Could NG Suction lead to collapsed lung? (take 2!)

[jeninejessica]

Apparently the last thread has nothing in it (?!) so I'll try this again...

This has been on my mind for almost a year now and I've been waiting until I found someone I thought might be able to give me a straight answer.

My niece was born 5 weeks premature via planned c-section due to mom having a bicornate utuerus. After 2 hours with mom she was whisked away to the NICU (actually... another NICU five blocks away but that's besides the point) because they were worried about her breathing patterns. Once they got to the NICU, they hooked her up to every machine known to man (Overkill? All they were worried about was her fast breathing?). They also would not allow mom to breastfeed or pump, telling her that "your milk would not have come in yet, so don't bother trying". Instead, they inserted an NG tube to feed her formula. They also began to use this tube for regular (fairly constant) suctioning, saying that she had too much fluid and mucus in her still. FH and I observed her be suctioned 6 times in a 30 minute span.

Then at a day and a half old, after being completely stable and told she could probably go home the next day, as the nurse finished suctioning her, her lung collapsed. Aside from scaring the daylights out of poor mom who was standing beside her... it also set back her progress and led to her being ektp in the hospital for another week.

So I guess what I'm wondering, is if it's normal for them to suction through the NG tube, and that often? And also, could this suctioning have been responsible for her lung collapse? It seems suspicious to me, but I can't seem to find any research that would support or disprove this.

Thanks guys...

[BugMacGee]

Are you talking about pneumothorax, or atalectasis? Either way, the answer to your question is no.

1) What probably appeared to be "every machine known to man" were just standard heart rate, respiratory, O2 sat monitor, maybe temp probe for the bed. Any baby with respiratory distress would certainly be hooked up to these for some amount of time.

Fast breathing is a sign of respiratory distress. Preemies, especially those born by planned c/s are notorious for having respiratory distress.

2) an NG is placed into the stomach (hence the *gastric* or *g* bit) It goes through the nose into the espohagus, into the stomach. It is aspirated (pulled back on, or what you may have interpreted as suctioned) prior to a feed to check for residuals (and amount of feed left over undigested) If there is a large quantity (say 6ml out of an 8ml feed) you watch for other signs that the baby isn't tolerating feeds.

Sometimes they do leave it in when baby is NPO (not eating) if baby has a ton of fluid in the stomach. Especially if the fluid is yellow-ish, green-ish or blood tinged. There may be something else going on.

Aspirating the NG would not cause any kind of lung collapse. And they don't collapse like *POP, there goes the lung* So I'm a little confused by it scaring mom.

I cannot believe they would not *let* her pump. Most NICU's provide pumps and LC's for moms.

[jeninejessica]

I understand that the tube is place into the stomach... obviously it wouldn't do much good elsewhere! Haha! We were told though, that they were suctioning/pulling back on it, because of the amount of amniotic fluid left still in her body. They were removing this fluid routinely throughout the day, not just at feeds. The NICU nurse explained to us what she was doing as she did it... there was no feed time scheduled anytime soon. Is this normally only done just prior to a feed? She was getting a very small amount of fluid back into the tube when she attempted.

Trust me, we were horrified that they wouldn't let her pump either. She delivered at 12:30am on Saturday, and it wasn't until she was discharged Monday afternoon that they gave her a pump to take home. Which actually made me laugh as a week prior, I had had one of the hospital LC's come into my work place and actually proceed to yell at us that we were ruining women's breastfeeding chances due to our lack of knowledge. Seems to me, denying women the right ot breastfeed would have a greater effect on that...

Sorry, I should have clarified... mom was not scared as in a "I saw the lung collapse", but because she was standing there with the nurse and the monitors went crazy and she got shoved to the side while the nurses figured out what was going on.

I'm sorry, I don't know which it was. I do know that they waited a few days to see if it would inflate on it's own, and then were going to try another procedure. I want to say needle aspiration, but that doesn't sound quite right (or perhaps I'm overtired!). They lucked out and just prior to the procedure, she managed to resolved the problem herself!

Thanks you for your response... it's good to know that even if it does seem a little 'off', that the suctioning could not have caused the collapse.

[mwherbs]

short answer yes suctioning can cause lung collapse-

the lack of support for pumping is crap- and needs to be complained about, most neonatal intensive care nurseries are better than average nurseries because they usually do support breastmilk/colostrum feeding- locally they provide access to a pump provide the pump kit-they have lactation consultants on staff-- so although a baby is tube fed they get fluids from mom or enriched fluids from mom--
wet lungs from c-section is common especially if there is no labor, for one when babies prepare to be born they stop doing the shallow little breathing movements that they do in pregnancy
- that the baby spent time in the intensive care nursery seems like something was wrong beyond wet lungs- usually healthy babies don't end up spending time in intensive care nurseries - nurseries yes I have seen that done where the regular nurseries watch , hover over or treat a baby often unnecessarily but intensive care nurses have so much more experience with very sick babies that their judgment is usually much better at figuring out who really needs their time and care

[1stimestar]

They wouldn't "let" her pump or they didn't provide pump and encouragement? What was keeping this mom from just pumping and providing on her own? I realize having a baby in NICU has to be very distracting, as well as recovering from a c-section of course. Did she ask to see a LC?

[BugMacGee]

MWHerbs, suctioning from an ng would NOT cause a lung collapse. Explain to me the reasoning that it could. Over suctioning an ETT tube can cause the alveoli to consolidate and cause atalectasis, but so can NOT suctioning.


It makes no sense whatsoever that they would be aspirating an ng anytime except immediately prior to a feeding. Otherwise, they'd be taking out what they'd just put in.


Did baby need a chest tube? You didn't mention that so I assume not.

BAbies sometimes do blow spontaneous pneumothoracies especially if there is some underlying pathology.



Seriously, if they were completely opposed to her pumping, they need to be reported somewhere. That is so opposite of the way any NICU I've experienced operates.

[jeninejessica]

1stimestar- Yes, she did ask to see an LC, and started asking for a ump at around 7am the morning she gave birth. She was varyingly told by nurses that either 'yes yes, they would bring her one' and then they wouldn't, or she was told that there wasn't any point in pumping yet since her milk won't have come in yet, and she would just get frustrated.

She *should* have made an effort to get a pump from elsewhere, but her plans were to rent the hospital grade pump to take home and she had done with her first, so she was just patiently waiting for them to bring one. They finally did at the time of discharge. Breastfeeding for her was an 'option' and not really something to be worked up about, so aside from asking, she didn't make any effort to find her own method to pump. She was not comfortable expressing colostrum either.

mwherbs- Oh some of the nurses she had in the NICU were fabulous, and completely made the stay there as good as it could possibly be- but as with any workplace... you've got some good ones and some bad ones. The one that the FH and I witnessed suctioning repeatedly turned out to be one of the bad ones. She actually yelled at the mom for touching her own baby asking "You DO know that you're pissing her off when you do that RIGHT?" Mom jumped back and asked if she could lightly touch her hand instead, the nurse responded "well I supposed you can if you're set on pissing her off more". This particular nurse I suppose was having a bad week.

As far as mom was told, up until the lung collapse, she was only in the NICU specifically for the rapid breathing- although I'm sure they were more watchful of that due to her being premature and her mother's circumstances I'm sure don't "help" things. I'm trying to think of anything else that was brought up, but I can't. She was eating fine, temp was regulated, heartrate was normal... Could they possibly have sent her to NICU for the breathing simply because she was a preemie?

And don't worry... I contacted the hospital myself a few weeks after the birth and gave them a piece of my mind... especially after having one of the LC's come into my work and verbally assault us. I do believe she got "punished", and was told there was going to be a review of policy and procedure.

BugMacGee- Baby did not need chest tube, no. But they were definately aspirating more than just prior to a feeding. NICU nurse told us she needed to removed the extra fluid. Said nothing about checking for feeding.

[BugMacGee]

A preemie in respiratory distress automatically buys themselves a trip to NICU.

In the places I've worked 35 weeks is the cut off for rooming in. They have to be "healthy" 35 weekers however. And they are watched closely for any issues.

So it sounds like no one flat out forbade mom from pumping.

[nashvillemidwife]

I had a client who insisted that the nurses' deep suctioning after birth caused a pneumothorax and that made sense to be, but what I read said that it was the meconium aspiration that necessitated the suction was what caused the collapse. That made sense to me too. mwherbs, I will certainly have to do further research!

[BugMacGee]

Ah yes. Meconium is not good for the lungs.

[jeninejessica]

Ok So me in my lack of medical knowledge was going to ask if it's possible she mistook the ng tube for the ett tube and that's why she was suctioning it so often, but it appears the ett is used orally, and not nasally, correct? So that could not have happened.

[BugMacGee]

ETT's are attached to ventilators. It doesn't sound like baby was on a vent.
Sometimes they can pass them nasally but it's MUCH more difficult. And you wouldn't be fed through an ETT.

[jeninejessica]

Originally Posted by BugMacGee

A preemie in respiratory distress automatically buys themselves a trip to NICU.

In the places I've worked 35 weeks is the cut off for rooming in. They have to be "healthy" 35 weekers however. And they are watched closely for any issues.

So it sounds like no one flat out forbade mom from pumping.

Oh no, I don't mean to make it sound like they forbid her to pump. Simply that after asking multiple times for a pump and help, the bedridden new mom was told 'don't bother, there's no point!', which all of us here know if a load of baloney! Nobody forbade her from doing it, they just refused to bring her a pump and told her not to, that she was wasting her time.

She was born 35 weeks to the day, and I don't believe they were planning on rooming in, but assumption was that she would be going to the normal nursery, not NICU, as she *was* a fairly healthy preemie.