Overview and Principles of Resuscitation

Lesson 1: Equipment Check

Performance Checklist
Birth
Yesstay
with mother

Term gestation?
Breathing or crying?
Good tone?

N R P TM

Routine Care
Provide warmth
Clear airway if necessary
Dry
Ongoing evaluation

No
Warm, clear airway if necessary,
dry, stimulate

HR below 100 bpm,

gasping, or apnea?

30 sec

No

No

Labored
breathing
or persistent
cyanosis?
Yes

Yes
Clear airway
SPO2 monitoring
Consider CPAP

PPV,
SPO2 monitoring
60 sec

HR below 100 bpm?

No

Yes
Take ventilation
corrective steps

Post-resuscitation
care

No
HR below 60 bpm?

Yes
Consider intubation
Chest compressions
Coordinate with PPV

HR below 60 bpm?

Targeted Pre-ductal SPO2

After Birth
1 min
60-65%
2 min
65-70%
3 min
70-75%
4 min
75-80%
5 min
80-85%
10 min
85-95%

Yes
IV epinephrine

The Performance Checklist Is a Learning Tool

The learner uses the checklist as a reference during independent
practice, or as a guide for discussion and practice with a Neonatal
Resuscitation Program (NRP) instructor. When the learner and
instructor agree that the learner can perform the skills correctly and
smoothly without coaching and within the context of a scenario, the
learner may move on to the next lessons Performance Checklist.
This Equipment Check Performance Checklist includes only the most
essential supplies and equipment for neonatal resuscitation. You may
wish to add supplies or additional safety checks to meet your units
standards or protocols. When the learner knows the routine and
supplies are present and functioning, the Equipment Check should take
approximately 1 minute to complete.

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LESSON

Knowledge Check
Why is it important to have an organized routine for checking the
presence and function of resuscitation supplies and equipment prior
to every birth?
Besides checking presence and function of equipment, what other
resources should be assembled prior to a birth identified as highrisk?
Learning Objectives
Demonstrate an organized routine for checking presence and function
of supplies and equipment necessary for newborn resuscitation, using
the NRP flow diagram interventions as your guide.
Identify any additional preparatory routines for high-risk birth
specific to this birth setting.
Locate the Quick Pre-resuscitation Checklist in the Appendix of
this lesson.
You are notified that a woman has been admitted to the hospital in
active labor. Check your supplies and equipment to prepare for the
birth. As you work, say your thoughts and actions aloud so I will
know what you are thinking and doing.
Instructor should check boxes as the learner responds correctly. The
learner may refer to this checklist or the Quick Pre-resuscitation
Checklist that follows it to ensure the availability and function of
essential supplies and equipment.

Performance Steps
Warm:
Preheat warmer
Lay out towels or blankets

Clear the airway 3 ways:

Bulb syringe
10F or 12F suction catheter
attached to wall suction, set at
80-100 mm Hg
Meconium aspirator
Auscultate
Stethoscope

Details
Learner begins with equipment
needed for initial steps of
resuscitation and ends with
equipment needed for complex
resuscitation.

Turns on wall suction to continuous

and occludes suction tubing; adjusts
suction to 80-100 mm Hg.
Picks up stethoscope, places in ears,
and taps on diaphragm to ensure
function.

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Overview and Principles of Resuscitation

Performance Steps
Oxygenate
Turn on oxygen flowmeter to
5-10 L/min

Details
If birth is imminent, suction and air/
oxygen should be turned on and
ready for use.

Adjust blender to hospital

standard for initiation of
resuscitation

Are air/O2 tanks full, if used in your

setting?

Pulse oximeter probe

Pulse oximeter

Safety Check: Even if beginning

resuscitation with 21% oxygen, the
air/oxygen flow should be turned on
in the event that supplemental
oxygen is needed. A self-inflating bag
will work even without gas flow;
therefore, turn on air/oxygen so that
gas is flowing if blender is turned up
to administer supplemental oxygen.

Ventilate
Check presence and function
of positive-pressure
ventilation (PPV) device
Check presence of term- and
preterm-size masks
8F feeding tube and 20-mL
syringe

Intubate
Laryngoscope
Size 0 and 1 blades with bright
light
Stylet (optional)
Endotracheal (ET) tubes (2.5,
3.0, 3.5, 4.0)
End tidal CO2 detector
Laryngeal mask airway and
5-mL syringe
Medicate
Access to
1:10,000 epinephrine
Supplies for administering
medications and placing
emergency umbilical venous
catheter
Documentation supplies

It is most important to check that

safety features are working to prevent
over-inflation of lungs with PPV.
Manometers present and
functioning? Connected to
oxygen/air?
Self-inflating bag: Pop-off valve
working?
Flow inflating bag: Does it inflate
properly (no rips or missing
attachments)?
T-piece: Maximum circuit pressure set
appropriately? Peak inspiratory
pressure and positive end-expiratory
pressure set appropriately?
Learner should know how to attach
and detach blade from laryngoscope;
check laryngoscope light.
If setting up for intubation, ET tube
should stay clean inside its package
even if package is open and stylet is
inserted.

Location and protocol for checking

emergency medications and supplies
for vascular access are specific to
each birth unit.

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LESSON
Performance Steps

Details

Thermoregulate
For very preterm newborns
Plastic wrap or bag
Chemically activated warming
pad
Transport incubator
Other
Unit-specific items

These items may be specific to your

unit.
Tailor the Equipment Checklist to
meet facility requirements.

Instructor asks the learner Reflective Questions to enable selfassessment, such as:
Tell me how using this organized approach to checking
resuscitation equipment works for you.
If all equipment and supplies were present, how long would it take
you to confirm readiness for a birth?
Did you notice anything in this Equipment Checklist that is
missing, specific to our birth setting? What would you change
about this checklist?
Neonatal Resuscitation Program Key Behavioral Skills
Know your environment.
Anticipate and plan.
Assume the leadership role.
Communicate effectively.
Delegate workload optimally.

Allocate attention wisely.

Use all available information.
Use all available resources.
Call for help when needed.
Maintain professional behavior.

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Overview and Principles of Resuscitation

Appendix
Neonatal Resuscitation Supplies and Equipment
Suction equipment
Bulb syringe
Mechanical suction and tubing
Suction catheters, 5F or 6F, 8F, 10F, 12F or 14F
8F feeding tube and 20-mL syringe
Meconium aspirator
Bag-and-mask equipment
Device for delivering positive-pressure ventilation, capable of delivering
90% to 100% oxygen
Face masks, newborn and premature sizes (cushioned-rim masks
preferred)
Oxygen source
Compressed air source
Oxygen blender to mix oxygen and compressed air with flowmeter
(flow rate up to 10 L/min) and tubing
Pulse oximeter and oximeter probe
Intubation equipment
Laryngoscope with straight blades, No. 0 (preterm) and No. 1 (term)
Extra bulbs and batteries for laryngoscope
Endotracheal tubes, 2.5-, 3.0-, 3.5-, 4.0-mm internal diameter (ID)
Stylet (optional)
Scissors
Tape or securing device for endotracheal tube
Alcohol sponges
CO2 detector or capnograph
Laryngeal mask airway
Medications
Epinephrine 1:10,000 (0.1 mg/mL)3-mL or 10-mL ampules
Isotonic crystalloid (normal saline or Ringers lactate) for volume
expansion100 or 250 mL
Dextrose 10%, 250 mL
Normal saline for flushes
Umbilical vessel catheterization supplies
Sterile gloves
Scalpel or scissors
Antiseptic prep solution
Umbilical tape
Umbilical catheters, 3.5F, 5F
Three-way stopcock
Syringes, 1, 3, 5, 10, 20, 50 mL
Needles, 25, 21, 18 gauge, or puncture device for needleless system

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LESSON

Neonatal Resuscitation Supplies and Equipmentcontinued

Miscellaneous
Gloves and appropriate personal protection
Radiant warmer or other heat source
Firm, padded resuscitation surface
Clock with second hand (timer optional)
Warmed linens
Stethoscope (with neonatal head)
Tape, 1/2 or 3/4 inch
Cardiac monitor and electrodes or pulse oximeter and probe (optional
for delivery room)
Oropharyngeal airways (0, 00, and 000 sizes or 30-, 40-, and 50-mm
lengths)
For very preterm babies
Size 00 laryngoscope blade (optional)
Reclosable, food-grade plastic bag (1-gallon size) or plastic wrap
Chemically activated warming pad (optional)
Transport incubator to maintain babys temperature during move to
the nursery

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Overview and Principles of Resuscitation

Neonatal Resuscitation Program Quick Pre-resuscitation Checklist
Newborn Resuscitation Supplies and Equipment at Radiant Warmer
This checklist includes only the most essential supplies and equipment
needed at the radiant warmer for most neonatal resuscitations. Tailor
this list to meet your unit-specific needs to ensure that supplies and
equipment are present and functioning and unit-specific safety checks
have been done prior to every birth.

Warm

Preheat warmer
Towels or blankets

Clear airway

Bulb syringe
10F or 12F suction catheter attached to wall suction set at 80-100 mm Hg
Meconium aspirator

Auscultate

Stethoscope

Oxygenate

Method to give free-flow oxygen (mask, tubing, flow-inflating bag, or

T-piece)
Gases flowing just prior to birth, 5-10 L/min
Blender set per protocol
Pulse oximeter probe (detached from oximeter until needed)
Pulse oximeter

Ventilate

Positive-pressure ventilation (PPV) device(s) present with term and preterm

masks
PPV device(s) functioning
Connected to air/oxygen source (blender)
8F feeding tube and 20-mL syringe

Intubate

Laryngoscope
Size 0 and Size 1 (and size 00, optional) blades with bright light
Endotracheal tubes, sizes 2.5, 3.0, 3.5, 4.0
Stylets
End tidal CO2 detector
Laryngeal mask airway (size 1) and 5-mL syringe

Medicate

Access to 1:10,000 epinephrine and normal saline

Supplies for administering meds and placing emergency umbilical venous
catheter
Documentation supplies

Thermoregulate Plastic bag or plastic wrap

Chemically activated warming pad
Transport incubator ready
Other

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