PRACTICAL SKILLS · FOUNDATIONS
Primers to help you prepare for, assist with and learn the practical procedures on the unit - what they are, your role, and how to stay safe.
ACCESS
From a peripheral cannula to umbilical lines in a sick or preterm baby. Umbilical access uses the stump for central access up to about 14 days of age.
What: Your everyday access for fluids and medications.
Your role: You will place these - it is a core early skill.
Prep: Smallest appropriate gauge, good light or transillumination, and comfort measures (sucrose, containment).
Watch for: Extravasation - check the site regularly; preterm skin is fragile.
What: Rapid central access in the first days - for resuscitation, fluids and glucose.
Anatomy: One vein at the 12 o’clock position (thin wall, large lumen) and two arteries (thick wall, small lumen). About 1% of babies have a single umbilical artery.
Your role: Often placed by you under supervision, or you assist.
Position: The catheter passes from the vein into the ductus venosus and should sit in the IVC just below the right atrium - confirm on X-ray before central use.
Sizes: 3.5-4 FG under 1500 g; 5 FG over 1500 g.
Avoid in: Gastroschisis, omphalocele, omphalitis, peritonitis, NEC (consultant-dependent), vascular compromise, and TGA where balloon atrial septostomy may be needed.
Watch for: Malposition, infection, thrombosis and air embolus - never leave the line open to air.
What: Arterial sampling and continuous blood pressure monitoring in sick babies.
Your role: Usually senior-led; you assist.
Position: Tip sits high or low, confirmed on X-ray. Keep the legs and toes visible.
Sizes: 3.5-4 FG under 1500 g; 5 FG over 1500 g.
Watch for: Vasospasm or limb ischaemia - if a leg or toe goes white or dusky, escalate immediately.
AIRWAY & RESPIRATORY
These support breathing - usually senior-led, but you prepare, assist, and learn under supervision.
If unsure: If you are not experienced, keep giving effective mask ventilation until skilled help arrives - most babies do well on PPV.
Indications: Ineffective or prolonged mask PPV (bradycardia HR <100, falling sats), CDH or extreme prematurity, frequent apnoea, or no detectable heartbeat at birth.
Route: Oral in an emergency; nasal if longer-term ventilation is likely.
Sizes: Straight blade size 1 (term), 0 (preterm), 00 (under 27 weeks). Nasal tube depth at the nares (cm) is about (weight in kg × 1.5) + 6.
Premedication: Give premedication except in emergency resuscitation. Avoid muscle relaxants if a difficult airway is expected (e.g. Pierre Robin) or the operator is inexperienced.
Confirm: Chest rise, a colour-change CO2 detector, symmetrical air entry, and X-ray.
Watch for: Desaturation and bradycardia - stop, bag-mask to recover, then try again.
What: A supraglottic airway that sits over the larynx - a rescue or alternative airway when mask ventilation is inadequate and intubation has failed or is not feasible.
When: ANZCOR includes it from about 34 weeks / 2 kg when face-mask ventilation is ineffective and intubation is unsuccessful or not possible - not for very preterm or very small infants.
Your role: An increasingly core skill - inserted blind over the larynx, no laryngoscope needed.
Size: Size 1 for the term newborn.
Watch for: Not a definitive airway - it does not protect against aspiration and is unreliable for surfactant or deep suction. Confirm ventilation (chest rise, CO2, heart-rate response).
What: Replacement for the surfactant-deficient preterm lung (RDS).
Your role: Prepare and assist; given via the tube, or by less-invasive (LISA / MIST) or INSURE methods per unit.
Key points: Warm to the right temperature and give the weight-based dose per guideline.
Watch for: Transient desaturation and a blocked tube.
What: Removes air or fluid (pneumothorax, effusion, chylothorax, haemothorax, empyema) from the pleural space so the lung can re-expand.
Recognise it: Sudden desaturation or deterioration, rising oxygen need, increased work of breathing, reduced or asymmetrical chest movement, unequal air entry, rising heart rate, or circulatory compromise.
Your role: Recognise it, call for help, and assist - the senior places the drain.
Confirm: Cold-light transillumination and X-ray - but in a collapsing baby with tension, do not wait for the film.
Sequence: Emergency needle aspiration first, then an intercostal catheter (chest drain).
Watch for: Time-critical - escalate immediately.
DIAGNOSTIC & OTHER
Procedures for diagnosis and specific treatments.
What: Part of the sepsis and meningitis work-up (CSF).
Your role: You may perform this under supervision.
Prep: Aseptic technique, good positioning by an assistant (flexed, not over-flexed), landmark below the level of the spinal cord.
Key points: Send the right tubes (cell count, protein and glucose, culture, consider PCR) with a paired blood glucose.
Defer if: The baby is unstable, or there are signs of raised intracranial pressure or a coagulopathy - treat first.
What: Rapid removal of bilirubin in severe jaundice not responding to intensive phototherapy.
Your role: Consultant / senior-led - you assist and monitor closely.
Key points: A high-risk procedure needing close monitoring of glucose, calcium, potassium and vital signs.
Watch for: Cardiorespiratory instability and electrolyte shifts.
Where these procedures fit in practice: