 

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